autonomic dysfunction and its causes and its clinical features

1. AUTONOMIC
DYSFUNCTION

2. Name of the disease & terminologies
Etiology
History, signs and symptoms
Physical examination
Investigation
Treatment according to allopathic medicine
Other therapies
Yoga practices
Books and journals for reference

3.  Dysfunction of the autonomic nervous system
(ANS) is known as dysautonomia.
 The autonomic nervous system regulates
unconscious body functions, including heart
rate, blood pressure, temperature regulation,
gastrointestinal secretion, and metabolic and
endocrine responses to stress such as the "fight
or flight" syndrome.
 As regulating these functions involves various
and multiple organ systems, dysfunctions of the
autonomic nervous systems encompass various
and multiple disorders.
DEFINITION

6.  The autonomic nervous system consists of three
subsystems:
 The sympathetic nervous system,
 The parasympathetic nervous system and
 The enteric nervous system.
 The ANS regulates the activities of cardiac
muscle, smooth muscle, endocrine glands, and
exocrine glands.
 The autonomic nervous system functions
involuntarily (reflexively) in an automatic
manner without conscious control.
DESCRIPTION

7.  The autonomic nervous system achieves this
control via two divisions:
 The sympathetic nervous system and
 The parasympathetic nervous system.
 Dysfunctions of the autonomic nervous system
are recognized by the symptoms that result from
failure of the sympathetic or parasympathetic
components of the ANS.
 Primary dysautonomias include multiple system
atrophy (MSA) and familial dysautonomia.
 The dysfunction can be extensive and manifest
as a general autonomic failure or can be confined
to a more localized reflex dysfunction.

8.  With multiple system atrophy, a generalized
autonomic failure, male patients experience
urinary retention or incontinence and impotence
(an inability to achieve or maintain a penile
erection).
 Both males and females experience ataxia (lack of
muscle coordination) and a dramatic decline in
blood pressure when they attempt to stand
(orthostatic hypotension).
 Symptoms similar to Parkinson's disease may
develop, such as slow movement, tremors, and
stiff muscles.
 Visual disturbances, sleep disturbances, and
decreased sweating may also occur.

9.  Persons with autonomic dysfunction who do
not exhibit the classical symptoms of
orthostatic hypotension may exhibit a less
dramatic dysfunction termed orthostatic
intolerance.
 These patients experience a milder fall in blood
pressure when attempting to stand.
 However, because the patients have an
increased heart rate when standing, they are
described as having postural tachycardia
syndrome (POTS).

10.  Although not as prevalent in the general
population as hypertension, orthostatic
intolerance is the second most common
disorder of blood pressure regulation and is the
most prevalent autonomic dysfunction.
 Orthostatic hypotension and orthostatic
intolerance can result in a wide array of
disabilities.

11.  Common orthostatic intolerance syndromes
include:
 Hyperadrenergic orthostatic hypotension (partial
dysautonomia);
 Orthostatic tachycardia syndrome (sympathicotonic
orthostatic hypotension);
 Postural orthostatic tachycardia syndrome (mitral
valve prolapse syndrome);
 Postural tachycardia syndrome (soldier's heart);
 Hyperadrenergic postural hypotension
(vasoregulatory asthenia);
 Sympathotonic orthostatic hypotension
(neurocirculatory asthenia);
 Hyperdynamic beta-adrenergic state (irritable heart
syndrome); And
 Idiopathic hypovolemia (orthostatic anemia).

12.  Milder forms of autonomic dysfunction such as
orthostatic intolerance affect an estimated
500,000 people in the United States.
 Orthostatic intolerance more frequently affects
women; female-to-male ratio is at least 4:1.
 It is most common in people less than 35 years
of age.
 More severe forms of dysautonomia such as
multiple system atrophy often occur later in life
(average age of onset 60 years) and affect men
four times as often as women.
DEMOGRAPHICS

13.  Symptoms of the autonomic dysfunction of
orthostatic intolerance include lightheadedness,
palpitations, weakness, and tremors when
attempting to assume an upright posture.
 Less frequently, patients experience visual
disturbances, throbbing headaches, and often
complain of fatigue and poor concentration.
 Some patients report fainting when attempting
to stand.
 The cause of lightheadedness, fainting, and
similar symptoms is a lack of adequate blood
pressure in the cerebral circulatory system.
CAUSES AND SYMPTOMS

14.  In addition to orthostatic hypotension and
Parkinson-type symptoms, persons with
multiple systems atrophy may have difficulty
articulating speech, sleep apnea and snoring,
pain in the back of the neck, and fatigue.
 Eventually, cognitive (mental reasoning) ability
declines in about 20% of cases.
 Multiple systems atrophy occurs sporadically
and the cause is unknown.

