Dysautonomia

Dysautonomia or autonomic dysfunction is a condition in which the autonomic nervous system (ANS) does not work properly. This may affect the functioning of the heart, bladder, intestines, sweat glands, pupils, and blood vessels. Dysautonomia has many causes, not all of which may be classified as neuropathic. A number of conditions can feature dysautonomia, such as Parkinson's disease, HIV/AIDS, multiple system atrophy, autonomic failure, postural orthostatic tachycardia syndrome, Ehlers-Danlos syndrome, autoimmune autonomic ganglionopathy, and autonomic neuropathy.

The diagnosis is achieved through functional testing of the ANS, focusing on the affected organ system. Investigations may be performed to identify underlying disease processes that may have led to the development of symptoms or autonomic neuropathy. Symptomatic treatment is available for many symptoms associated with dysautonomia, and some disease processes can be directly treated.

Signs and symptoms

The symptoms of dysautonomia, which are numerous and vary widely for each individual, are due to inefficient or unbalanced efferent signals sent via both systems. The primary symptoms in individuals with dysautonomia include

• Anhydrosis
• Anxiety
• Blurry or double vision
• Bowel incontinence
• Brain fog
• Constipation
• Dizziness
• Difficulty swallowing
• Exercise intolerance
• Chronic fatigue
• Insomnia
• Low blood pressure
• Orthostatic hypotension
• Syncope
• Tachycardia
• Tunnel vision
• Urinary incontinence or urinary retention
• Vertigo
• Weakness

Causes

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Dysautonomia can be caused by a variety of factors, including:

• Genetic predisposition
• Autoimmune diseases
• Nervous system disorders
• Infections
• Diabetes
• Traumatic injuries

Some specific conditions that can lead to dysautonomia include:

• Parkinson's disease
• Multiple sclerosis
• Guillain-Barré syndrome
• Diabetic neuropathy
• Lyme disease
• Sjögren's syndrome

Diagnosis

Diagnosing dysautonomia involves a thorough evaluation of the patient's medical history, a physical examination, and various tests to assess autonomic function. These tests may include:

• Tilt table test: This test measures blood pressure and heart rate changes in response to changes in body position.
• Quantitative sudomotor axon reflex test (QSART): This test evaluates the functioning of sweat glands.
• Valsalva maneuver: This test measures changes in heart rate and blood pressure in response to forced exhalation against a closed airway.
• Heart rate variability: This test measures changes in heart rate during different activities, such as deep breathing or standing.
• Gastric emptying test: This test assesses the speed at which the stomach empties its contents.
• Urinary function tests: These tests evaluate the functioning of the bladder and urinary system.

Treatment

Treatment for dysautonomia focuses on managing the symptoms and addressing the underlying cause if possible. Depending on the specific symptoms and their severity, treatment options may include:

• Medications: Various medications can be used to manage symptoms, such as drugs to increase blood pressure, medications to manage gastrointestinal symptoms, and drugs to treat urinary problems.
• Non-pharmacological treatments: Lifestyle modifications, such as increasing fluid and salt intake, wearing compression stockings, and practicing regular physical activity, can help manage some symptoms.
• Specific treatments for underlying conditions: If dysautonomia is caused by a specific condition, such as diabetes or Parkinson's disease, treating the underlying condition may improve autonomic function.
• Supportive care: Patients with dysautonomia may benefit from occupational and physical therapy to help maintain daily functioning and improve quality of life.

See Also

• Autonomic nervous system
• Postural orthostatic tachycardia syndrome
• Multiple system atrophy
• Orthostatic hypotension
• Vasovagal syncope

External links

• PubMed

Classification	ICD-10: G90 ICD-9-CM: 337.9 MeSH: D001342

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