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Pattern of autonomic dysfunctions in patients with Parkinson’s disease


Author: Dorina Ţiple
Degree:doctor of medicine
Speciality: 14.00.13 - Neurology
Year:2005
Scientific adviser: Ion Moldovanu
doctor habilitat, professor,
Scientific consultant: Victor Vovc
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 7 September, 2005
Approved by NCAA on the 27 October, 2005

Abstract

Adobe PDF document0.23 Mb / in romanian

Thesis

CZU 616.858+616.839

Adobe PDF document 1.20 Mb / in romanian
168 pages


Keywords

Parkinson’s disease, vascular parkinsonism, motor disturbances, autonomic dysfunction, cardiovascular, gastrointestinal, urogenital, sexual and thermoregulatory systems, autonomic electrophysiological tests, breathing pattern, l-dopa, bromocriptin

Summary

The research is based on the study of 70 patients with neurological manifestations of parkinsonian syndrome (60 patients with clinical diagnosis of Parkinson’s disease and 10 patients with suspected vascular parkinsonism) and 20 healthy people (control group).

Clinic-neurological examination established that autonomic disorders appear in both Parkinson’s disease (PD) and vascular parkinsonism (VP), but the result of autonomic electrophysiological tests (deep breathing, 30/15 ratio, Valsalva, orthostatic and isometric tests) emphasized a severe modificated parameters just in PD patient’s group.

Autonomic disturbances were established at the level of different functional systems: gastrointestinal, cardiovascular, urogenital, sexual and thermoregulatory one.

Clinic and electrophysiological autonomic heterogeneity of tremorigen and akinetic-rigid forms of PD emphasized a different pattern for these fundamental forms of the disease: adequate control of autonomic regulation for patients with tremor predominant form and, severe affected autonomic regulation for patients with akinetic-rigid form of PD.

Analysis of breathing pattern revealed the “rigidity”of respiratory frequency during all recording conditions, accomplishing a voluntary hyperventilation by means of increased respiratory volume, not by means of respiratory frequency acceleration. Compared with control group volume of respiration in PD patient’s group was decreased.

The involvement of parasympathetic activity in PD appeared more affected than sympathetic activity, suggesting an intrasystemic “disagreement” in functioning of these autonomic pathways. Analysis of both cardiovascular and respiratory activity in patients with PD revealed an intersystemic “disagreement” in functioning of these two systems: pathological control of cardiovascular function and relatively preserved control of respiratory function.

The complex treatment (L-dopa & Bromocriptin) was used, that influenced on dopaminergic and adrenergic systems and revealed the improvement of autonomic disturbances in patients with Parkinson’s disease.