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Effect of L-threo-3,4-dihydroxy-phenylserine on muscle sympathetic nerve activities in Shy-Drager syndrome

From the Research Institute of Environmental Medicine (Dn. Iwase and Mano, Mr. Saito, and Dr. Kunimoto), Nagoya University, Nagoya, and the Department of Neurology (Drs. Kachi and Sobue), National Chubu Hospital, Obu, Japan.

We observed changes in postganglionic efferent discharges of muscle sympathetic nerve (muscle sympathetic activity, MSA) microneurographically before and after the oral administration of L-threo-3,4-dihydrozyphenylserine (L-threo-DOPS), a precursor of norepinephrine, in a patient with Shy-Drager syndrome and irregular fluctuations of blood pressure. Before drug administration, MSA was only rarely observed with the patient in the supine position. There was a slight increase in MSA during head-up tilting to 40°, and orthostatic hypotension (OH) occurred just after the body was tilted head upward to 40°. MSA became prominent 30 minutes after the oral administration of 200 mg of L-threo-DOPS while the patient was in a 40° head-up position, and the OH was improved. The MSA discharge rate decreased and OH reappeared 3 hours after oral administration, when the plasma concentration of norepinephrine was at its highest level. We suggest that the OH improved mainly because of the increase in MSA due to L-threo-DOPS, and that the drug may activate sympathetic outflow at a site proximal to the sympathetic ganglion.

Address correspondence and reprint requests to Dr. Iwase, The Research Institute of Environmental Medicine, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-01, Japan.

Received July 21,1987. Accepted for publication in final form November 9,1987.

Supported by a Grant-in-Aid for Special Project Research of Selected Intractable Neurological Disorders from the Ministry of Education, Science, and Culture, and by a Grant-in-Aid for the Research Committee of CNS Degenerative Diseases, the Ministry of Health and Welfare of Japan.

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