Dysautonomia is defined as malfunction of the autonomic nervous system. This system regulates the unconscious function of our body including the heart, gastrointestinal tract, bladder and endocrine systems.
An unbalanced autonomic nervous system can cause multiple symptoms from mild to severe in intensity.
Developmental dysautonomia is not a secondary type of autonomic dysfunction. It usually manifests in the early teen years with a 5:1 ratio female/male. The age for peak symptoms is 16 years of age.
In many cases the exact cause for the dysautonomia remains unknown. Dysautonomia may be primary or secondary. Conditions such as Multiple Sclerosis, Parkinson?s, Diabetes, alcoholism, Guillian-Barre syndrome, Multiple System Atrophy, Familiar Dysautonomia and even prolonged bed rest may produce this condition. Genetic testing is being performed in selected tertiary centers.
Symptoms depend on the type of dysautonomia. The most common symptoms are lightheadedness, palpitations, dizziness, syncope and fatigue. Orthostatic intolerance is the hallmark of dysautonomia. Patients may develop dizziness after standing for about 3-10 minutes. In addition, their blood pressure may drop significantly. This is usually accompanied by an increased heart rate. Symptoms may be serious enough that the patient may miss several school days. In addition, they may complain of exercise intolerance, vertigo, nausea or upset stomach, frequent urination, visual blurring, head migraines, insomnia and temperature regulation problems. Many patients complain of brain fog, visual blurring, anxiety and tremulousness. Their hands may be cold and sweaty and their lips may look pale.
A thorough medical history and examination by a physician knowledgeable in this area is the first step to take. Dr. Villafa?e has been treating children, adolescents and young adults with dysautonomia for over 15 years. He feels that history-taking is essential to the diagnosis as there are other conditions such as Chronic Fatigue Syndrome and Fibromyalgia which may be confused with Dysautonomia. Part of the evaluation includes an electrocardiogram, echocardiogram and vital signs in the supine and standing position.
Tilt table testing is helpful in clarifying the diagnosis. This test evaluates how the patient responds to changes in body position. We monitor the heart rate and blood pressure response to positional stress. Patients with postural orthostatic tachycardia syndrome (POTS) have a typical response to tilt table testing with sinus tachycardia.
Blood testing is also performed as part of the evaluation as it may help to rule out other conditions such as Lupus, Thyroid disorders, Mononucleosis, Anemia, etc. Some patients with Dysautonomia may have abnormal elevation of the norepinephrine levels.
Optimal fluid intake of about 2-2.5 liters per day (in adolescents), along with an increased sodium intake, in patients with low to normal blood pressures, is recommended. Various medications may be necessary to help relieve symptoms. This may include volume expanders, blood pressure regulators and others.
Gentle reconditioning and exercises such as walking and swimming may be helpful. Patients usually start by exercising 20-30 minutes 3 times a week and gradually increasing it up to 35-60 minutes on weekdays. Some exposure to sunlight may help uplift the patient's mood. Patients should refrain from alcohol consumption.
There is limited data on the outcome of patients afflicted with Dysautonomia. Over 80% of patients will have improvement in their symptoms by 19-24 years of age. Patients who do not fully recover will often see a significant improvement in their symptoms. Patients may experience exacerbation of symptoms, especially during the winter months and at various times throughout their life.
The patient with Dysautonomia is encouraged to share their symptoms with the immediate family and friends. In addition, they may contact other children, adolescents and young adults with similar symptoms. A support group is very helpful as many patients struggle with some of the most basic functions that healthy people may take for granted, beginning with getting out of bed in the morning. Unfortunately, Dysautonomia brings plenty of frustration to the patient, family and physicians involved. Understanding and good communication is essential in all that are involved.
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