Skip to main content

Advertisement

Log in

Autonomic nervous system dysfunction in Parkinson’s disease

  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Autonomic nervous system (ANS) dysfunction is common in Parkinson’s disease (PD), affects 70% to 80% of patients, and causes significant morbidity and discomfort. Autonomic nervous system dysfunction symptoms in PD include sexual dysfunction, swallowing and gastrointestinal disorders, bowel and bladder abnormalities, sleep disturbances, and derangements of cardiovascular regulation, particularly, orthostatic hypotension. Autonomic nervous system dysfunction in PD may be caused by an underlying degenerative process that affects the autonomic ganglia, brainstem nuclei, and hypothalamic nuclei. Anti-parkinsonian medications can cause or worsen symptoms of ANS dysfunction. The care of a PD patient with ANS dysfunction relies on its recognition and directed treatment, including coordinated care between the neurologist and appropriate subspecialist. Pharmacotherapy may be useful to treat orthostasis, gastrointestinal, urinary, and sexual dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Spiegel EA, Wycis HT, Schor S, et al.: The incidence of vegetative symptoms in Parkinson patients with and without bradykinesia. In In Third Symposium on Parkinson Disease Royal College of Surgeons in Edinburgh. Edinburgh: E & S Livingston, Ltd; 1969:200.

    Google Scholar 

  2. Turkka J, Suominen K, Tolonen U, et al.: Selegiline diminishes cardiovascular autonomic responses in Parkinson’s disease. Neurology 1997, 48:662–667.

    PubMed  CAS  Google Scholar 

  3. Martignoni E, Micieli G, Cavallini A, et al.: Autonomic disorders in idiopathic Parkinsonism. J Neural Transm 1986, 22:149–161.

    CAS  Google Scholar 

  4. Parkinson J: An essay on shaking palsy. London: Sherwood, Neely and Jones; 1817.

    Google Scholar 

  5. Gowers WR: A Manual of Diseases of the Nervous System, edn 2. London: Churchill; 1893:648.

    Google Scholar 

  6. Porter RW, Bors E: Neurogenic bladder in Parkinson’s disease: effect of thalamotomy. J Neurosurg 1971, 34:27.

    PubMed  CAS  Google Scholar 

  7. Singer C, Weiner WJ, Sanchez-Ramos JL: Autonomic dysfunction in men with Parkinson’s disease. Eur Neurol 1992, 32:134–140.

    PubMed  CAS  Google Scholar 

  8. Lemack GE, Dewey RB Jr, Roehrborn CG, et al.: Questionnaire-based assessment of bladder dysfunction in patients with mild to moderate Parkinson’s disease. Urology 2000, 56:250–254.

    Article  PubMed  CAS  Google Scholar 

  9. Lisenmeyer TA, Stone JM: Neurogenic Bladder and Bowel Dysfunction. Rehabilitation Medicine: Principles and Practice, edn 3. Edited by Delisa JA, Gans BM. Philadelphia: Lippincott-Raven Publishers; 1998:1073–1106.

    Google Scholar 

  10. Principles of Neuroscience. Edited by Kandel ER, Schwartz JH, Jessel TH. New York: McGraw-Hill; 2000:968.

    Google Scholar 

  11. Pavlakis AJ, Siroky MB, Goldstein I, Krane RJ: Neurourologic findings in Parkinson’s disease. J Urol 1983, 129:80–83.

    PubMed  CAS  Google Scholar 

  12. Lewin RV, Dilland GV, Porter RW: Extrapyramidal inhibition of the urinary bladder. Brain Res 1967, 4:301.

    Article  PubMed  CAS  Google Scholar 

  13. Andersen JT, Bradley WE: Cystometric, sphincter and electromyelographic abnormalities in Parkinson’s disease. J Urol 1976, 116:75–78.

    PubMed  CAS  Google Scholar 

  14. Resnick NM, Yalla SV: Management of urinary incontinence in the elderly. N Engl J Med 1985, 313:800–805.

    Article  PubMed  CAS  Google Scholar 

  15. Yarker YE, Goa KL, Fitton A: Oxybutynin: a review of its pharmacodynamic and pharmacokinetic properties, and its therapeutic use in detrusor instability. Drugs Aging 1995, 6:243–262. This paper reviews the pharmacodynamic and pharmacokinetic properties of oxybutynin.

