Studying the dysautonomic symptoms of the autonomic nervous system (the one that innervates the viscera) in Parkinson’s already in the initial stages of the disease, understanding its evolution and differentiating it from other atypical parkinsonisms: this is the purpose of the new Laboratory for the Evaluation of the Autonomous Nervous System installed at the ASST Gaetano Pini-CTO in Milan and built with the Parkinson and Parkinsonism Center of the ASST Gaetano Pini-CTO in Milan, with the contribution of the Grigioni Foundation for Parkinson’s Disease. One of the commitments of our Foundation materialized precisely in the creation of this highly innovative and sophisticated structure, located within the same hospital where the Parkinson Center is located (ASST Gaetano Pini-CTO). There are very few centers in Italy that have such technological and cutting-edge equipment and a dedicated team of experts – said Gianni Pezzoli, President of the Grigioni Foundation for Parkinson’s Disease and former Director of the Parkinson and Parkinsonism Center of the ASST Gaetano Pini -CTO, Milan – This Laboratory was created with the aim of acquiring new knowledge relating to non-motor disorders, through the evaluation of the Autonomous Nervous System, to contribute to clarifying this area still little known and pioneering in the neurological field, to aim to conduct increasingly innovative research projects and provide patients with increasingly personalized treatments.

The autonomic nervous system has the function of regulating blood pressure, heart rate, body temperature, digestion, urination, sweating that is, all those activities that are generally beyond the voluntary control. The most frequent causes of alteration of the autonomic nervous system, or dysautonomia, are both Parkinson’s disease (PD) but especially atypical parkinsonisms. It has always been reported in the advanced phase of PD, but recently it has been shown that dysautonomia can also occur in the initial phases of the disease through some cardiovascular symptoms (for example, hypotension in standing position, hypotension during meals and supine hypertension), gastrointestinal (eg constipation), urinary symptoms (eg increased urinary frequency, urgency and urinary incontinence) and sexual function disorders (eg erectile dysfunction). In this new laboratory, the functioning of the autonomic nervous system is investigated through the objective examination, the collection of autonomic symptoms (through questionnaires aimed at finding these symptoms) and the administration of specific cardiovascular tests that study the autonomic nervous system that controls. the function of the heart and blood vessels. Even the continuous monitoring of blood pressure over 24 hours can give valuable information about the presence of alterations compatible with dysautonomia: in fact, this investigation allows to detect diurnal blood pressure drops, also in relation to the intake of drugs and meals, and presence of nocturnal hypertension specifies Francesca Del Sorbo, MD specialist in Neurology, a Master in Movement Disorders and a PhD in Biomedical Sciences, Medical Director at the UOC Parkinson and Parkinsonisms of the ASST Gaetano Pini-CTO of Milan. In the new laboratory it will therefore be possible to carry out a specific and detailed analysis of the autonomic nervous system (the one that regulates vital functions) through a battery of cardiovascular neurophysiological tests aimed at the evaluation, diagnosis and follow-up of patients potentially suffering from dysautonomia. This examination involves the use of a very sophisticated and cutting-edge instrumentation, the ANScovery system, which allows you to perform any type of functional test in a standard and repeatable manner with the support of software capable of analyzing the results in semi-automatic mode.

The exam, which lasts a total of 60 minutes, is simple, non-invasive and makes use of the continuous recording of biological signals: heart rate, respiratory activity and blood pressure. These are indispensable tests for the diagnosis of dysautonomia in Parkinson’s disease and in other forms of Parkinson’s, as they evaluate its presence, quantify its severity and its eventual evolution, as well as evaluate the response to therapy. Furthermore, in the presence of ascertained dysautonomia, further cardiac tests can be useful in the diagnosis of other forms of parkinsonism, explains Francesca Del Sorbo. But the evaluation and management of dysautonomia in Parkinson’s disease is anything but simple and is still being studied today, as the pathophysiological mechanisms underlying this alteration are still largely unknown. Symptoms of dysautonomia can be managed with non-pharmacological measures and pharmacotherapy, and new drugs are being studied. Given the variety and multiplicity of dysautonomic symptoms, the management and treatment of these patients requires a multidisciplinary approach and a continuous and constant dialogue between the neurologist and the other specialists involved in the treatment process such as the cardiologist, the urologist, the dietician. and the gastroenterologist. Future studies in this area are projected precisely in this interdisciplinary direction and will have to focus on the validation of new treatment protocols shared by more specialties, concludes the specialist. The study of the neurodegenerative system plays a fundamental pathophysiological role in diseases such as heart failure, ischemic heart disease, chronic obstructive pulmonary disease and diabetes mellitus. For this reason, the equipment donated by the Grigioni Foundation will be placed in the Rehabilitation Cardiology clinics, thus favoring multi-specialist diagnostic paths, adds Oreste Febo, Director of the Cardiology Rehabilitation and Pneumology Unit of the ASST Gaetano Pini-CTO.

Parkinson’s disease is a disorder of the central nervous system. It usually occurs around the age of 60, although in 5% of cases there may be an onset before the age of 40. Until a few years ago it was thought that Parkinson’s symptoms were exclusively motor, while recent evidence confirms that non-motor symptoms, including symptoms of dysautonomia, can also be frequent at the onset of the disease, and have a negative impact on quality. of life of patients. Considering the progressive aging of the population, we have elements to believe that the number of patients is higher, about 450,000. These are figures that further underline the clinical and social impact of Parkinson’s disease and parkinsonisms – underlines Gianni Pezzoli – The early identification of symptoms through even non-motor symptoms therefore becomes crucial for an increasingly timely diagnosis and intervention that could be decisive. when we have available therapies capable of blocking or reducing the evolution of the disease. This goal may not be very far away.

April 10, 2021 (change April 10, 2021 | 15:50)

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