# New approach in the treatment of Neurogenic Orthostatic Hypotension



## M&M (Jan 20, 2002)

I don't think anyone besides Susan and myself deal with NMH/NCS or Orthostatic Hypotension, but just in case, I'm posting this. It was posted to the Co-Cure mailing list:


> quote:Acetylcholinesterase inhibition: a novel approach in the treatment ofneurogenic orthostatic hypotension.Neurol Neurosurg Psychiatry. 2003 Sep;74(9):1294-8Singer W, Opfer-Gehrking TL, McPhee BR, Hilz MJ, Bharucha AE, Low PA.Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.PMID: 12933939BACKGROUND: Pharmacological treatment of orthostatic hypotension is oftenlimited because of troublesome supine hypertension.OBJECTIVE: To investigate a novel approach to treatment usingacetylcholinesterase inhibition, based on the theory that enhancedsympathetic ganglion transmission increases systemic resistance inproportion to orthostatic needs.DESIGN: Prospective open label single dose trial.MATERIAL: 15 patients with neurogenic orthostatic hypotension caused by:multiple system atrophy (n = 7), Parkinson's disease (n = 3), diabeticneuropathy (n = 1), amyloid neuropathy (n = 1), and idiopathic autonomicneuropathy (n = 3).METHODS: Heart rate, blood pressure, peripheral resistance index (PRI),cardiac index, stroke index, and end diastolic index were monitoredcontinuously during supine rest and head up tilt before and one hour afteran oral dose of 60 mg pyridostigmine.RESULTS: There was only a modest non-significant increase in supine bloodpressure and PRI. In contrast, acetylcholinesterase inhibitionsignificantly increased orthostatic blood pressure and PRI and reduced thefall in blood pressure during head up tilt. Orthostatic heart rate wasreduced after the treatment. The improvement in orthostatic blood pressurewas associated with a significant improvement in orthostatic symptoms.CONCLUSIONS: Acetylcholinesterase inhibition appears effective in thetreatment of neurogenic orthostatic hypotension. Orthostatic symptoms andorthostatic blood pressure are improved, with only modest effects in thesupine position. This novel approach may form an alternative orsupplemental tool in the treatment of orthostatic hypotension, speciallyfor patients with a high supine blood pressure.Publication Types:ï¿½ Clinical Trial


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## Susan Purry (Nov 6, 2001)

As you know, I take slow sodium which is certainly helpful, but not nearly enough. So, this looks promising MrsM! Much better than current treatment options. Wonder if/when it will be available to CFS patients with NMH?


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