    PubMed  CAS  Google Scholar 

  16. Andersson KE: Drug therapy for urinary incontinence. Bailliere’s Clin Obstet Gynaecol 2000, 14:291–313.

    CAS  Google Scholar 

  17. Hills CH, Winter SA, Balfour JA: Tolterodine. Drugs 1998, 55:813–820.

    Article  PubMed  CAS  Google Scholar 

  18. van Kererebroeck PE, Amarence G, Thuroff JW, et al.: Dose-ranging study of tolterodine in patients with detrusor hyperreflexia. Neurourol Urodyn 1998, 17:499–512.

    Article  Google Scholar 

  19. Larsson G, Hallen B, Nilvebrant L: Tolterodine in the treatment of overactive bladder: analysis of the pooled phase II efficacy and safety data. Urology 1999, 53:990–998.

    Article  PubMed  CAS  Google Scholar 

  20. Abrams P, Freeman R, Anderstrom C, Mattiasson A: Tolterodine, a new antimuscarinic agent: as effect but better tolerated than oxybutynin in patients with an overactive bladder. Br J Urol 1998, 81:801–810. In this randomized, double blind trial, tolterodine at 2mg twice daily was effective in treating bladder overactivity and was better tolerated than oxybutynin.

    PubMed  CAS  Google Scholar 

  21. Hilton P, Hertogs K, Stanton SL: The use of desmopression (DDAVP) for nocturia in women with multiple sclerosis. J Neurol Neurosurg Psych 1983, 46:854–855.

    CAS  Google Scholar 

  22. Kinn AC, Larsson PO: Desmopressin: a new principle for symptomatic treatmetn of urgency and incontinence in patients with multiple sclerosis. Scand J Urol Nephrol 1990, 24:1109–1121.

    Article  Google Scholar 

  23. Eckford SD, Swami KS, Jackson SR, Abrams PH: Desmopressin in the treatment of nocturia and enuresis in patients with multiple sclerosis. Br J Urol 1994, 74:733–735.

    PubMed  CAS  Google Scholar 

  24. Fredrikson S: Nasal spray desmopressin treatment of bladder dysfunction in patients with multiple sclerosis. Acta Neurol Scand 1996, 94:31–34.

    PubMed  CAS  Google Scholar 

  25. Horowitz M, Combs AJ, Gerdes D: Desmopressin for nocturnal incontinence in the spina bifida population. J Urol 1997, 158:2267–2268.

    Article  PubMed  CAS  Google Scholar 

  26. Robson WL, Norgaard JP, Leung AK: Hyponatremia in patients with nocturnal enuresis treated with DDAVP. Eur J Pediatr 1996, 155:959–962.

    Article  PubMed  CAS  Google Scholar 

  27. Schwab M, Ruder H: Hyponatremia and cerebral convulsion due to DDAVP administration in patients with enuresis nocturia or urine concentration testing. Eur J Pediatr 1997, 156:668.

    PubMed  CAS  Google Scholar 

  28. Raybould HE, Pandol SJ: The integrated response of the gastrointestinal tract to a meal. In In Textbook of Gastroenterology, edn 3. Edited by Yamada T, Alpers DH, Laine L, et al. Philadelphia: Lippincott Williams & Wilkins; 1999:2–10.

    Google Scholar 

  29. Furness JB, Costa M: The Enteric Nervous System. Edinburg: Churchill Livingston; 1997.

    Google Scholar 

  30. Furness JB, Bornstein JC, Kunze WAA, Clerc N: The enteric nervous system and its extrinsic connections. In In Textbook of Gastroenterology, edn 3. Edited by Yamada T, Alpers DH, Laine L, et al. Philadlephia: Lippincott Williams & Wilkins; 1999:11–30.

    Google Scholar 

  31. Hasler WL: Motility of the small intestine and colon. In In Textbook of Gastroenterology, edn 3. Edited by Yamada T, Alpers DH, Laine L, et al. Philadlephia: Lippincott Williams & Wilkins; 1999:236.

