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My husband has had PD for at least 16 years with the additional diagnosis of Shy-drager syndrome since l991. As I understand it, many of the symptoms are similar, but not all SDS patients respond to PD meds. Ken was the exception to this as he responded extremely well to both sinemet and deprenyl for many years. The main symptom of SDS is extreme postural hypotension. Ken has had his BP measured as high as 220/160 in a prone position and as low as 40/20 when he attempts to stand. Needless to say, he passes out when this kind of a drop takes place in the space of a minute. In addition to sinemetCR for PD he takes florinef and midodrine with salt tablets and much fluids to keep his BP high enough to stand. His sitting BP should be above 170/100 to take the drop when he stands. Rather than confine him to a wheelchair fulltime, he has a fulltime helper always at his side to help him if he stands and falls. This has enabled him to continue to walk most of the time and to exercize regularly. My understanding is that SDS/MSA patients slowly lose all their autonomic functions, but then so do many PD patients so the difference between the diseases is hard to define. I guess if the patient does not respond well to sinemet and continues to have PD symptoms, the SDS/MSA diagnosis might be easier. With my husband, his Neurologist resisted putting SDS on his insurance forms until using florinef and salt alone no longer controlled his standing BP and we had to use midodrine too. I notice she now writes shy-drager syndrome as his diagnosis. There is a separate listserv for SDS. Write [log in to unmask] and in the message write Subscribe shy-drager. The listserv has been a lifesaver for us. Barbara Smith/CG/Ken/69/16