Treatment of dysautonomia in extrapyramidal disorders Tjalf Ziemssen • Gerd Fuchs • Wolfgang Greulich • Heinz Reichmann • Michael Schwarz • Birgit Herting Ó Springer-Verlag 2011 Abstract Although extrapyramidal diseases are com- monly thought to solely affect the (extrapyramidal) motor system, non-motor symptoms such as behavioural abnor- malities, dysautonomia, sleep disturbances and sensory dysfunctions are also frequently observed. Autonomic dysfunction is an important clinical component of extra- pyramidal disease, but it is often not formally assessed, and thus frequently misdiagnosed. Symptoms of autonomic dysfunction can impact more on quality of life than motor symptoms. Appropriate symptom-oriented diagnosis and symptomatic treatment as part of an interdisciplinary approach can greatly benefit the patient. This review elaborates a limited overview on the treatment of cardio- vascular, gastrointestinal, urogenital and sudomotor auto- nomic dysfunction in various extrapyramidal syndromes. Keywords Extrapyramidal disease Á Parkinson’s disease Á Autonomic dysfunction Á Multiple system atrophy Á Treatment Á Dysautonomia Introduction Parkinson’s disease (PD) and other extrapyramidal disor- ders are clinically characterized by non-motor symptoms which include behavioural, sleep or perception dysfunc- tions as well as dysautonomia [48, 70, 71]. The prevalence of dysautonomia in PD varies between 14 and 80% depending on the population and methodology. The occurrence of dysautonomia increases as disease pro- gresses, thereby impacting on the subjective picture of the symptoms, quality of life and the treatment of the disease [24, 53]. The almost ubiquitous loss of neurons and the appear- ance of Lewy bodies within completely different parts of the nervous system is thought to be a primary cause of this dysautonomia. Interestingly, Braak et al. observed the occurrence of lesions in the dorsal vagal nucleus and in other autonomic cerebral stem centres of PD patients before manifestation of clinical symptoms and of characteristic histopathological changes in the substantia nigra [8]. Beyond the atypical parkinsonian syndromes, multiple system atrophy (MSA) is an important differential diag- nosis especially in the case of early dysautonomia in combination of extrapyramidal, cerebellar and pyramidal tract signs and histological neuron loss, gliosis and glial This article is part of a supplement sponsored by GlaxoSmithKline. T. Ziemssen (&) Autonomic and neuroendocrinological laboratory, Department of Neurology, University Clinic Carl Gustav Carus, Dresden University of Technology, Fetscherstraße 74, 01307 Dresden, Germany e-mail: Tjalf.Ziemssen@uniklinikum-dresden.de G. Fuchs Parkinson Clinic, Wolfach, Germany W. Greulich Neurological clinic, HELIOS clinic Hagen-Ambrock, University Witten/Herdecke, Hagen, Germany H. Reichmann Á B. Herting Movement Disorders Research Group, Department of Neurology, University Clinic Carl Gustav Carus, Dresden University of Technology, Dresden, Germany M. Schwarz Neurological Clinic, Dortmund, Germany B. Herting Neurological clinic, Diakonie hospital, Schwaebisch Hall, Germany 123 J Neurol (2011) 258 (Suppl 2):S339–S345 DOI 10.1007/s00415-011-5946-8