    Google Scholar 

  32. Byrne KG, Pfeiffer R, Quigley EM: Gastrointestinal dysfunction in Parkinson’s disease: a report of clinical experience at a single center. J Clin Gastroenterol 1994, 19:11–16.

    Article  PubMed  CAS  Google Scholar 

  33. Eadie MJ, Tyrer JH: Alimentary disorders in Parkinsonism. Aust Ann Med 1965, 14:13–22.

    PubMed  CAS  Google Scholar 

  34. Edwards LL, Quigley EM, Pfeiffer RF: Gastrointestinal dysfunction in Parkinson’s disease: frequency and pathophysiology. Neurology 1992, 42:726–732.

    PubMed  CAS  Google Scholar 

  35. Stroudley J, Walsh M: Radiological assessment of dysphagia in Parkinson’s disease. Br J Radiol 1991, 64:890–893.

    Article  PubMed  CAS  Google Scholar 

  36. Johnston BT, Li Q, Castell JA, Castell DO: Swallowing and esophageal function in Parkinson’s disease. Am J Gastroenterol 1995, 90:1741–1746. This paper reviews swallowing abnormalities in Parkinson’s disease.

    PubMed  CAS  Google Scholar 

  37. Ali GN, Wallace KL, Laundl TM, et al.: Oropharnyngeal dysfunction in patients with Parkinson’s disease and dysphagia [abstract]. Gastroenterology 1994, 106:459.

    Google Scholar 

  38. Weber J, Roman C, Hannequin D, et al.: Esophageal manometry in patients with unilateral hemispheric cerebrovascular accidents or idiopathic Parkinsonism. J Gastrointest Motility 1991, 3:98–106.

    Article  Google Scholar 

  39. Den Hartog Jager WA, Bethlem J: The distribution of Lewy bodies in the central and autonomic nervous system in idiopathic paralysis agitans. J Neurol Neurosurg Psychiatry 1960, 23:283–290.

    Google Scholar 

  40. Qualman SJ, Haupt HM, Yang P, et al.: Esophageal Lewy bodies associated with ganglion cell loss in achalasia: similarity to Parkinson’s disease. Gastroenterology 1984, 87:848–856.

    PubMed  CAS  Google Scholar 

  41. Wakabayashi K, Takahahi H, Takeda S, et al.: Parkinson’s disease: the presence of Lewy bodies in Auerbach’s and Meissner’s plexuses. Acta Neuropathol 1988, 76:217–221.

    Article  PubMed  CAS  Google Scholar 

  42. Bramble MG, Cunliffe J, Dellipiani AW: Evidence for a change in neurotransmitter affecting esophageal motility in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1978, 41:709–712.

    PubMed  CAS  Google Scholar 

  43. Soykan I, Sarosiek I, Shifflett J, et al.: Effect of chronic oral domperidone therapy on gastrointestinal symptoms and gastric emptying in patients with Parkinson’s disease. Mov Disord 1997, 12:952–957.

    Article  PubMed  CAS  Google Scholar 

  44. Edwards LL, Pfeiffer RF, Quigley EM, et al.: Gastrointestinal symptoms in Parkinson’s disease. Mov Disord 1991, 6:151–156.

    Article  PubMed  CAS  Google Scholar 

  45. Mathers SE, Kemptster PA, Swash M, Lees AJ: Constipation and paradoxical puborectalis contraction in animus and Parkinson’s disease: a dystonic phenomenon? J Neurol Neurosurg Psychiatry 1988, 51:1503.

    PubMed  CAS  Google Scholar 

  46. Byrne KG, Pfeiffer R, Quigley EM: Gastrointestinal dysfunction in Parkinson’s disease: a report of clinical experience at a single center. J Clin Gastroenterol 1994, 19:11–16.

    Article  PubMed  CAS  Google Scholar 

  47. Bedford TA, Rowbotham DJ: Cisapride: drug interactions of clinical significance. Drug Saf 1996, 15:167–175.

    PubMed  CAS  Google Scholar 

  48. DiPalma JA, DeRidder PH, Orlando RC, et al.: A randomized, placebo-controlled, multicenter study of the safety and efficacy of a new polyethylene glycol laxative. Am J Gastroenterol 2000, 95:446–450. In this trial, Braintree polyethylene glycol laxative was safe and effective in the short-term treatment of constipation.

