Dysautonomia: symptoms, causes and treatment

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

In this article We will see what dysautonomia is, what are its symptoms, how to classify the different types that exist and how to treat the affected people.

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What is dysautonomia?

Dysautonomia is a medical term that refers to a set of symptoms or a disorder produced by improper functioning of the autonomic nervous system, whose function is to regulate and coordinate bodily functions that are involuntary, unconscious and automatic (such as blood pressure or body temperature).

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

dysautonomia involves a chronic and multi-symptomatic condition that causes a degree of disability in the person who suffers it. Although women tend to be more likely to develop the disorder (by a ratio of 1 in 20 compared to men), it can affect anyone.

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Signs and symptoms

People who suffer from dysautonomia usually present a series 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 these types of patients remain standing for a long time, it is common for them to have a feeling of fainting, similar to a hypoglycemic reaction. The person turns pale and may pass out or have a syncope. The hands and feet tend to swell when immobile or when walking slowly or from excessive heat.

Patients suffering from dysautonomia generally have an intolerance to cold., although they can also present it to heat (due to inadequate thermal regulation). It is also common for them to complain that they get tired easily and have a lack of motivation to perform daily tasks.

Types of dysautonomias: classification

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

According to its 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 that affects the autonomic fibers secondarily (for example, diabetes or amyloidosis).

Primary dysautonomias are a type of neurodegenerative diseases in which central autonomic neurons, peripheral neurons, or both, end up degenerating and dying.

clinically, may present as well-defined syndromes, among which it is worth noting: pure autonomic failure, in which patients only suffer from autonomic 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.

According to the deficient neurotransmitter

Dysautonomias can also be classified based on the deficient neurotransmitter they carry into: dysautonomias purely cholinergic, in adrenergic dysautonomia and in pandysautonomia, when the cholinergic and adrenergic systems are deficient.

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

In adrenergic dysautonomia, which are usually congenital diseases, there is a deficiency of the enzyme dopamine beta-hydroxylase. This type of dysautonomia characterized by the lack of conversion of dopamine to norepinephrine. 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 often have 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 disorders (sleep apnea and laryngomalacia).

According to the anatomical distribution of affected neurons

Dysautonomias can also be classified based on 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 disorders of the central nervous system. Some diseases that affect the specific autonomic innervation of an organ (specifically, the pupil and the skin, for example). hyperhidrosis and facial flushing) and regional pain syndromes, in which the autonomic nervous system may be affected.

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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's see what they are below:

1. Do not stand for a long time

If the person can't help it, there are a number of movements that can help you, such as: put one foot in front of the other and then change feet, lean up and release several times; bend over (as if you were going to tie your shoes); or stretch your leg on a chair.

2. avoid walking slowly

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

3. Move your feet and knees frequently

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

4. rest lying down

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

5. Avoid dehydration

To avoid suffering the effects of dehydration, It is convenient to take 2 to 3 liters of liquid (preferably water) daily, especially if the patient suffers from vomiting, diarrhea, fever or excessive heat. Likewise, excessive use of diuretics should 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 position of foot.

7. Perform moderate aerobic exercise

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

8. Raise the head of the bed

It is convenient to raise the head of the bed 45º (between 15 and 30 cm, approximately), which reduces nocturnal enuresis because the person remains in a supine position (face up). A foot board can also be placed to prevent rolling out of bed.

9. Increase intravascular volume

This It is achieved by increasing the amount of salt in food, always taking into account that the person does not suffer from high blood pressure or kidney problems.

10. use of medications

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

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

The use of alpha-adrenergic drugs, which produce vasoconstriction and would 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.