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CSF acetylcholinesterase levels are reduced in multiple system atrophy with autonomic failure

Clinical Neuropharmacology Section, Clinical Neuroscience Branch, National Institute of Neurological and Communicative Disorders and Stroke, Bethesda, MD.

Diminished CSF levels of acetylcholinesterase in patients with multiple system atrophy attended by autonomic failure suggest that CNS cholinergic involvement may occur in this disorder. The lack of correlation between the low enzyme levels and low CSF levels of monoamine metabolites in these patients indicates that the acetylcholinesterase reduction is not directly related to disruption in these neurotransmitter systems. Normal CSF acetylcholinesterase levels in those patients with pure autonomic failure are consistent with functional integrity of central cholinergic pathways and support a pathophysiologic involvement limited to the peripheral nervous system.

Address correspondence and reprint requests to Dr. Polinsky, National Institutes of Health, Building 10, Room 5N-236, 9000 Rockville Pike, Bethesda, MD 20892.

Received March 11, 1988. Accepted for publication in final form June 6, 1988.