    Article  PubMed  CAS  Google Scholar 

  49. Welsh M, Hung L, Waters CH: Sexuality in women with Parkinson’s disease. Mov Disord 1997, 12:923–927.

    Article  PubMed  CAS  Google Scholar 

  50. Singer C, Weiner WJ, Sanchez-Ramos J, Ackerman M: Sexual function in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 1991, 54:94–237.

    Google Scholar 

  51. Brown EB, Brown GM, Kofman O, Quarrington B: Sexual function and affect in Parkinsonian men treated with L-dopa. Am J Psychiatry 1978, 135:1552–1555.

    PubMed  CAS  Google Scholar 

  52. Zesiewicz TA, Helal M, Hauser RA: Sildenafil citrate (Viagra) for the treatment of erectile dysfunction in men with Parkinson’s disease. Mov Disord 2000, 15:305–308.

    Article  PubMed  CAS  Google Scholar 

  53. Goetz CG, Lutge W, Tanner CM: Autonomic dysfunction in Parkinson’s disease. Neurology 1986, 36:73–75.

    PubMed  CAS  Google Scholar 

  54. Hirashima F, Yokota T, Miyatake T, et al.: Sudomotor dysfunction in Parkinson’s disease. Rinsho Shinkeigaku 1993, 33:709–714.

    PubMed  CAS  Google Scholar 

  55. Mano Y, Nakamuro T, Takayanagi T, Mayer RF: Sweat function in Parkinson’s disease. J Neurol 1994, 241:573–576.

    Article  PubMed  CAS  Google Scholar 

  56. Sage JI, Mark MH: Drenching sweats as an off phenomenon in Parkinson’s disease: treatment and relation to plasma levodopa profile. Ann Neurol 1995, 37:120–122.

    Article  PubMed  CAS  Google Scholar 

  57. Saito H, Kogure K: Thermal sudomotor deficits in Parkinson’s disease. Rinsho Shinkeigaku 1989, 29:734–740.

    PubMed  CAS  Google Scholar 

  58. McLeod JG, Tuck RR: Disorders of the autonomic nervous system: II. Investigation and treatment. Ann Neurol 1987, 21:519–529.

    Article  PubMed  CAS  Google Scholar 

  59. Adams RD, Victor M, Ropper AH: Principles of Neurology, edn 6. New York: McGraw-Hill; 1997.

    Google Scholar 

  60. Mathias CJ: Disorders affecting autonomic function in Parkinsonian patients. Adv Neurol 1996, 69:383–391.

    PubMed  CAS  Google Scholar 

  61. Gross M, Bannister R, Godwin-Austen R: Orthostatic hypotension in Parkinson’s disease. Lancet 1972, 1:174–176.

    Article  PubMed  CAS  Google Scholar 

  62. Mathias CJ: Orthostatic hypotension: causes, mechanisms, and influencing factors. Neurology 1995, 45(suppl):S6-S11.

    PubMed  CAS  Google Scholar 

  63. Shy G, Drager GA: A neurological syndrome associated with orthostatic hypotension. Arch Neurol 1960, 2:511.

    PubMed  CAS  Google Scholar 

  64. Barbeau A, Gillo-Joffroy L, Boucher R, et al.: Renin-aldosterone system in Parkinson’s disease. Science 1969, 165:291–292.

    Article  PubMed  CAS  Google Scholar 

  65. McDowell FH, Lee JE: Levodopa, Parkinson’s disease, and hypotension. Ann Intern Med 1970, 72:751.

    PubMed  CAS  Google Scholar 

  66. Gross M, Bannister R, Godwin-Austen R: Orthostatic hypotension in Parkinson’s disease. Lancet 1972, 1:174–176.

    Article  PubMed  CAS  Google Scholar 

  67. Orskov L, Jakobsen J, Dupont E, et al.: Autonomic function in Parkinsonian patients relates to duration of disease. Neurology 1987, 37:1173–1178.

    PubMed  CAS  Google Scholar 

  68. Meco G, Pratesi L, Bonifati V: Cardiovascular reflexes and autonomic dysfunction in Parkinson’s disease. J Neurol 1991, 238:195–199.

