title: Baroreflex sensitivity and power spectral analysis during autonomic testing in different extrapyramidal syndromes.
abstract: Autonomic dysfunction has been frequently demonstrated in patients with extrapyramidal diseases by cardiovascular autonomic testing. In addition to classical testing, we applied the more detailed baroreflex and spectral analysis on three traditional cardiovascular tests in this study to get additional information on autonomic outflow. We recorded continuously blood pressure, electrocardiogram, and respiration in 35 patients with multiple system atrophy, 32 patients with progressive supranuclear palsy, 46 patients with idiopathic Parkinson's disease and in 27 corresponding healthy subjects during cardiovascular autonomic testing (metronomic breathing, Valsalva manoeuvre, head-up tilt). Baroreflex and spectral analyses were performed by using trigonometric regressive spectral analysis between and during the manoeuvres. Consistent with previous interpretations, our data showed an increase of sympathetic activity in head-up tilt and Valsalva test in healthy controls. This sympathetic activity was significantly decreased in patients with typical and atypical Parkinson syndromes. Significant modulation of baroreflex activity could be observed especially during metronomic breathing; again it was significantly lower in all patient groups. Baroreflex and spectral parameters could not only differentiate between patients and healthy controls, but also differentiate between clinically symptomatic (with autonomic dysfunction as eg. orthostatic hypotension) and asymptomatic patients. In conclusion, our approach allows the evaluation of autonomic variability during short and nonstationary periods of time and may constitute a useful advance in the assessment of autonomic function in both physiological and pathological conditions.
authors.affiliation: Autonomic and Neuroendocrinological Laboratory, University Clinic Carl Gustav Carus, Dresden University of Technology, Germany.
authors.forename: Constanze
authors.initials: C
authors.lastname: Friedrich
authors.forename: Heinz
authors.initials: H
authors.lastname: Rüdiger
authors.forename: Claudia
authors.initials: C
authors.lastname: Schmidt
authors.forename: Birgit
authors.initials: B
authors.lastname: Herting
authors.forename: Silke
authors.initials: S
authors.lastname: Prieur
authors.forename: Susann
authors.initials: S
authors.lastname: Junghanns
authors.forename: Katherine
authors.initials: K
authors.lastname: Schweitzer
authors.forename: Christoph
authors.initials: C
authors.lastname: Globas
authors.forename: Ludger
authors.initials: L
authors.lastname: Schöls
authors.forename: Daniela
authors.initials: D
authors.lastname: Berg
authors.forename: Heinz
authors.initials: H
authors.lastname: Reichmann
authors.forename: Tjalf
authors.initials: T
authors.lastname: Ziemssen
mesh_terms: D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology*; D017704:Baroreflex / Q000502:physiology*; D001480:Basal Ganglia Diseases / Q000145:classification / Q000150:complications*; D001793:Blood Preservation / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012120:Respiration Disorders / Q000175:diagnosis / Q000209:etiology; D012680:Sensitivity and Specificity; D013057:Spectrum Analysis / Q000379:methods*; D018709:Statistics, Nonparametric; D014636:Valsalva Maneuver / Q000502:physiology