| Dysautonomia | |
|---|---|
| Classification and external resources | |
| ICD-10 | G90 |
| ICD-9 | 337.9 |
| MeSH | D001342 |
Dysautonomia (autonomic dysfunction) is a broad term that describes any disease or malfunction of the autonomic nervous system. This includes postural orthostatic tachycardia syndrome (POTS), inappropriate sinus tachycardia (IST), vasovagal syncope, pure autonomic failure, neurocardiogenic syncope (NCS), neurally mediated hypotension (NMH), orthostatic hypertension, autonomic instability and a number of lesser-known disorders such as cerebral salt-wasting syndrome. Dysautonomia is associated with multiple system atrophy (Shy-Drager syndrome), Ehlers-Danlos syndrome (EDS), and Marfan syndrome for reasons that are not fully understood.
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Symptoms of dysautonomia are numerous and vary widely from person to person. Since dysautonomia is a full-body condition, a large number of symptoms may be present that can greatly alter a person's quality of life. Each patient with dysautonomia is different—some are affected only mildly. while others are left completely bed-ridden and disabled.
The primary symptoms that present in patients with dysautonomia are:
Other symptoms frequently associated with dysautonomia include: headaches, pallor, malaise, facial flushing, salt cravings, mydriasis (abnormal dilation of the pupils), constipation, diarrhea, nausea, acid reflux, visual disturbances, orthostatic hypotension, numbness, nerve pain, trouble breathing, chest pains, in some cases loss of consciousness and seizures.[1] Dysautonomia can also present with orthostatic hypertension.[2] A full list of symptoms may be found at the Dysautonomia Information Network.[3]
Causes of dysautonomias are not fully understood, but they are thought to include:
In some cases, a cardiac ablation procedure can be performed to stop the heart symptoms completely. It is not recommended in POTS patients, and can in fact worsen tachycardia.[9] Medications are also used to stabilize the condition on a long-term basis. Benzodiazepines can be used for some of the physical problems such as anxiety. In many cases treatment of primary dysautonomia is symptomatic and supportive. Measures to combat orthostatic intolerance include elevation of the head of the bed, frequent small meals, a high-salt diet, fluid intake, and compression stockings. Drugs such as fludrocortisone, midodrine, ephedrine and SSRIs can also be used to treat symptoms. Treating dysautonomia can be difficult and usually requires a combination of drug therapies.
The outlook for patients with dysautonomia depends on the particular diagnostic category. There is no way of predicting whether symptoms of dysautonomia will resolve over time, or continue over the entire course of one's lifespan. Some forms of dysautonomia are not life threatening, even if life-changing in the form of minor to major limitations in activities of daily living. However patients with Ehlers-Danlos Syndrome, Marfan Syndrome or Parkinson's disease have a chronic, progressive, generalized form of dysautonomia in the setting of central nervous system degeneration, leading to a generally poor long-term prognosis. Patients can die from pneumonia, acute respiratory failure, or sudden cardiopulmonary arrest.[10]
In the nineteenth and earlier twentieth centuries, a diagnosis that was almost solely given to women was "neurasthenia," or a "weak nervous system." (During World War I, doctors began to apply it to men exhibiting symptoms of what is now called post-traumatic stress disorder.) Women would present with 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.
With advances in modern medicine, diagnostic criteria and treatment for various forms of dysautonomia have sharpened. Doctors and researchers are including males in their subject population for this disorder.
The prototype of dysautonomia is the ancient scourge of beriberi, a nutritional deficiency disease due to excess of simple carbohydrate and concomitant vitamin B1 deficiency. In the early stages, this results in loss of functional efficiency in the central control mechanisms of the autonomic nervous system. If the nutritional deficiency continues, there is gradual degeneration of the system. Other vitamin deficiencies have been implicated in causing dysautonomia and, unlike the genetically determined forms of the disease, they are treatable.[11]
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