What is autonomic dysfunction (autonomic failure)?

When the autonomic nerve system fails to regulate those processes that lead to health and balance, a condition known as autonomic dysfunction occurs. It is also referred to as:

• Dysautonomia
• Autonomic malfunction
• Neuropathy of the autonomic nervous system

What are the effects of autonomic dysfunction?

• Control of heart rate
• Regulation of blood pressure
• Breakdown
• Regulation of temperature
• Sweat glands
• Function of the urinary system
• Sexual activity

Some people with autonomic dysfunction have problems with several bodily systems, while others primarily have problems with:

• Breakdown
• Heart rate
• Regulation of temperature

What signs of autonomic failure are there?

Orthostatic hypotension is the most common sign of autonomic failure. When you stand up, this can make you feel dizzy and/or lightheaded.

Multiple organ systems may be affected by PAF. Other PAF symptoms might include:

• Sweating too much (hyperhidrosis) or too little (anhidrosis).
• Having problems with the proper dilation and constriction of your pupils, which can lead to blurry vision.
• Urinary retention, or inability to fully empty your bladder.
• Incontinence, or loss of bladder control.
• Loss of control over one's bowels (faecal incontinence) or constipation.
• Sexual dysfunction, such as anorgasmia or erectile dysfunction.
• Orthostatic hypotension may precede or follow these symptoms. Mild anaemia is also present in almost half of autonomic failure patients.

What causes autonomic failure?

Pure autonomic failure is due to the aberrant accumulation of a protein called alpha-synuclein in autonomic neurones.

On either side of your spinal cord or next to organs, the affected nerve cells are grouped together (referred to as autonomic ganglia). These nerve cells become fewer in number over time, leading to autonomic dysfunctions. PAF does not harm your brain or spinal cord, nor does it impact any other nerves. The cause of alpha-synuclein accumulation and the protein's function are both unknown to researchers.

If you have Lewy body dementia, multiple system atrophy, or Parkinson's disease, your brain also accumulates alpha-synuclein. One of these disorders eventually develops in some, but not all, individuals with pure autonomic failure.

How is autonomic failure diagnosed?

To diagnose pure autonomic failure, other conditions that cause orthostatic hypotension must be excluded.

Your doctor will first:

• Ask you for your medical history and symptoms.
• Conduct a neurological and physical examination.

They will then likely recommend some tests. These may include:

• Tilt table test: This test measures the response of your blood pressure when you stand up from lying down.
• Quantitative sudomotor axon reflex test or QSART: This is the exam where the nerves controlling sweat are tested. A QSART could be used to diagnose peripheral neuropathies, diseases related to the autonomic nervous system, and a few pain syndromes.
• Imaging tests: Brain MRI scans and cardiac functional imaging might help rule out further diseases.
• Laboratory tests: A PAF diagnosis is supported by low blood and urine levels of norepinephrine when you are lying down, with little or no increase in the levels when you stand.
• Thermoregulatory sweat test: In a room where the humidity, temperature, and airflow are controlled, sweating is measured. The providers do not commonly use this test.

How is autonomic failure managed?

Because autonomic failure has no cure, its symptoms must be kept under control. You and your healthcare team can work together on a plan particular to your needs and goals.

Caring for orthostatic hypotension

Your doctor may recommend many strategies for controlling orthostatic hypotension.

Non-medical strategies include:

• Getting up very slowly from the seated or reclined position.
• Hydration should be enhanced. Providers may recommend three liters of water per day.
• You can use electrolyte-replacement drinks or increase your intake of salt.
• To lie on an incline, elevate the head of your bed by four to six inches.
• Wearing compression clothing that is waist- or thigh-high.

Orthostatic hypotension may also be treated with several prescription drugs.

Care for intestinal problems

If your constipation doesn't go away, your doctor might advise taking stool softeners and consuming foods high in fibre. You might have to use enemas.

Your treatment options include:

• Dietary adjustments.
• Bowel exercises.
• Drugs like diphenoxylate and loperamide.
• Surgery, such as colostomy or sacral nerve stimulation.

Taking care of urinary problems

Your doctor may recommend a Foley catheter to drain your bladder if you have urine retention. Some medications, like bethanechol, may also be beneficial.

The following drugs can treat an overactive bladder, or urine incontinence:

A catheter may be a better option if medication is not effective.

Managing sexual dysfunction

Tadalafil and sildenafil are some of the drugs that can be used to assist with erectile dysfunction. However, some drugs might worsen orthostatic hypotension.

This could be very daunting going through the testing procedure. Be aware that the best care is determined by the right diagnosis.

Can autonomic failure be prevented?

Autonomic failure cannot be stopped. Scientists do not know what causes alpha-synuclein to collect in autonomic nerves in autonomic failure.

When should I come to see my doctor?

If you have pure autonomic failure, you will need to see your doctor regularly so that you can be monitored as to the progression of autonomic failure and whether or not your treatment is working.

View a doctor right away if you begin to display signs of multiple system atrophy, Parkinson's disease, or Lewy body dementia.

What questions about autonomic failure should I ask my doctor?

You might want to ask your doctor the following questions if you have autonomic failure:

• What treatments would you recommend?
• How can I manage autonomic failure at home?
• How fast will autonomic failure progress?
• What other symptoms and signs should I be aware of?
• How likely am I to get multiple system atrophy, Parkinson's disease, or Lewy body dementia?
• How often do I need to see my doctor?

Why Tender Palm Super-Speciality Hospital for autonomic failure?

Tender Palm Hospital, owned by doctors, is renowned for attracting the most experienced professional in the country. With the finest neurologist and neurosurgeons specialized in autonomic failure. Tender Palm stands out as the premier Neurology hospital in Lucknow, India. Boasting cutting-edge infrastructure and advanced technology, Tender Palm ensures top-notch medical care for its patients.

To seek an expert consultation for any Neurology condition

Call us at +91-9076972161
Email at care@tenderpalm.com

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