Non-pharmacological and drug treatment of autonomic dysfunction in multiple system atrophy: current status and future directions.
J Neurol
; 270(11): 5251-5273, 2023 Nov.
Article
en En
| MEDLINE
| ID: mdl-37477834
ABSTRACT
Multiple system atrophy (MSA) is a sporadic, fatal, and rapidly progressive neurodegenerative disease of unknown etiology that is clinically characterized by autonomic failure, parkinsonism, cerebellar ataxia, and pyramidal signs in any combination. Early onset and extensive autonomic dysfunction, including cardiovascular dysfunction characterized by orthostatic hypotension (OH) and supine hypertension, urinary dysfunction characterized by overactive bladder and incomplete bladder emptying, sexual dysfunction characterized by sexual desire deficiency and erectile dysfunction, and gastrointestinal dysfunction characterized by delayed gastric emptying and constipation, are the main features of MSA. Autonomic dysfunction greatly reduces quality of life and increases mortality. Therefore, early diagnosis and intervention are urgently needed to benefit MSA patients. In this review, we aim to discuss the systematic treatment of autonomic dysfunction in MSA, and focus on the current methods, starting from non-pharmacological methods, such as patient education, psychotherapy, diet change, surgery, and neuromodulation, to various drug treatments targeting autonomic nerve and its projection fibers. In addition, we also draw attention to the interactions among various treatments, and introduce novel methods proposed in recent years, such as gene therapy, stem cell therapy, and neural prosthesis implantation. Furthermore, we elaborate on the specific targets and mechanisms of action of various drugs. We would like to call for large-scale research to determine the efficacy of these methods in the future. Finally, we point out that studies on the pathogenesis of MSA and pathophysiological mechanisms of various autonomic dysfunction would also contribute to the development of new promising treatments and concepts.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Asunto principal:
Enfermedades del Sistema Nervioso Autónomo
/
Atrofia de Múltiples Sistemas
/
Trastornos Parkinsonianos
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Disfunción Eréctil
Tipo de estudio:
Screening_studies
Límite:
Humans
/
Male
Idioma:
En
Revista:
J Neurol
Año:
2023
Tipo del documento:
Article