Dysautonomia or autonomous dysfunction is a condition in which the autonomic nervous system (ANS) is not functioning properly. this can affect the function of the heart, bladder, intestines, sweat glands, pupils and blood vessels. Dysautonomia has many causes, not all of which can be classified as neuropathic. [5] a number of disorders can have dysautonomia, such as. B. Parkinson’s disease, multisystem atrophy, and dementia with lewy bodies. [6] ehlers-danlos syndrome, [7] autoimmune autonomic ganglionopathy and autonomic neuropathy, [8] HIV/AIDS, [9] autonomic failure and postural orthostatic tachycardia syndrome.
Diagnosis is made by functional testing of the ANS with focus on the affected organ system. Investigations can 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 treated directly. [10]
Table of Contents
Signs and symptoms[ edit ]
The symptoms of dysautonomia, which are numerous and vary widely from individual to individual, are due to inefficient or imbalanced efferent signals sent through both systems. [ medical citation needed ] are among the primary symptoms in individuals with dysautonomia:
Dysautonomia can be due to inherited or degenerative neurological diseases (primary dysautonomia) [5] or it can occur due to injury to the autonomic nervous system from an acquired disease (secondary dysautonomia). [1] [12] the most common causes of dysautonomia include
In the sympathetic nervous system (SNS), predominant dysautonomia is common along with fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis, raising the possibility that such dysautonomia may be its common underlying pathogenesis. [17]
In addition to sometimes being a symptom of dysautonomia, anxiety can sometimes physically exhibit symptoms that resemble autonomic dysfunction. [18] [19] [20] thorough investigation to rule out physiological causes is critical, but in cases where relevant testing is performed and no causes are found or symptoms are not consistent with known disorders, a primary anxiety disorder is possible but should not be suspected. [21] in such patients, the anxiety sensitivity index may be more predictive of anxiety disorders, while the beck anxiety inventory may falsely suggest anxiety in patients with dysautonomia. [22]
Mechanism[ edit ]
The autonomic nervous system is a component of the peripheral nervous system and consists of two branches: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PSNS). The SNS controls the more active responses such as the increase in heart rate and blood pressure. The PSNS slows the heart rate and helps with digestion, for example. Symptoms typically arise from abnormal responses of either the sympathetic or parasympathetic systems, depending on the situation or environment. [5] [23] [16]
Diagnosis[ edit ]
Diagnosis of dysautonomia depends on the overall function of three autonomic functions – cardiovagal, adrenergic, and sudomotor. At a minimum, a diagnosis should include measurement of blood pressure and heart rate while lying down and after standing for at least 3 minutes. The best way to make a diagnosis involves a series of tests, specifically an autonomic reflex screen, a tilt table test, and a sudomotor response test (ESC, QSART, or thermoregulatory sweat test). [24]
Additional tests and examinations to establish a dysautonomia diagnosis include
Tests to clarify the cause of dysautonomia may include:
Vegetative vascular dystonia[ edit ]
Especially in the Russian literature [25] a subtype of dysautonomia that particularly affects the vascular system is called vegetative-vascular dystonia. [26] the term "vegetative" reflects an older name for the autonomic nervous system: the vegetative nervous system. [ citation needed ]
A similar form of this disruption has been seen in the past in various wars, such as the Crimean and American civil wars, and among British troops colonizing india dacosta. [27]
Administration [ edit ]
Treatment of dysautonomia can be difficult; because it involves many different symptoms, a combination of drug therapies is often needed to treat individual symptomatic complaints. Therefore, if autoimmune neuropathy is present, immunomodulatory therapies are used to treat it, or if diabetes mellitus is the cause, controlling blood glucose is important. [1] treatment may include proton pump inhibitors and H2 receptor antagonists used for digestive symptoms such as acid reflux. [28]
For the treatment of urogenital autonomic neuropathy, medications may include sildenafil (a guanine monophosphate type 5 phosphodiesterase inhibitor). For the treatment of hyperhidrosis can be used anticholinergics such as trihexyphenidyl or scopolamine, in some cases, intracutaneous injection of botulinum toxin type A can also be used for treatment. [29]
Balloon angioplasty, a procedure called transvascular autonomic modulation, is specifically not approved for the treatment of autonomic dysfunction. [30]
Prognosis[ edit ]
the prognosis of dysautonomia depends on several factors; persons with chronic, progressive, generalized dysautonomia in the context of central nervous system degeneration such as parkinson’s disease or multiple systematrophy generally have a poorer long-term prognosis. Consequently, dysautonomia due to pneumonia, acute respiratory failure or sudden cardiopulmonary arrest can be fatal. [5]
Autonomic dysfunction symptoms such as orthostatic hypotension, gastroparesis and gustatory sweating are found more frequently in deaths. [31]