15.  Diagnosis of orthostatic intolerance is made
when a patient experiences a decrease of blood
pressure (not exceeding 20/10 mm Hg) when
attempting to stand and a heart rate increase of
less than 30 beats per minute.
 Diagnosis of other types of dysautonomia is
difficult, as the disorders are varied and mimic
other diseases of the nervous system.
 As Parkinsonism (slowed movement, rigidity)
is the most frequent motor deficit seen in
multiple systems atrophy, it is often
misdiagnosed as Parkinson's disease.
DIAGNOSIS

16.  Magnetic resonance imaging (MRI) of the brain
can sometimes detect abnormalities of striatum,
cerebellum, and brainstem associated with
multiple systems atrophy.
 A test with the drug clonidine has also been
used to differentiate Parkinson's disease from
multiple systems atrophy, as certain hormone
levels in the blood will increase in persons with
Parkinson's disease after clonidine
administration, but not in persons with multiple
systems atrophy.

17.  Symptoms such as severe dysarthria (difficulty
articulating speech) and stridor (noisy inspiration)
alert the physician to the possibility of multiple
systems atrophy, as they occur in the disorder, but
are rare in Parkinson's disease.
 No test can diagnose multiple system atrophy.
 A neurologist makes the diagnosis based on the
history of symptoms, a physical examination and
by ruling out other causes.
 Tests that may help confirm the diagnosis include
checking plasma norepinephrine levels and
breakdown, and an MRI (magnetic resonance
imaging) of the head to rule out other causes.

18.  Parkinsonism (tremors, muscle rigidity)
 Cerebellar or corticospinal signs (balance and
movement difficulties)
 Orthostatic hypotension (drops in blood
pressure when body position changes, leading
to dizziness, headache, clouding of vision, or
fainting)
 Impotence
 Urinary incontinence or retention, usually
preceding or within two years after the onset of
the motor symptoms
SYMPTOMS

19.  Reduced sweating, leading to heat intolerance
 Double vision or other vision problems
 Speech problems
 Difficulty swallowing
 Difficulty breathing

20.  At present there is no cure for severe autonomic
dysfunction.
 The goal of treatment is to make the patient
more comfortable and preserve bodily
functions as long as possible.
 The fluctuating blood pressure that is a
hallmark of the disorder can make the condition
difficult to treat, but medications can be used to
control some symptoms.
 Dietary changes, such as increasing salt and
fluid intake, may help elevate blood pressure.
TREATMENT

21.  A breathing or feeding tube may have to be
surgically inserted to manage swallowing and
breathing difficulties.
 Treatment is centered on the remediation of
symptoms, patient support, and the treatment of
underlying diseases and disorders in cases of
secondary autonomic dysfunction.
 In many cases, cure or an improvement in the
underlying disease or disorder improves the
patient prognosis with regard to remediation of
autonomic dysfunction symptoms.

22.  With regard to orthostatic hypotension, drug
treatment includes fludrocortisone, ephedrine,
or midodrine.
 Medications are accompanied by postural relief
such as elevation of the bed at the head and by
dietary modifications to provide some relief for
the symptoms of dizziness and tunnel vision.
 In multiple systems atrophy, anti-Parkinson
medications such as Sinemet often help with
some of the symptoms of muscle rigidity and
tremor, and create an overall feeling of well-
being.

23.  Medications used in the treatment of orthostatic
hypotension tend to not perform as well in this
group; although they elevate the blood pressure
while standing, they decrease the blood
pressure while reclining.

25.  Recovery from some dysautonomias can be
complicated by secondary conditions such as
alcoholism, diabetes, or Parkinson's disease.
 Some conditions improve with treatment of the
underlying disease, while only halting of the
progression of symptoms is accomplished in
others.
 Some mild dysautonomias stabilize and, with
treatment, cause few limitations to daily
activities.
RECOVERY AND REHABILITATION

26.  Overall, as there are no cures for most severe or
progressive dysautonomias, the emphasis is
instead placed upon maintaining mobility and
function for as long as possible.
 Aids for walking and reaching, positioning
devices, and strategies for maintaining posture,
balance, and blood pressure while rising can be
provided by physical and occupational
therapists.
 Speech and nutritional therapists can devise
diets and safe strategies for eating, and
recommend tube feedings if necessary.

27.  The prognosis for persons suffering autonomic
dysfunction is variable and depends on specific
dysfunction and on the severity of the
dysfunction.
 Autonomic dysfunctions can present as acute and
reversible syndrome can present in more chronic
and progressive forms.
 Persons with orthostatic intolerance can usually
maintain a normal lifespan and active lifestyle
with treatment and minimal coping measures,
while persons with multiple systems atrophy
usually have a lifespan of about 5–7 years after
diagnosis.
PROGNOSIS

28.  Homeopathy
 Ayurvedic
 Herbs
 Naturopathy
 Diet
 Reiki
 Acupuncture
 Cognitive therapy
OTHER THERAPIES

29. YOGA PRACTICES
YOGA IS BALANCE (SAMATVAM)
I T CORRECTS IMBALANCES
AIMS :
• STRESS REDUCTION
• RELIEF OF PAIN
• MEDICATION REDUCTION