Autonomic Neuropathy Follow-up

  • Author: Steven D Arbogast, DO; Chief Editor: Nicholas Lorenzo, MD   more...
 
Updated: Feb 6, 2012
 

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.

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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

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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.

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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?

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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  Assistant Professor of Neuroscience, Marshall University School of Medicine, and Clinical Instructor of Neurology, 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.

Specialty Editor Board

Paul E Barkhaus, MD  Professor, Department of Neurology, Medical College of Wisconsin; Director of Neuromuscular Diseases, Milwaukee Veterans Affairs 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Glenn Lopate, MD  Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Director of Neurology Clinic, St Louis ConnectCare; Consulting Staff, Department of Neurology, 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: Baxter Grant/research funds Other; Amgen Grant/research funds None

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

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: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Nicholas Lorenzo, MD  Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and American College of Physician Executives

Disclosure: Nothing to disclose.

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Table. Types of HSAN
HSANMode of InheritanceOnsetSymptomsSigns
Type IAutosomal dominant, point mutations in SPT, 9q22.1-9q22.3Second decade of lifeDistal lower-limb involvement, ulceration of the feet, particularly the solesLow sensory action potential amplitude
Type II, Morvan diseaseAutosomal recessiveCongenital onsetPansensory loss of upper and lower limbs, also trunk and forehead; early ulcersLoss of myelinated and unmyelinated fibers
Type III, Riley-Day syndrome or familial dysautonomia)Autosomal recessive, 9q31Childhood onset, predominantly Ashkenazi JewsPallor in infancy, irregularities in temperature and blood pressure; Difficulties in eating and swallowingAbsence of unmyelinated fibers
Type IVAutosomal recessive, 1q21-1q22Congenital onsetWidespread anhidrosis, lost sense of pain, mental retardationLoss of myelinated and small unmyelinated fibers
Type VAutosomal recessiveCongenital onsetPain insensitivity in extremitiesNot applicable
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