Droxidopa effectively reduces neurogenic orthostatic hypotension. Fludrocortisone also may be beneficial, but patients with MSA may become resistant to the drug after six months. A 50-mg dose of captopril may reduce blood pressure in patients with supine hypertension, which is a risk factor for stroke. Collaboration with a cardiologist may be helpful for neurologists.
Alpha-adrenergic blockers can improve bladder emptying, but may exacerbate neurogenic orthostatic hypotension. Patients with a hypoactive detrusor may require a bladder stimulator. Sildenafil or tadalafil can treat erectile dysfunction effectively, and a gynecologist may provide advice for treating female genital hyposensitivity. Furthermore, urologists can advise neurologists about treating urologic symptoms.
Melatonin should be the first choice for treating REM sleep behavior disorder, said Dr. Hedera. If the drug does not provide improvement, the neurologist may consider clonazepam, which increases non-REM sleep and may lead to more restful sleep.
—Erik Greb