Dysautonomia: When the Autonomic Nervous System or Body’s Autopilot Fails

The Autonomic Nervous System is the body’s “autopilot,” innervating and managing most bodily systems, including the cardiovascular, gastrointestinal, urinary, temperature regulation, sex organs (in both genders), and metabolic and endocrine systems.(1) We are not aware of these actions or responses as they are constantly carried out through autonomic nerves, bringing forth appropriate action – and reaction – of the various systems it controls. Comprised of the antagonistic sympathetic and parasympathetic systems, the ANS controls functions as simple as stimulating saliva production to speeding up heart rate.

Under the control of the sympathetic system, the body responds with the appropriate actions and energies needed to deal with stress, fear or extreme physical activity (“flight, fright or fight”). The sympathetic system raises the blood pressure, speeds up the heart rate, and increases the blood supply to the skeletal muscles; dilates both the pupils and bronchioles to provide improved vision and oxygenation; inhibits urination and bowel function; and generates energy by stimulating the liver and fatty tissues. Conversely, the parasympathetic system is responsible for resting the body. This system lowers the heart rate and blood pressure; diverts blood back from the skeletal muscles to the skin and gastrointestinal tract; contracts the pupils and bronchioles; restores urination; stimulates saliva secretion; and restores peristaltic function.(2)

When part of the ANS dysregulates or fails, Dysautonomia results.

Characterized in the 19th and early 20th centuries as “neurasthenia”(3), Dysautonomia is classified in two categories: primary (such as with Orthostatic Intolerance conditions) and secondary, or acquired (as with Diabetes Mellitus or cardiac conditions like Mitral Valve Prolapse).(4) According to the National Institute of Neurological Disorders & Stroke, Dysautonomia “can be local, as with Reflex Sympathetic Dystrophy, or generalized, as in pure autonomic failure. It can be acute and reversible, as in Guillain-Barre syndrome, or chronic and progressive. Several common conditions such as Diabetes and alcoholism can include Dysautonomia. Dysautonomia also can occur as a primary condition or in association with degenerative neurological diseases such as Parkinson’s disease.”(5) Some patients can inherit the propensity to develop Dysautonomia, as it tends to run in families. The disorder can also be triggered by viral illness, exposure to chemicals, and various types of trauma.(6) There is no cure for Dysautonomia.(7 )

Symptoms include general malaise, syncope, excessive fatigue, panic attacks, abnormally rapid beating of the heart (tachycardia), bradycardia (an abnormally slow or unsteady heart rhythm), low blood pressure, frequent urination, irritable bowel syndrome, hyperhidrosis (excessive sweating) and intolerance to heat, numbness and tingling, anxiety, depression and sexual dysfunction in both genders. Symptoms of ANS dysfunction are physiological – not psychological (“in your head”) – and appropriate treatment is warranted in patients with the disorder.

Combined with symptom presentation, clinical workup for Dysautonomia should also include quantitative assessment of the ANS based on heart rate variability (HRV) analysis, the gold standard for characterizing ANS dysfunction. Autonomic function tests directly estimate the extent of involvement of the sympathetic and parasympathetic divisions.(8) Characterized as the beat-to-beat change in heart rate, HRV has long been heralded as an accurate indicator of ANS activity by providing a picture of the interplay between the sympathetic and parasympathetic branches.[9]

While there is no cure for Dysautonomia, there are various treatments dependent upon the patient and his or her underlying condition. Therapies range from non-drug treatment like low-impact exercise, which helps to even out the ANS, to prescription drugs such as tricyclic anti-depressants and anti-anxiety drugs. If necessary, anti-low blood pressure drugs like Fludrocortisone may also be prescribed to certain patients. Over-the-counter medications such as NSAIDs (non-steroidal anti-inflammatory drugs like as Motrin) may also help to alleviate some of the pain associated with Dysautonomia.

Autonomic Nervous System dysfunction can have a massive and often debilitating impact on the lives of patients affected by the disorder. If you or someone you love suffers from Dysautonomia, be sure to obtain guidance and information from a qualified physician. Patients should also seek support from one of the various organizations founded to assist those suffering from Dysautonomia.

References:
1, 4-National Dysautonomia Research Foundation. “What is Dysautonomia?” Online: http://www.ndrf.org. Accessed June 20, 2005.
2-Millar N., White, I. “The Human Nervous System.” Online: http://www.biologymad.com/NervousSystem/nervoussystemintro.htm. Accessed June 16, 2005.
3, 6-Fogoros, Richard N., M.D. “Dysautonomia.” Online: http://heartdisease.about.com/cs/womensissues/a/dysautonomia_2.htm. Accessed June 20, 2005.
5, 7-National Institute of Neurological Disorders & Stroke. Publication: “NINDS Dysautonomia Information.” Online: http://www.ninds.nih.gov/disorders/dysautonomia/dysautonomia.htm. Accessed June 20, 2005.
8-Chelimsky, Thomas, MD, Director, Autonomic Laboratory at University Hospitals of Cleveland. “Autonomic Testing: Clinical Information.” Online: http://mediswww.meds.cwru.edu/dept/autonomic/ANSTEST/BROCHUR.HTML. Accessed June 14, 2005.
9-Duke University Medical Center Psychiatry & Behavioral Sciences. Publication: “Heart Rate Variability.” Online: http://psychiatry.mc.duke.edu/behcard/Clinical.html. Accessed: June 11, 2005.

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