Autonomic Nervous System Disorders Diagnosis and Treatment 

Doctors diagnose autonomic disorders based on a person’s history, a physical examination, tests of the autonomic functions, and laboratory results. During the physical examination, physicians assess blood pressure and pulse while the individual is lying and standing, the pupils’ reaction to light, and the color and temperature of the skin. Autonomic tests measure sweat production and changes in the heart rate during breathing. The doctor will also check how the blood pressure responds to straining (the patient closes his or her mouth and nose and tries to blow out, called the Valsalva maneuver), to being switched from a horizontal to a vertical position as the patient lies on a tilt table, and to standing. It is sometimes necessary to check how well a person can urinate and move his or her bowels. Blood glucose and other blood tests are done to exclude diabetes and other conditions that may produce similar symptoms. 

People diagnosed with an autonomic disorder should work with a health care team: a neurologist, a dietitian, a physical therapist, and in some cases, a urologist or gastroenterologist. The principles for managing these disorders are: 

• Learn about your condition. 
• Work with your doctor to correct potentially reversible causes, particularly unnecessary medications. 
• Adjust your diet and physical activities as necessary. 
• Take drugs specific to the autonomic condition, if prescribed. 

 As an example, here  is the usual program of advice  for people  with orthostatic hypotension: 

• Increase your intake of salt to 8 to 10 grams a day and of water to 2 to 2.5 liters (over half a gallon) a day. 
• Sleep with the head of your bed raised 20 to 30 cm (8 to 12 inches) to prevent hypertension and excessive urination at night. 
• Eat smaller, more frequent meals with low carbohydrate content, and a high-fiber diet to avoid constipation. 
• Learn to use small postural maneuvers as standing with your legs crossed and squatting to prevent fainting. 
• Perform regular exercise, but avoid heavy exercise and exposure to heat. 
• Some people benefit from the use of support stockings. 
• Drug  treatment potentially includes fludrocortisone (Florinef), which increases the kidneys’ retention  of sodium from salt, and midodrine (Proamatine), which constricts  the blood vessels. 

Other drugs used to treat symptoms of autonomic failure are metoclopramide (Reglan) to improve the working of the stomach and intestine, and sildenafil (Viagra) to treat erectile impotence. Although many elderly people take oxybutynin (Ditropan) or tolterodine (Detrol) to reduce excessive bladder contractions and incontinence, individuals with autonomic failure should not take these medicines. People suffering from urinary problems caused by an autonomic disorder need to follow a fluid schedule and may eventually have to learn to empty their bladders with a catheter. 

For some people, doctors may recommend surgical procedures, such as a gastrostomy (a feeding tube is inserted into the stomach to bypass swallowing problems) or penile implant. Individuals whose autonomic problems stem from diabetes may be advised to have a pancreas or kidney transplant. These surgeries can’t fix the autonomic system itself, but they can either alleviate the  underlying problem or counteract the troublesome symptoms. 

The prognosis for autonomic disorders varies greatly because of their many causes.  In multiple system atrophy, autonomic problems worsen along with the other manifestations of the disease. This illness has a poor prognosis;  many patients experience potentially fatal breathing difficulties during sleep and may require a tracheotomy. On the other hand, about two thirds  of acute autonomic failures following an infection  and an immune attack on the autonomic nerves improve within two  to four weeks. The prognosis  of autonomic failure in diabetes parallels that of  the underlying neuropathy and other manifestations  of the disease,  and may improve with appropriate control of blood glucose and, in some cases, surgery. 

Intensive ongoing research is aimed at understanding the brain mechanisms that control autonomic function, as well as the causes of mechanisms of disorders in this system. These investigations may yield results that help prevent and treat not only the diseases associated with autonomic failure but also conditions  such as panic attacks, high blood pressure,  and sudden cardiac death. 

Notes: DrJMinor

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EditText of this page (last edited December 12, 2009)