Autonomic dysfunction

Dysautonomia is any disease or malfunction of the autonomic nervous system. This includes postural orthostatic tachycardia syndrome (POTS), neurocardiogenic syncope, mitral valve prolapse dysautonomia, pure autonomic failure, multiple system atrophy (Shy-Drager syndrome), and a number of lesser-known disorders. more...

In some cases, dysautonomia results in a reduction in the ability of the heart and circulatory system to compensate for changes in posture, causing dizziness or syncope (fainting) when one, eg, stands suddenly. In other cases, the heart may race (tachycardia) for no apparent reason, or the kidneys may fail to properly retain water (diabetes insipidus).

The effects of dysautonomia may be minor, only limiting the patient's activities slightly, or they may be totally disabling, leaving the patient bedridden. Chronic fatigue syndrome is often associated with dysautonomia.

History

In the nineteenth and earlier twentieth centuries, a diagnosis that was almost solely given to women was called "neurasthenia," or a "weak nervous system." These women would present symptoms of fatigue, weakness, dizziness and fainting, and the doctor's orders would simply be bed rest. Some of these women died, while many others recovered. No one understood where the problems came from.

Nowadays, diagnostic criteria and treatment for various forms of dysautonomia have sharpened, and doctors have realized that some men have it, too.

Treatment

There is no cure for dysautonomia. Secondary forms may improve with treatment of the underlying disease. In many cases treatment of primary dysautonomia is symptomatic and supportive. Measures to combat orthostatic hypotension include elevation of the head of the bed, frequent small meals, a high-salt diet, and drugs such as fludrocortisone, midodrine, and ephedrine.

Prognosis

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

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