    Article  PubMed  CAS  Google Scholar 

  69. Piha SJ, Rinne JO, Rinne UK, Seppanen A: Autonomic dysfunction in recent onset and advanced Parkinson’s disease. Clin Neurol Neurosurg 1988, 90:221–226.

    Article  PubMed  CAS  Google Scholar 

  70. Kuroiwa Y, Shimada Y, Toyokura Y: Postural hypotension and low R-R interval variability in Parkinsonism, spinocerebellar degeneration, and Shy-Drager syndrome. Neurology 1983, 33:463–467.

    PubMed  CAS  Google Scholar 

  71. Aminoff MJ, Wilcox CS: Assessment of autonomic function in patients with a Parkinsonian syndrome. BMJ 1971, 4:80–84.

    PubMed  CAS  Google Scholar 

  72. Ludin SM, Steiger UG, Ludin HP: Autonomic disturbances and cardiovascular reflexes in idiopathic Parkinson’s disease. J Neurol 1987, 235:10–15.

    Article  PubMed  CAS  Google Scholar 

  73. Turkka J, Tolonen U, Myllyla V: Cardiovascular reflexes in Parkinson’s disease. Eur Neurol 1987, 26:104–112.

    PubMed  CAS  Google Scholar 

  74. Senard JM, Rai S, Lapeyre-Mestre M, et al.: Prevalence of orthostatic hypotension in Parkinson’s disease. J Neurol Neurosurg Psych 1997, 63:584–589.

    CAS  Google Scholar 

  75. Uono Y: Parkinsonism and autonomic dysfunction. Auton Nerv Syst 1993, 10:163–170.

    Google Scholar 

  76. Netten PM, De Vos K, Horstink MWIM, et al.: Autonomic dysfunction in Parkinson’s disease, tested with a computerized method using Finapres device. Clin Auton Res 1995, 5:85–89.

    Article  PubMed  CAS  Google Scholar 

  77. Barbeau A, Gillo-Joffroy L, Brossard Y: L-Dopa and Parkinsonism. Edited by Barbeau A, McDowell FH. Philadelphia: FA Davis; 1970:286.

    Google Scholar 

  78. Gross M, Bannister R, Godwin-Austen R: Orthostatic hypotension in Parkinson’s disease. Lancet 1972, 1:174–176.

    Article  PubMed  CAS  Google Scholar 

  79. Micieli G, Martignoni E, Cavallini A, et al.: Postprandial and orthostatic hypotension in Parkinson’s disease. Neurology 1987, 37:386–393.

    PubMed  CAS  Google Scholar 

  80. Michelakis AM, Robertson D: Plasma renin activity and levodopa in Parkinson’s disease. JAMA 1970, 213:83–85.

    Article  PubMed  CAS  Google Scholar 

  81. Rappelli A, Glorioso N, Tedde R, et al.: Effects of levodopa alone and in combination with dopadecarboxylase inhibitors on plasma renin activity in patients with Parkinson’s disease. J Neurol Neurosurg Psych 1978, 41:915–918.

    CAS  Google Scholar 

  82. Turkka JT, Juujarvi KK, Lapinlampi TO, Myllyla VV: Autonomic dysfunction in Parkinson’s disease: serum noradrenaline response to standing up. J Neurol 1985, 232:66.

    Google Scholar 

  83. Camerlingo M, Ferraro B, Gazzaniga GC, et al.: Cardiovascular reflexes in Parkinson’s disease: long-term effects of levodopa treatment on de novo patients. Acta Neurol Scand 1990, 81:346–348.

    Article  PubMed  CAS  Google Scholar 

  84. Hilsted J: Autonomic neuropathy: the diagnosis. Acta Neurol Scand 1983, 67:193–201.

    PubMed  CAS  Google Scholar 

  85. Persson A, Solders G: R-R variations in Guillain-Barré syndrome: a test of autonomic dysfunction. Acta Neur Scand 1983, 67:294–300.

    CAS  Google Scholar 

  86. Wheeler T, Watkins P: Cardiac denervation in diabetes. BMJ 1973, 4:584–586.

    PubMed  CAS  Google Scholar 

  87. Meco G, Pratesi L, Bonifati V: Cardiovascular reflexes and autonomic dysfunction in Parkinson’s disease. J Neurol 1991, 238:195–199.

