URODYNAMIC AND NEUROPHYSIOLOGICAL EVALUATION IN PARKINSONS-DISEASE AND MULTIPLE SYSTEM ATROPHY

Aims-To determine whether Parkinson's disease and multiple system atro phy each has a distinct pattern. of micturition abnormalities and whet her a urodynamic evaluation could be useful in the differential diagno sis between the two diseases. Methods-Sixty two patients (30 with Park inson's disease and 32 with multiple system atrophy) underwent a compl ete urodynamic evaluation and neurophysiological testing. Results-Of t he parkinsonian patients 36.6% had normal micturition findings with no rmal bladder sensitivity; 26.7% had delayed or incomplete pelvic floor relaxation; 26.7% had hyperreflexia with vesicosphincteric synergy; a nd 10% had hyperreflexia with vesicosphincteric synergy associated wit h incomplete pelvic floor relaxation. Parkinsonian patients with a nor mal urodynamic pattern had significantly less severe disease and a sho rter duration of disease in years than those who had abnormal patterns . Patients with hyperreflexia had significantly higher severity of dis ease. Conclusions-Urodynamic evaluation and sphincter EMG are both use ful tests in the differential diagnosis between Parkinson's disease an d multiple system atrophy. Urodynamic findings may be abnormal before patients with multiple system atrophy reach an advanced stage of the d isease. Recordings of EMGs from perineal muscles become abnormal as th e disease progresses in multiple system atrophy but not in Parkinson's disease.