Dysautonomia: symptoms, causes and treatment

Dysautonomia is a neurological disorder that damages the functions of the autonomic nervous system.

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 dysautonomia iswhat are its symptoms, how to classify the different types that exist and how to treat the affected persons.

What is dysautonomia?

The dysautonomia is a medical term that alludes to a set of symptoms or a disorder produced by inadequate functioning of the autonomic nervous systemThe function of the autonomic nervous system is to regulate and coordinate body functions that are involuntary, unconscious and automatic (such as Blood Pressure or body temperature).

This disorder generates significant difficulties in the patient to develop actions normally, due to the alterations in the regulation mechanisms it causes. Years ago this same disease was known as neurasthenia.The most visible consequence is a decrease in the efficiency to perform or solve daily tasks, which can lead to anxiety disorders and depression.

Dysautonomia involves a chronic and multisymptomatic condition that causes a degree of disability in the that causes a degree of disability in the person who suffers from it. Although it is usually women who have a greater propensity to develop the disorder (in a ratio of 1 to 20 with respect to men), it can affect any person.

Signs and symptoms

People suffering from dysautonomia usually present a series of common symptoms caused by alterations in the autonomic nervous system, consisting of sensation of weakness, diaphoresis (excessive sweating), blurred vision and loss of consciousness in the most extreme cases. in the most extreme cases. However, the most common symptom is chronic fatigue.

When such patients stand for a prolonged period of time, it is common for them to have a feeling of faintness, similar to a hypoglycemic reaction. The person becomes pale and may faint or have syncope. The hands and feet tend to swell when immobile or when walking slowly or from excessive heat.

Patients with dysautonomia are generally intolerant to cold, although they may also be intolerant to heat.but may also be intolerant to heat (due to inadequate thermoregulation). It is also common for them to complain that they tire easily and show a lack of motivation to perform daily tasks.

Types of dysautonomias: classification

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

According to their etiology

Dysautonomias can be classified according to their etiology as: primary, when the etiology is unknown; or secondary, when they are the consequence of a disease affecting the autonomic fibers. a disease that affects the autonomic fibers in a secondary way (e.g., diabetes or (e.g., 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 as well-defined syndromesThese include: pure autonomic failure, in which patients suffer only autonomic-type symptoms; Parkinson's disease, when autonomic symptoms are combined with an extrapyramidal deficit; dementia with Lewy bodies, autonomic symptoms combined with an extrapyramidal deficit and dementia; and multiple system atrophy, with autonomic symptoms and an extrapyramidal and cerebellar deficit.

Depending on the neurotransmitter deficit

Dysautonomias can also be classified according to the neurotransmitter deficit they cause: purely cholinergic dysautonomias, adrenergic dysautonomias and pandisautonomias, when both cholinergic and adrenergic systems are deficient.

In the cholinergic type, patients present neuromuscular transmission disorders.. For example, in Lambert-Eaton myasthenic syndrome and botulism, acetylcholine release is deficient in both somatic and autonomic neurons, resulting in muscle weakness, loss of reflexes and general autonomic dysfunction.

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

The most common pandysautonomia is multiple system atrophy, a neurodegenerative disease whose cause is still unknown. Patients with this condition usually present with autonomic dysfunction combined with parkinsonism and cerebellar and pyramidal deficits in various combinations. Signs of autonomic dysfunction include orthostatic hypotension, intestinal hypomotility, erectile dysfunction, urinary incontinence, and respiratory disturbances (sleep apnea and laryngomalacia).

According to the anatomical distribution of the affected neurons

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

There are also characteristic clinical autonomic syndromes secondary to focal central nervous system disorders. Some diseases affecting organ-specific autonomic innervation (specifically, pupil and skin, for hyperhidrosis and facial flushing) and syndromes causing regional pain, in which the autonomic nervous system may be affected.

Treatment

Although there is no cure for dysautonomia, there are various actions that can be implemented to prevent or alleviate, as far as possible, the associated symptoms. Let us see what they are:

1. Do not stand for a prolonged period of time.

If the person cannot avoid it, there are a number of movements that can help, for examplePutting one foot in front of the other and then changing feet, stepping up and letting go several times, bending down (as if you were going to fasten your shoes), or stretching out your leg on a chair.

2. Avoid walking slowly

If you go to shopping malls or supermarkets, it is not a good idea to go through them slowly. Avoid staying in them for more than an hour, and if it is less, the better.

3. Move your feet and knees frequently.

When sitting on a bus or plane, try to move your feet and knees frequently, stand up and walk around (as much as possible). From time to time, it is advisable to adopt a position in hyperflexion from chest to knee and/or head between the knees..

4. Resting lying down

Another measure that can help is to rest lying down after lunch or lunch, even if only for about 15 minutes. This should be done whenever the person experiences symptoms of dysautonomia.

5. Avoiding dehydration

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

6. Wear elastic clothing

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

7. Perform moderate aerobic exercise

It is very useful to perform moderate aerobic exercise, which improves blood flow in venous areas, due to inadequate vasoconstriction during standing.which improve blood flow to the heart (venous return). Exercises that require progressively longer periods of standing and water activities are more beneficial.

8. Elevate the head of the bed

It is advisable to raise the head of the bed by 45º (between 15 and 30 cm, approximately), which reduces nocturnal enuresis because the person remains in the supine position (face up). A board can also be placed on the feet to avoid getting out of bed.

9. Increase intravascular volume

This is achieved by increasing the amount of salt at mealtimesalways taking into account that the person does not suffer from arterial hypertension or renal problems.

10. Use of medications

In the most severe casesIn the most severe cases, various drugs have been tried whose function is to interrupt the afferent or efferent pathway of the neuroanatomical reflex arc.

Mineralocorticoids may be used when the patient does not respond to increased salt in his diet; beta-blocking drugs, used to treat neurocardiogenic syncope, may also be used.

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

Bibliographic references:

• Kaufmann H. (2003) Most common dysautonomias. Rev Neurol. 36(1):93 - 96.
• Mathias CJ (2005). Disorders of the autonomic nervous system. In: Bradley WG, Daroff RB, Fenichel GM, Marsden CD (Eds), Neurology in clinical practice, (pp 2131-2166). Philadelphia: Butterworth Heinemann.