    Article  PubMed  CAS  Google Scholar 

  88. Appenzeller O, Goss JE: Autonomic deficits in Parkinson’s syndrome. Arch Neurol 1971, 24:50–57.

    PubMed  CAS  Google Scholar 

  89. Reid JL, Calne DB, Pallis GC, Vakil SD: Cardiovascular reflexes in Parkinsonism. Clin Sci 1971, 41:63–67.

    PubMed  CAS  Google Scholar 

  90. Goldstein DS, Holmes C, Li ST, et al.: Cardiac sympathetic denervation in Parkinson’s disease. Ann Intern Med 2000, 133:338–347.

    PubMed  CAS  Google Scholar 

  91. Sachs C, Berglund B, Kaijser L: Autonomic cardiovascular responses in Parkinsonism: effect of levodopa with dopa-decarboxylase inhibition. Acta Neurol Scand 1985, 71:37–42.

    Article  PubMed  CAS  Google Scholar 

  92. Dooley M, Markham A: Pramipexole: a review of its use in the management of early and advanced Parkinson’s disease. Drugs Aging 1998, 12:495–514.

    Article  PubMed  CAS  Google Scholar 

  93. Abs R, Verhelst J, Maiter D, et al.: Cabergoline in the treatment of acromegaly: a study in 64 patients. J Clin Endocrin Met 1998, 83:374–378.

    Article  CAS  Google Scholar 

  94. Micieli G, Martignoni E, Cavallini A, et al.: Lisuride and bromocryptine in levodopa stable-responder Parkinsonian patients: a comparative, double-blind evaluation of cardiopressor and neurochemical effects. Func Neurol 1996, 11:317–325.

    CAS  Google Scholar 

  95. Kujawa K, Leurgans S, Raman R, et al.: Acute orthostatic hypotension when starting dopamine agonists in Parkinson’s disease. Arch Neurol 2000, 57:1461–1463.

    Article  PubMed  CAS  Google Scholar 

  96. Schoenberger JA: Drug-induced orthostatic hypotension. Drug Saf 1991, 6:402–407.

    Article  PubMed  CAS  Google Scholar 

  97. Micek ST, Ernst ME: Tolcapone: a novel approach to Parkinson’s disease. Am J Health Syst Pharm 1999, 56:2195–2205.

    PubMed  CAS  Google Scholar 

  98. Heinonen EH, Myllyla V: Safety of selegiline (deprenyl) in the treatment of Parkinson’s disease. Drug Saf 1998, 19:11–22.

    Article  PubMed  CAS  Google Scholar 

  99. Turkka J, Suominen K, Tolonen U, et al.: Selegiline diminishes cardiovascular autonomic responses in Parkinson’s disease. Neurology 1997, 48:662–667.

    PubMed  CAS  Google Scholar 

  100. Bannister R: Testing autonomic reflexes. In Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System. Edited by Bannister R. London: Oxford University Press; 1983.

    Google Scholar 

  101. Goldberg LI, Whishett TL: Cardiovascular effects of levodopa. Clin Pharmacol Ther 1971, 12:376–382.

    PubMed  CAS  Google Scholar 

  102. Wright RA, Kaufmann HC, Perera R, et al.: A double-blind, dose-response study of midodrine in neurogenic orthostatic hypotension. Neurology 1998, 51:120–124.

    PubMed  CAS  Google Scholar 

  103. Low PA, Gilden JL, Freeman R, et al.: Efficacy of midodrine vs placebo in neurogenic orthostatic hypotension: a randomized, double-blind multicenter study. Midodrine Study Group. JAMA 1997, 277:1046–1051.

    Article  PubMed  CAS  Google Scholar 

  104. Polinsky FJ, Martin JB: Disorders of the autonomic nervous system. In In Harrison’s Principles of Internal Medicine, edn 13. Edited by Isselbacher KJ. New York: McGraw-Hill; 1994:2344–2246.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zesiewicz, T.A., Baker, M.J., Wahba, M. et al. Autonomic nervous system dysfunction in Parkinson’s disease. Curr Treat Options Neurol 5, 149–160 (2003). https://doi.org/10.1007/s11940-003-0005-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-003-0005-0

Keywords

Navigation