There is no cure, and treatments only last a few years before they start adding to the debilitating symptoms. Well-known patients include actor Michael J. Fox and U.S. Attorney General Janet Reno. But no one has been able to find out why those cells get destroyed in the first place. Goldstein was not even looking for an answer to that question. He was studying patients with failure of the sympathetic nervous system, which affects blood pressure, pulse rate, perspiration, and other automatic responses to stress.
Some patients have it all the time, complaining of dizziness and even fainting when they stand.
The symptom has been described in association with Parkinson's, and has sometimes been blamed on the drugs used to treat Parkinson's. But Goldstein found this drop in blood pressure was associated with a loss of the sympathetic nerve endings. These nerve endings produce a neurotransmitter that is related to dopamine, called norepinephrine. It turned out that nearly all 29 Parkinson's patients in his study had this loss, even if they did not have the blood- pressure symptoms. The discovery might open ways to find the underlying cause of Parkinson's, and might explain the unusual finding that heavy coffee drinkers seem to have a lower rate of Parkinson's, Goldstein said.