Dysautonomia

• Article
• 2021-03-02

Dysautonomia refers to a disorder of autonomic nervous system (ANS) function that typically involves failure of the sympathetic or parasympathetic components of the ANS, but dysautonomia with excessive or overactive ANS actions may also occur. Dysautonomia can be local, as with sympathetic reflex dystrophy, or generalized, as with pure autonomic failure. It can be acute and reversible, such as in Guillain-Barre syndrome, or chronic and progressive. Several common conditions, such as diabetes and alcoholism, can include dysautonomia. Dysautonomia can also occur as a primary condition or in conjunction with degenerative neurological conditions such as Parkinson's disease. Other diseases with generalized primary dysautonomia include multiple system atrophy and familial dysautonomia. Characteristics of generalized dysautonomia due to sympathetic failure are impotence (in men) and a drop in blood pressure while standing (orthostatic hypotension). Excessive sympathetic activity can manifest itself in hypertension or a rapid pulse.

Therapy

There is usually no cure for dysautonomia. Secondary forms may improve in the treatment of the underlying disease. In many cases, treatment of primary dysautonomia is symptomatic and supportive. Measures to combat postural hypotension include raising the head of the bed, water bolus (rapid infusion of water administered intravenously), a high-salt diet, and drugs such as fludrocortisone and midodrine.

Prognosis

The outlook for individuals with dysautonomia depends on the specific diagnostic category. People with chronic, progressive, generalized dysautonomia in the setting of central nervous system degeneration generally have a poor long-term prognosis. Death can occur from pneumonia, acute respiratory failure, or sudden cardiac arrest.

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