Junie Shiwen Koay, MBBS, University College London Queen Square Institute of Neurology, London, UK, outlines the potential mechanisms underlying orthostatic hypotension in pure autonomic failure (PAF). Deposition of α-synuclein varies within different networks in different diseases. In diseases like multiple system atrophy (MSA) and Parkinson’s disease (PD), deposition is more central, whereas in PAF, it is more peripheral. Slightly different mechanisms contribute to the manifestation of autonomic failure in the different α-synucleinopathies, but this is not fully understood. Dr Koay’s research into the deposition of α-synuclein in the skin found that peripheral deposition correlated with markers of cardiovascular autonomic failure related to autonomic control of total peripheral resistance but was not found to correlate with markers for heart rate variability. This supports the hypothesis that peripheral deposition of α-synuclein on autonomic nerves may impair control of total peripheral resistance, which gives rise to symptoms like orthostatic hypotension. This interview took place at the European Academy of Neurology (EAN) Annual Meeting 2024 in Helsinki, Finland.
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