Syncope is the medical term that can be used in conjunction with
hypotension (Low blood pressure episodes), light headedness, and
fainting. Orthostatic hypotension is the lowering of the blood
pressure when one changes positions from lying or sitting to standing.
This creates a blood shortage in the extremities and brain, leading to syncope. Neurally mediated syncope on the other hand can happen while urinating or having a bowel movement.
Dr. Olanow, is a well respected neurologist at Columbia-Presbyterian Hospital. He was a panel member of the satellite symposium last year
along with Dr. Silver from San Diego, Calif. sponsored by the makers of Eldepryl.
Since it is unclear whether Parkinson's causes orthostatic
hypotension or the medicines cause it, here is Dr. Olanow's answer
about it.
Q. Give me a simple treatment format for orthostatic hypotension.
Dr. Olanow: Orthostatic Hypotension refers to a drop in blood
pressure upon standing. This can be mild and innocent found on
blood pressure taking as one changes from lying to standing
positions, but it can also be extremely troublesome and be
associated with syncope episodes (light-headedness, fainting)
and literally prevent a patient from rising to their feet and
being able to walk, so it can be very disabling. It usually
results in autonomic dysfunction in parkinsonian patients. It is
not rare to occur in Parkinson's disease, but is usually very
mild. If it is present to a severe degree, it suggests that it is
not Parkinson's disease but rather a more wide spread degenerative
disease called, Multiple System Atrophy (MSA) in which autonomic
involvement is prominent. When patients have autonomic dysfunction,
there are a few things that can be done to treat them
symptomatically. One thing is to increase their salt intake always
bearing in mind that that may have an adverse effect on blood
pressure. Patients can also take a drug called Fluorinef which is
a form of steroid that retains salt and control blood pressure.
0.1 to 0.2 mg/day is usually sufficient. If you need more than that
it is not particularly helpful. In the most severe cases, one could
wear stockings which are like an antigravity stocking that wraps
up all the way to your waist. If you wear stockings only to the
thigh, it is not particularly helpful. They have to be worn to the
waist to be effective. In regions like Florida where it is hot and
humid, you can imagine that this is not a particularly popular
therapy. Patients in this environment, even though they need them,
will not take them.
Dr. Silver: When I do not see a patient who has orthostatic
hypotension for a while, I check their medicines that their HMOs
may have prescribed since I saw them last. I especially look for
anti-hypertensives and see if we can adjust their dosage.
Question was from: Charleston, West Virginia
[log in to unmask] That man may last, but never lives,
Who much receives, but nothing gives;
HomeBoy #Parkinsons Whom none can love, whom none can thank,--
Creation's blot, creation's blank.
John Cottingham Thomas Gibbons (1720-1785): When Jesus dwelt.
