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: My father was diagnosed with Parkinson's about 3 years ago. All Parkinson's medications made him feel worse instead of better. I attributed his autonomic symptoms (hypotension, dizziness, flushed feeling, anxiety, etc.) as expected with mitral valve prolapse's dysautonomic symptoms. This week his neurologists changed his diagnosis from Parkinson's to Shy-Drager Syndrome. The men in his family have a predominance of neurological problems. My questions are: 1. Is there a relationship between Shy-Drager Syndrome and Mitral Valve Prolapse (Dysautonomial)? 2. Does Shy-Drager run in families, as does Mitral Valve Prolapse? 3. What is the prognosis for Shy-Drager?
Dr. Chelimsky: Your question is an excellent one. The usual thought is that Shy-Drager (SD) and mitral valve prolapse (MVP), while both autonomic disorders in their own right, do not have much to do with one another. SD is a progressive degeneration of the autonomic and motor neurons, and autonomic testing will demonstrate LOSS of most autonomic reflexes as time goes on. On the other hand, MVP, although sometimes associated with similar symptoms such as dizziness, fainting and bladder and bowel problems, generally demonstrates EXAGGERATION of the autonomic reflexes. Thus, the two should be relatively easy to distinguish. This is more than just an academic issue, because MVP is usually non-progressive, while SD progresses. Also the treatment strategies differ significantly.
Specific answers to your questions:
1. Is there a relationship between Shy-Drager Syndrome and Mitral Valve Prolapse (Dysautonomial)? Probably not.
2. Does Shy-Drager run in families, as does Mitral Valve Prolapse? It can, but this is the exception, not the rule.
3. What is the prognosis for Shy-Drager? 3-15 years of life from diagnosis.
Best regards, Thomas Chelimsky, MD
If you have a question, please submit it to Dr. Chelimsky.