Premium
Pharmacologic Probes to Differentiate Chronic Autonomic Failure Syndromes
Author(s) -
Goldstein David S,
Holmes Courtney,
Sharabi Yehonatan
Publication year - 2008
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.22.1_supplement.953.13
Subject(s) - pure autonomic failure , medicine , yohimbine , axon reflex , acetylcholine , reflex , anticholinergic agents , neuroscience , heart failure , valsalva maneuver , autonomic nervous system , cardiology , anticholinergic , blood pressure , endocrinology , heart rate , psychology , antagonist , receptor , orthostatic vital signs
Objective: The current clinical classification of chronic autonomic failure (CAF) recognizes four primary forms—pure autonomic failure (PAF), multiple system atrophy (MSA), Parkinson disease (PD), and autoimmune autonomic ganglionopathy (AAG). We provide a pathophysiologic classification scheme, based on neuropharmacologic probes: tyramine (TYR), trimethaphan (TRI) or pentolinium (PEN), yohimbine (YOH), acetylcholine (ACh, quantitative sudomotor axon reflex test, QSART), and 6‐[18F]fluorodopamine (18F‐DA) scanning. Methods: CAF groups received i.v. TYR, TRI/PEN, YOH, or 18F‐DA or ACh by iontophoresis. Blood pressure (BP) and dihydroxyphenylglycol (DHPG) responses were measured. Results: PAF involved low cardiac 18F‐DA‐derived radioactivity and attenuated (Atten.) increments (Inc.) to TYR and YOH and decrements (Dec.) to TRI/PEN, in contrast with normal reponses in AAG and MSA. MSA involved augmented (Aug.) responses to YOH and TRI/PEN and normal (Nl.) cardiac 18F‐DA, in contrast with Atten. in PD+NOH. Conclusions: Pharmacologic probes provide a pathophysiologic classification of chronic autonomic failure that can be utilized in individual patients.