Dysautonomia

Dysautonomia
Classification and external resources
Specialty Neurology
ICD-10 G90
ICD-9-CM 337.9
MeSH D001342

Dysautonomia (or autonomic neuropathy) is a term for various conditions in which the autonomic nervous system (ANS) does not work correctly. Dysautonomia is a type of neuropathy affecting the nerves that carry information from the brain and spinal cord to the heart, bladder, intestines, sweat glands, pupils, and blood vessels.[1]

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

Signs and symptoms

Tachycardia

The symptoms of dysautonomia are numerous and vary widely for each individual,symptoms of dysautonomia are due to inefficient or unbalanced efferent signals sent via both systems.[2] The primary symptoms present in individuals with dysautonomia include:

Causes

Vincristine

Dysautonomia may be due to inherited or degenerative neurologic diseases (primary dysautonomia)[1] or it may occur due to injury of the autonomic nervous system from an acquired disorder (secondary dysautonomia).[3][6] The most common causes of dysautonomia include:

In the sympathetic nervous system predominant dysautonomia is common in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis, raising the possibility that such dysautonomia could be their common clustering underlying pathogenesis.[8]

Mechanism

The autonomic nervous system (ANS) is a component of the peripheral nervous system and is made up of two branches: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). The SNS controls the more active responses such as increasing heart rate and blood pressure. The PNS slows down the heart rate and aids in digestion,for example. Symptoms typically arise from abnormal responses of either the sympathetic or parasympathetic systems based on situation or environment.[1][9]

Diagnosis

Valsalva maneuver

The diagnosis of dysautonomia should include measurements of blood pressure and heart rate while lying flat, and after 3 minutes of standing.[10] Additional tests and exams to determine dysautonomia (neuropathy diagnosis) includes the following:

Management

The treatment of dysautonomia can be difficult, since it is made up of many different symptoms, a combination of drug therapies is often required to manage individual symptomatic complaints. Therefore, if an autoimmune neuropathy is the case, then treatment with immunomodulatory therapies is done, or if diabetes mellitus is the cause, control of blood glucose is important.[3] In treatment there can be: proton-pump inhibitors and H2 receptor antagonists used for digestive symptoms such as acid reflux.[11]

For the treatment of genitourinary autonomic neuropathy medications may include sildenafil (a guanine monophosphate type-5 phosphodiesterase inhibitor). For the treatment of hyperhidrosis, anticholinergic agents such as trihexyphenidyl or scopolamine can be used, also intracutaneous injection of botulinum toxin type A can be used for management in some cases.[12]

Prognosis

The prognosis of dysautonomia depends on several factors, individuals with chronic, progressive, generalized dysautonomia in the setting of central nervous system degeneration such as Parkinson's disease or multiple system atrophy have a generally poorer long-term prognosis. Consequently dysautonomia could be fatal due to pneumonia, acute respiratory failure, or sudden cardiopulmonary arrest.[1]

According to Vinik, et al, it was found that autonomic dysfunction symptoms such as orthostatic hypotension, gastroparesis, and gustatory sweating are more frequently identified in morttalities.[13]

See also

References

  1. 1 2 3 4 5 "Dysautonomia". NINDS. Retrieved 2012-04-03.
  2. ↑ Lonsdale, Derrick (2009-03-01). "Dysautonomia, A Heuristic Approach to a Revised Model for Etiology of Disease". Evidence-based Complementary and Alternative Medicine : eCAM 6 (1): 3–10. doi:10.1093/ecam/nem064. ISSN 1741-427X. PMC 2644268. PMID 18955227.
  3. 1 2 3 4 5 6 7 8 9 10 11 "Autonomic Neuropathy Clinical Presentation: History, Physical, Causes". emedicine.medscape.com. Retrieved 2016-02-21.
  4. 1 2 3 4 5 6 7 8 9 "Autonomic Neuropathy. Information about AN. Patient | Patient". Patient. Retrieved 2016-02-21.
  5. 1 2 3 4 5 6 7 8 9 "Autonomic neuropathy: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2016-02-20.
  6. ↑ KIRK, KATHERINE A; SHOYKHET, MICHAEL; JEONG, JONG H; TYLER-KABARA, ELIZABETH C; HENDERSON, MARYANNE J; BELL, MICHAEL J; FINK, ERICKA L (2012-08-01). "Dysautonomia after pediatric brain injury". Developmental Medicine and Child Neurology 54 (8): 759–764. doi:10.1111/j.1469-8749.2012.04322.x. ISSN 0012-1622. PMC 3393822. PMID 22712762.
  7. ↑ De Wandele I, Rombaut L, Leybaert L, Van de Borne P, De Backer T, Malfait F, De Paepe A, Calders P., “Dysautonomia and its underlying mechanisms in the hypermobility type of Ehlers-Danlos syndrome”, PMID 24507822 [PubMed - indexed for MEDLINE]
  8. ↑ Martínez-Martínez LA, Mora T, Vargas A, Fuentes-Iniestra M, Martínez-Lavín M (Apr 2014). "Sympathetic nervous system dysfunction in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis: a review of case-control studies.". J Clin Rheumatol. 20: 146–50. doi:10.1097/RHU.0000000000000089. PMID 24662556.
  9. ↑ Information, National Center for Biotechnology; Pike, U. S. National Library of Medicine 8600 Rockville; MD, Bethesda; Usa, 20894. "Autonomic Nervous System - National Library of Medicine". PubMed Health. Retrieved 2016-02-21.
  10. 1 2 3 4 5 6 7 8 9 Mustafa, Hossam I.; Fessel, Joshua P.; Barwise, John; Shannon, John R.; Raj, Satish R; Diedrich, André; Biaggioni, Italo; Robertson, David (2012-01-01). "Dysautonomia: Perioperative Implications". Anesthesiology 116 (1): 205–215. doi:10.1097/ALN.0b013e31823db712. ISSN 0003-3022. PMC 3296831. PMID 22143168.
  11. ↑ "H2 Blockers. Reducing stomach acid with H2 Blockers. | Patient". Patient. Retrieved 2016-02-21.
  12. ↑ "Medscape Log In". www.medscape.com. Retrieved 2016-02-21.
  13. ↑ Vinik, Aaron I.; Maser, Raelene E.; Mitchell, Braxton D.; Freeman, Roy (2003-05-01). "Diabetic Autonomic Neuropathy". Diabetes Care 26 (5): 1553–1579. doi:10.2337/diacare.26.5.1553. ISSN 0149-5992. PMID 12716821.

Further reading

External links

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