Autonomic dysfunction in PD has remained controversial. Sir James Parkinson in his first description of shaking palsy reported the association of motor features with symptoms suggesting the involvement of the autonomic nervous system. His description included clinical features such as orthostatic hypotension, seborrhea, excessive salivation and dysuria (Parkinson J). Yet, the clinical importance of autonomic dysfunction in PD has continued to be disputed, and the presence of prominent autonomic dysregulation is considered to be suggestive of disease with more widespread involvement of the CNS like multiple system atrophy, an important differential diagnosis of Parkinson disease. (Bannister et al).