Implanted System for Orthostatic Hypotension in Multiple-System Atrophy

N Engl J Med. 2022 Apr 7;386(14):1339-1344. doi: 10.1056/NEJMoa2112809.


Orthostatic hypotension is a cardinal feature of multiple-system atrophy. The upright posture provokes syncopal episodes that prevent patients from standing and walking for more than brief periods. We implanted a system to restore regulation of blood pressure and enable a patient with multiple-system atrophy to stand and walk after having lost these abilities because of orthostatic hypotension. This system involved epidural electrical stimulation delivered over the thoracic spinal cord with accelerometers that detected changes in body position. (Funded by the Defitech Foundation.).

MeSH terms

  • Accelerometry
  • Atrophy
  • Blood Pressure / physiology
  • Electric Stimulation Therapy* / methods
  • Electrodes, Implanted
  • Epidural Space
  • Humans
  • Hypotension, Orthostatic* / diagnosis
  • Hypotension, Orthostatic* / etiology
  • Hypotension, Orthostatic* / therapy
  • Multiple System Atrophy* / therapy
  • Posture / physiology
  • Thoracic Vertebrae

Supplementary concepts

  • Multiple system atrophy (MSA) with orthostatic hypotension