Abdominal Binders to Treat Orthostatic Hypotension in Parkinsonian Syndromes

Abdominal Binders to Treat Orthostatic Hypotension in Parkinsonian Syndromes: a Randomized, Placebo-controlled, Double-blind, Crossover Phase II Trial

The purpose of the present clinical trial is to determine whether the use of an elastic abdominal binder is effective in the non-pharmacological management of symptomatic, neurogenic orthostatic hypotension (OH) in individuals suffering from Parkinson's disease (PD) or Parkinson variant multiple system atrophy (MSA-P).

This is a monocentric, randomized, placebo-controlled, double-blind, crossover phase II clinical trial with an open-label treatment extension phase. The investigators plan to recruit n = 30 individuals with MSA-P or PD with known or suspected OH.

At the Screening Visit, after patient information and written informed consent, the participants will first undergo a comprehensive neurological and cardiological evaluation, as well cardiovascular autonomic function testing to confirm the diagnosis of symptomatic, neurogenic OH.

Afterwards, the participants will be asked to wear physical activity monitoring (PAM) sensors for five consecutive days and to measure the blood pressure (BP) regularly following a home BP diary (i.e. Home Phase I).

On treatment day-1 (i.e. Visit 1), the participants will undergo an instrumented in-lab gait analysis, followed by a head-up tilt and active standing test. Afterwards, they will wear the first type of binder for two hours (either the investigational elastic abdominal binder or the placebo-comparator binder, depending on the randomization assignment). At the end of the two hours, the participants will repeat the in-lab gait analysis and the head-up tilt-/active standing test.

After one-day wash-out, the same procedure of treatment day-1 (i.e. Visit 1) will be repeated with the outstanding type of binder (i.e. treatment day-2, Visit 2).

At the end of this, all participants will be invited to wear the investigational elastic abdominal binder and the PAM sensors for five more days and to repeat the home BP measurements (i.e. Home Phase II).

A final follow-up visit is scheduled to return the PAM sensors, the BP monitor and to detect eventual adverse and serious adverse events occurred during Home Phase II.

Inclusion Criteria:

• diagnosis of possible or probable MSA-P (Gilman 2008) or clinically established PD (Postuma 2015);
• 50 to 85 years of age;
• laboratory-confirmed symptomatic (i.e. OHQ - OH Symptom Assessment item #1 ≥ 4), neurogenic OH at screening visit or previously diagnosed as such (i.e. neurogenic OH ratio [≤ 0.492 Δ heart rate rise/systolic BP fall] or missing BP overshoot at phase IV of Valsalva maneuver;
• stable medication schedule in the preceding 3 weeks;
• no infectious disease in the preceding 3 weeks;
• Hoehn & Yahr stage ≤ 3;
• gait item of the Unified MSA Rating Scale (UMSARS) Part II or the Movement Disorder Society - Unified PD Rating Scale (MDS-UPDRS) Part III score < 3;
• body sway item of the UMSARS II/MDS-UPDRS III score < 3;
• arising from chair item of the UMSARS II/MDS-UPDRS III score < 3;
• full legal capacity;
• written informed consent has been obtained.

Exclusion Criteria:

• participation in other interventional trials;
• prescribed and regular use of abdominal binders OR compression stockings for OH treatment;
• other major neurologic or psychiatric diseases which could influence OH or gait;
• untreated diabetes mellitus with clinical features of peripheral neuropathy;
• non-neurological causes of gait disorders;
• major cardiac diseases (ischemic, structural, arrhythmias);
• evidence of varices (venous insufficiency stage ≥ C2, "varicose veins");
• known abdominal aortic aneurism;
• indwelling catheterisation;
• recent surgery (3 months) requiring anaesthesia;
• known or suspected pregnancy;
• breast-feeding female participants.