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Pattern and lesion site (preganglionic, postganglionic, or mixed) were determined based on thermoregulatory sweat test and postganglionic sudomotor testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The majority of the 232 patients were MSA\u2010parkinsonism (145, 63%). Initial postganglionic sudomotor testing was abnormal in 59%, whereas thermoregulatory sweat test was abnormal in 95% of all patients. MSA\u2010parkinsonism patients were more likely to have an abnormal thermoregulatory sweat test compared with MSA\u2010cerebellar (98% versus 90%, <jats:italic>P<\/jats:italic>\u2009=\u20090.006) and had a higher mean percentage of anhidrosis (57%) compared with MSA\u2010cerebellar (48%; <jats:italic>P<\/jats:italic>\u2009=\u20090.033). Common anhidrosis patterns were regional (38%) and global (35%). The site of the lesion was preganglionic in 47% and mixed (preganglionic and postganglionic) in 41%. The increase in anhidrosis per year was 6.2% based on 70 repeat thermoregulatory sweat tests performed on 29 patients. The frequency of postganglionic sudomotor abnormalities increased over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings suggest: (1) sudomotor dysfunction is almost invariably present in MSA and even more common and severe in MSA\u2010parkinsonism than MSA\u2010cerebellar; (2) a preganglionic pattern of sweat loss is common in MSA; however, pre\u2010 and postganglionic abnormalities may coexist; and (3) the increasing frequency of postganglionic sudomotor dysfunction over time suggests involvement of postganglionic fibers or sweat glands later in the disease course. \u00a9 2016 International Parkinson and Movement Disorder Society<\/jats:p><\/jats:sec>","DOI":"10.1002\/mds.26864","type":"journal-article","created":{"date-parts":[[2016,11,10]],"date-time":"2016-11-10T09:34:30Z","timestamp":1478770470000},"page":"397-404","source":"Crossref","is-referenced-by-count":63,"title":["Anhidrosis in multiple system atrophy involves pre\u2010 and postganglionic sudomotor dysfunction"],"prefix":"10.1002","volume":"32","author":[{"given":"Elizabeth A.","family":"Coon","sequence":"first","affiliation":[{"name":"Department of Neurology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert D.","family":"Fealey","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Sletten","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay N.","family":"Mandrekar","sequence":"additional","affiliation":[{"name":"Department of Clinical Statistics Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo E.","family":"Benarroch","sequence":"additional","affiliation":[{"name":"Department of 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