Autonomic Laboratory

Patient Question, March 1998

This Web page is designed for the general education of patients and their families.

Disclaimer: The answers provided are the opinion of Dr. Tom Chelimsky. No patient should make any changes in their care without first consulting their physician.

Question: Have you ever found any connection between Shy Drager Syndrome and nocturnal epilepsy? My doctors are not sure if there is a connection or if they are seperate issues.

Dr. Chelimsky: Shy-Drager syndrome (multiple system atrophy) in and of itself should not produce seizures, nocturnal or otherwise. There are some reports of their coexistence, but the disease itself should not be associated with seizures, as it produces little cortical damage, the usual source of seizures (for example, another cortical problem, dementia, is generally NOT considered to be a part of multiple system atrophy). Multiple system atrophy attacks mainly the motor and autonomic centers of the basal ganglia, brainstem and spinal cord.

There are a few possible explanations as to why these might occur together:

1. The diagnosis of Shy-Drager is incorrect, and the correct diagnosis is one of the other central nervous system diseases where the cortex IS involved, such as progressive supranuclear palsy, or diffuse Lewy body disease.
2. The diagnosis of nocturnal epilepsy is incorrect, and the night-time events called seizures are really abnormal movements associated with the underlying process of multiple system atrophy.
3. They just happen to exist together in one person, but are coincidental, and have no relationship with one another (perhaps the most likely explanation).

Best regards, Thomas Chelimsky, MD

If you have a question, please submit it to Dr. Chelimsky.

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