Autonomic dysfunction in hereditary spastic paraplegia type 4

Background and purpose SPAST mutations are the most common cause of hereditary spastic paraplegia (SPG4‐HSP), which is characterized by progressive lower limb weakness, spasticity and hyperreflexia. There are few studies about non‐motor manifestations in this disease and none about autonomic involvement. Therefore, the aim was to determine the frequency and pattern of autonomic complaints in patients with SPG4‐HSP, as well as to determine the clinical relevance and the possible factors associated with these manifestations. Methods Thirty‐four molecularly confirmed SPG4 patients were recruited in a multicenter cross‐sectional study, of whom 26 underwent detailed neurophysiological testing (heart rate variability, sympathetic skin response and the Quantitative Sudomotor Axonal Reflex Test). The Scales for Outcomes in Parkinson's Disease – Autonomic Questionnaire (SCOPA‐AUT) was applied to quantify the severity of autonomic symptoms. Results were compared with 44 age‐ and gender‐matched healthy controls using non‐parametric tests. P values