Dysautonomia: symptoms, causes and treatment

Dysautonomia is a disease that affects the autonomic nervous system and causes severe disability in the sufferer, with symptoms such as fatigue or fainting.

In this article we will see what disautonomy is, What are its symptoms, how to classify the different types that exist and how to treat those affected.

    What is disautonomy?

    Dysautonomia is a medical term for a set of symptoms or a disorder caused by poor functioning of the autonomic nervous systemThe function is to regulate and coordinate bodily functions which are involuntary, unconscious and automatic (such as blood pressure or body temperature).

    This disorder generates significant difficulties for the patient to develop actions with normality, due to the alterations in the regulatory mechanisms that result from it. Years ago this same disease was known as neurasthenia gravisAnd the most visible consequence is a decrease in efficiency in performing or solving daily tasks, and can lead to anxiety and depressive disorders.

    Dysautonomia it involves chronic and multisymptomatic suffering which causes a certain degree of disability in the person who suffers from it. Although it is usually women who are most likely to develop the disorder (a ratio of 1 to 20 compared to men), it can affect anyone.

      Signs and symptoms

      People with dysautonomia usually have a number of common symptoms, caused by alterations in the autonomic nervous system, which consist of feeling weak, diaphoresis (excessive sweating), blurred vision and loss of consciousness in the most extreme cases. However, the most common symptom is chronic fatigue.

      When such patients are standing for a long time, it is common for them to have a sensation of fainting, similar to a hypoglycemic reaction. The person becomes pale and may pass out or have syncope. Hands and feet tend to ignite when they are stationary or when walking slowly or due to excessive heat.

      Patients with dysautonomia usually have cold intolerance, Although they can also present it to heat (through inadequate thermal regulation). It is also common for them to complain that they tire easily and show a lack of motivation to perform daily tasks.

      Types of disautonomies: classification

      There are different types of disautonomies and can be classified according to their etiology, deficient neurotransmitter or the anatomical distribution of affected neurons.

      According to its etiology

      The désautonomías can be classified according to their etiology in: primary, when the etiology is not known; or secondary, when they are the consequence of a disease that affects the autonomic fibers in a secondary way (For example, diabetes or amyloidosis).

      Primary dysautonomias are a type of neurodegenerative disease in which central autonomic neurons, peripheral neurons, or both eventually degenerate and die.

      clinically, they can present well-defined syndromes, Among which it is necessary to emphasize: the pure autonomous decision, in which the patients suffer only symptoms of autonomic type; Parkinson’s disease, when autonomic symptoms are associated with extrapyramidal deficit; Lewy body dementia, autonomic symptoms associated with extrapyramidal deficit and dementia; and multisystem atrophy, with autonomic symptoms and extrapyramidal and cerebellar deficit.

      According to the deficient neurotransmitter

      Disautonomies can also be classified according to the deficient neurotransmitter that involves: purely cholinergic disautonomies, adrenergic disautonomies and pandisautonomias, when the cholinergic and adrenergic systems are deficient.

      In cholinergic patients, patients present with impaired neuromuscular transmission. For example, in Lambert-Eaton myasthenic syndrome and botulism, the release of acetylcholine is deficient in somatic and autonomic neurons, so the person suffers from muscle weakness, loss of reflexes, and dysfunction.

      In adrenergic dysautonomias, which are usually congenital diseases, there is a deficiency in the enzyme dopamine beta-hydroxylase. This kind of disautonomy is characterized by a lack of conversion of dopamine to norepinephrine. The most common symptoms are acute orthostatic hypotension, accompanied by ptosis, problems with ejaculation, nocturia, nasal congestion and hyperextensible joints.

      The most common autonomic condition is multisystem atrophy, a neurodegenerative disease whose cause is still unknown. Patients with this condition usually present with autonomic dysfunction associated with parkinsonism and cerebellar and pyramidal deficit in different combinations. Signs of autonomic dysfunction include orthostatic hypotension, intestinal hypomotility, erectile dysfunction, urinary incontinence and respiratory disorders (Sleep apnea and laryngomalacia).

      According to the anatomical distribution of the affected neurons

      Disautonomies can also be classified according to the anatomical distribution of neurons affected by the disorder. The main subtypes are: central (preganglionic) and peripheral (ganglionic or postganglionic) disautonomies; and localized and diffuse disautonomies.

      There are also characteristic clinical autonomic syndromes secondary to focal central nervous system disorders. Certain diseases that affect the specific autonomic innervation of an organ (in particular, the pupil and skin, due to hyperhidrosis and redness of the face) and syndromes that cause regional pain, in which the autonomic nervous system could be affected.

        treatment

        Although there is no cure for dysautonomia, there are several things you can do to prevent or alleviate, if possible, the associated symptoms. Let’s see below what they are:

        1. Do not stand for a long time

        If the person cannot help him, there are a number of movements that can help you, such as: Put one foot in front of the other then change feet, climb and let go several times; squat (like putting on lace-up shoes); or stretch the bed on a chair.

        2. Avoid walking slowly

        If you are going to malls or supermarkets, it is not a good idea to drive slowly. Avoid staying there for more than an hour, and if less, the better.

        3. Frequently move your feet and knees

        When the person is seated on a bus or plane, they should try to move their feet and knees frequently, stop and walk (if possible). Sometimes, it is advisable to adopt a position in hyperflexion from the chest to the knees and / or the head between the knees.

        4. Rest in bed

        Another measure that can help is to rest in bed after breakfast or lunch, even for about 15 minutes. This should be done whenever the person has symptoms of dysautonomia.

        5. Avoid dehydration

        To avoid the effects of dehydration, it is advisable to take 2 to 3 liters of liquid (Preferably water) every day, especially if the patient suffers from vomiting, diarrhea, fever or excessive heat. Excessive use of diuretics should also be avoided.

        6. Use of elastic clothing

        Try to wear elastic stockings or socks with an ankle pressure of at least 20 mm Hg. This measurement decreases the increase of blood in the venous areas, due to inadequate vasoconstriction when standing.

        7. Do moderate aerobic exercise

        It is very useful to perform moderate aerobic exercises, Which improve blood flow to the heart (venous return). Exercises that gradually require standing longer and activities in the water are more beneficial.

        8. Raise the headboard

        It is advisable to raise the head of the bed to 45 ° (between 15 and 30 cm approximately), which reduces nocturnal enuresis because the person remains supine (upside down). You can also put a table on your feet to prevent getting out of bed.

        9. Increase intravascular volume

        this it is obtained by increasing the amount of salt in mealsAlways keep in mind that the person does not have high blood pressure or kidney problems.

        10. Use of medication

        In the most serious casesSeveral drugs have been tested whose function is to interrupt the afferent or efferent pathway of the neuroanatomic reflex arc.

        Mineralocorticoids can be used when the patient does not respond to increased salt in their diet; Beta-blocker drugs, used to treat neurocardiogenic syncope, can also be used.

        The use of alpha-adrenergic drugs, which produce vasoconstriction and counteract the loss of sympathetic tone following syncope, has also been suggested.

        Bibliographical references:

        • Kaufmann H. (2003) Most common dysautonomias. Rev Neurol. 36 (1): 93-96.
        • CJ Mathias (2005). Autonomic nervous system disorders. In: Bradley WG, Daroff RB, Fenichel GM, Marsden CD (Eds), Neurology in Clinical Practice, (pages 2131-2166). Philadelphia: Butterworth Heinemann.

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