Publication Date: 2013.
Introduction: Autonomic dysfunction, including orthostatic hypotension (OH), sialorrhea, sexual dysfunction, urinary dysfunction and constipation is a common feature of Parkinson’s disease (PD). Even though its treatment has been recognized as a major unmet need in PD, there is a paucity of clinical trials to assess their treatment. Areas covered: Evidence about the efficacy and safety of available treatments for autonomic dysfunction is summarized. Potential targets for upcoming therapies are then discussed in light of what is currently known about the physiopathology of each disorder in PD. Proof-of-concept trials and circumstantial evidence about treatments for autonomic dysfunction as well as upcoming clinical trials are discussed. Finally, critical aspects of clinical trials design are considered. Expert opinion: Botulinum toxin (BTX) or glycopyrrolate might be used for sialorrhea whereas macrogol could be useful in constipation. There is preliminary evidence suggesting that fludrocortisone, domperidone, droxidopa or fipamezole may be effective for the treatment of OH. Tropicamide, clonidine or radiotherapy are under development for sialorrhea. Sildenafil may be effective for the treatment of erectile dysfunction; BTX or behavioral therapy for urinary incontinence and lubiprostone and probiotics for constipation. Sound clinical trials are needed in order to allow firm evidence-based recommendations about these treatments.
Author affiliation: Pérez Lloret, Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Université Paul Sabatier; Francia
Author affiliation: Rey, María Verónica. Université Paul Sabatier; Francia
Author affiliation: Pavy Le Traon, Anne. Université Paul Sabatier; Francia
Author affiliation: Rascol, Olivier. Université Paul Sabatier; Francia
Keywords: Probiotics; Parkinson's disease; Drugs; Efficacy and safety; Botulinum toxin; Clinical trials design; Constipation; Domperidone; Droxidopa; Erectike dysfunction; Fipamezole; Fludrocortisone; Sexual dysfunction; Urinary dysfunction; Bioquímica y Biología Molecular; Medicina Básica; CIENCIAS MÉDICAS Y DE LA SALUD.
Repository: CONICET Digital (CONICET). Consejo Nacional de Investigaciones Científicas y Técnicas