eMedicine Specialties > Neurology > Neuromuscular Diseases

Autonomic Neuropathy: Follow-up

Author: Steven D Arbogast, DO, Fellow, Neuromuscular Medicine, University Hospitals Case Medical Center, Cleveland
Coauthor(s): J Douglas Miles, MD, PhD, Clinical Instructor of Neuromuscular Medicine, Case Western Reserve University School of Medicine; Bashar Katirji, MD, FACP, Director, Neuromuscular Center and EMG Laboratory, The Neurological Institute, University Hospitals Case Medical Center; Professor of Neurology, Case Western Reserve University School of Medicine
Contributor Information and Disclosures

Updated: Jun 25, 2009

Follow-up

Deterrence/Prevention

Maneuvers to avoid complications of orthostatic hypotension, particularly falls in elderly patients, as described above, are important to avoid further associated morbidity.

Bladder and gastrointestinal difficulties must be monitored to prevent anuria and bowel obstruction.

Patients with hypohidrosis/anhidrosis must be cautious in warm climates to avoid excessive heat, preventing heat stroke.

Foot care is essential in patients with small-fiber neuropathy and diabetic neuropathy. Patients should be instructed to test temperatures with a sensitive limb and to avoid trauma that could have ulcerative complications.

Patients with dry mouth should be instructed to seek regular dental checkups and be instructed about proper methods of oral hygiene.

Patients with dry eyes should be given advice regarding proper hydration of the eyes to avoid conjunctival difficulties.

Complications

Many complications of autonomic neuropathy exist, as described above. The most severe are cardiac arrest, cardiac dysrhythmia, blood pressure fluctuations, and risk of cerebral and cardiac ischemia

Prognosis

The prognosis depends on the particular syndrome causing autonomic neuropathy. In many cases, the course is gradually progressive in nature. In specific cases, the prognosis may be improved by controlling diabetes mellitus, limiting alcohol intake, and treating correctable syndromes or diseases as applicable to prevent progression. In the case of acute autonomic neuropathies, such as acute pandysautonomia and GBS, the prognosis is often good after resolution of the acute illness.

Patient Education

Patient education begins in the primary care office or with the neurologist as a consultant. Discussion of the following simple questions should be encouraged:

What is autonomic neuropathy?

 Autonomic neuropathy is damage to nerves controlling many everyday body activities. It can be caused by a number of different diseases, each of which affects the nerves forming the autonomic nervous system. Some of the functions regulated by the autonomic nervous system are control of heart rate, blood pressure, digestion, bladder function, bowel function, sweating, and even breathing. These are unconscious vital functions important to the body.

How does it occur?
Different diseases may damage the nervous system, which includes the autonomic nervous system. The most common of these diseases is probably diabetes mellitus, but other diseases of nerves can do this as well.

What are the symptoms?

  • Lightheadedness and low blood pressure upon rising, which can lead to unconsciousness in severe cases
  • Heart-rate variability
  • Heart-rhythm variability with irregular beats
  • Lack of tears within the eyes
  • Lack of saliva
  • Feeling full earlier than expected with a meal
  • Nausea and vomiting
  • Problems with swallowing
  • Constipation, which if severe can result in bowel obstruction
  • Diarrhea
  • Incontinence of bladder and bowel functions
  • Urgency of bladder (rushing to the bathroom)
  • Problems with penile erection
  • Lack of sweating

How is it treated?

 In many cases, no specific treatment is available for autonomic neuropathy. In some cases, such as with diabetes mellitus, the best approach is to control the diabetes to prevent progression. In mild cases, changes in diet, sleeping position, and nonmedicinal changes can help some patients. In more severe cases, drugs can be used to maintain blood pressure to prevent fainting. Medications can help with bladder function and erectile function.

How can a patient take care of him or herself?

  • Avoid rising too quickly.
  • Drink water regularly if standing blood pressure falls too much.
  • Follow physician guidelines about how to treat specific symptoms.
  • Avoid excessive alcohol intake, which may reduce blood pressure and lead to a neuropathy, which can worsen the autonomic problems.
  • Men who have trouble having erections should talk to their health care providers. Medications such as sildenafil, tadalafil, or vardenafil can help a man achieve and maintain an erection. In some cases, prosthetic devices or other devices to assist in erection may be useful.

How long will the effects last?

 In most cases, autonomic neuropathy is permanent. It may become worse as the disease progresses. The goal of treatment is to relieve symptoms of the disease, or to prevent disease progression when possible.

Where can further information be obtained?

Miscellaneous

Medicolegal Pitfalls

  • Management of autonomic neuropathy should start from the initial diagnosis. The primary care physician should be responsible for educating patients about possible complications.
  • Failure to diagnose autonomic neuropathy can lead to complications such as injuries from fainting, cardiac arrest, and severe bladder and bowel problems.
  • Increase the medical and public awareness of the importance of seeing a neurologist with this condition, preferably one with training in peripheral neuropathy. The neurologist can make specific suggestions to the primary care physician regarding the individual patient with autonomic neuropathy.
 


More on Autonomic Neuropathy

Overview: Autonomic Neuropathy
Differential Diagnoses & Workup: Autonomic Neuropathy
Treatment & Medication: Autonomic Neuropathy
Follow-up: Autonomic Neuropathy
References
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Further Reading

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Keywords

syndrome of acute pandysautonomia, postural orthostatic tachycardia syndrome, POTS, Guillain-Barré syndrome, GBS, acute inflammatory demyelinating polyneuropathy, AIDP, Lambert-Eaton myasthenic syndrome, LEMS, Holmes-Adie syndrome, idiopathic distal small-fiber neuropathy, human immunodeficiency virus, HIV, Chagas disease, Chagas' disease, botulism, chronic idiopathic anhidrosis, familial amyloid polyneuropathy, FAP, diabetes mellitus, uremic neuropathy, hepatic disease, vitamin B-12 deficiency, paraneoplastic autonomic neuropathy, Sjögren syndrome, acute intermittent porphyria, variegate porphyria, hereditary sensory autonomic neuropathy, HSAN, Fabry disease, autonomic dysreflexia, AD, acquired immunodeficiency syndrome, AIDS, autonomic nervous system, ANS, autonomic reflex screen, ARS, composite autonomic scoring scale, CASS, collapsin response–mediator family, CRMP-5, cerebrospinal fluid, CSF, vasopressin, DDAVP, electromyography, EMG, inhibitor of k-light polypeptide gene enhancer inB-cells, IKBKAP, mitochondrial neurogastrointestinal encephalomyopathy, MNGIE, M-phase phosphoprotein-1, MPPI, multiple system atrophy, MSA, nerve conduction studies, NCS, progressive autonomic failure, PAF, primary biliary cirrhosis, PBC, Purkinje cell cytoplasmic antibody-2, PCA-2, Parkinson disease, PD, positron emission tomography, PET, peripheral nervous system, PNS, quantitative sudomotor axon reflex test, QSART, quantitative sensory testing, QST, single-photon emission computed tomography, SPECT, serine palmitoyltransferase, SPT, sympathetic skin responses, SSR, selective serotonin reuptake inhibitor, SSRI, thermoregulatory sweat test, TST

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Contributor Information and Disclosures

Author

Steven D Arbogast, DO, Fellow, Neuromuscular Medicine, University Hospitals Case Medical Center, Cleveland
Steven D Arbogast, DO is a member of the following medical societies: American Academy of Neurology and American Osteopathic Association
Disclosure: Nothing to disclose.

Coauthor(s)

J Douglas Miles, MD, PhD, Clinical Instructor of Neuromuscular Medicine, Case Western Reserve University School of Medicine
J Douglas Miles, MD, PhD is a member of the following medical societies: American Academy of Neurology, American Medical Association, and Society for Neuroscience
Disclosure: Nothing to disclose.

Bashar Katirji, MD, FACP, Director, Neuromuscular Center and EMG Laboratory, The Neurological Institute, University Hospitals Case Medical Center; Professor of Neurology, Case Western Reserve University School of Medicine
Bashar Katirji, MD, FACP is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Physicians, and American Neurological Association
Disclosure: Nothing to disclose.

Medical Editor

Paul E Barkhaus, MD, Professor, Department of Neurology, Medical College of Wisconsin; Director of Neuromuscular Diseases, Milwaukee Veterans Administration Medical Center
Paul E Barkhaus, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Neurological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Glenn Lopate, MD, Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Chief of Neurology, St Louis ConnectCare, Consulting Staff, Barnes Jewish Hospital
Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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