autonomic-dysfunction causes and its clinical features.ppt

autonomic dysfunction and its causes and its clinical features

1. AUTONOMIC
DYSFUNCTION

2. Name of the disease & terminologies
Etiology
History, signs and symptoms
Physical examination
Investigation
Treatment according to allopathic medicine
Other therapies
Yoga practices
Books and journals for reference

3. Dysfunctionoftheautonomicnervoussystem
(ANS)isknownasdysautonomia.
Theautonomicnervoussystemregulates
unconsciousbodyfunctions,includingheart
rate,bloodpressure,temperatureregulation,
gastrointestinalsecretion,andmetabolicand
endocrineresponsestostresssuchasthe"fight
orflight"syndrome.
Asregulatingthesefunctionsinvolvesvarious
andmultipleorgansystems,dysfunctionsofthe
autonomicnervoussystemsencompassvarious
andmultipledisorders.
DEFINITION

6. Theautonomicnervoussystemconsistsofthree
subsystems:
Thesympatheticnervoussystem,
Theparasympatheticnervoussystemand
Theentericnervoussystem.
TheANSregulatestheactivitiesofcardiac
muscle,smoothmuscle,endocrineglands,and
exocrineglands.
Theautonomicnervoussystemfunctions
involuntarily(reflexively)inanautomatic
mannerwithoutconsciouscontrol.
DESCRIPTION

7. Theautonomicnervoussystemachievesthis
controlviatwodivisions:
Thesympatheticnervoussystemand
Theparasympatheticnervoussystem.
Dysfunctionsoftheautonomicnervoussystem
arerecognizedbythesymptomsthatresultfrom
failureofthesympatheticorparasympathetic
componentsoftheANS.
Primarydysautonomiasincludemultiplesystem
atrophy(MSA)andfamilialdysautonomia.
Thedysfunctioncanbeextensiveandmanifest
asageneralautonomicfailureorcanbeconfined
toamorelocalizedreflexdysfunction.

8. Withmultiplesystematrophy,ageneralized
autonomicfailure,malepatientsexperience
urinaryretentionorincontinenceandimpotence
(aninabilitytoachieveormaintainapenile
erection).
Bothmalesandfemalesexperienceataxia(lackof
musclecoordination)andadramaticdeclinein
bloodpressurewhentheyattempttostand
(orthostatichypotension).
SymptomssimilartoParkinson'sdiseasemay
develop,suchasslowmovement,tremors,and
stiffmuscles.
Visualdisturbances,sleepdisturbances,and
decreasedsweatingmayalsooccur.

9. Personswithautonomicdysfunctionwhodo
notexhibittheclassicalsymptomsof
orthostatichypotensionmayexhibitaless
dramaticdysfunctiontermedorthostatic
intolerance.
Thesepatientsexperienceamilderfallinblood
pressurewhenattemptingtostand.
However,becausethepatientshavean
increasedheartratewhenstanding,theyare
describedashavingposturaltachycardia
syndrome(POTS).

10. Althoughnotasprevalentinthegeneral
populationashypertension,orthostatic
intoleranceisthesecondmostcommon
disorderofbloodpressureregulationandisthe
mostprevalentautonomicdysfunction.
Orthostatichypotensionandorthostatic
intolerancecanresultinawidearrayof
disabilities.

11. Common orthostaticintolerancesyndromes
include:
Hyperadrenergic orthostatic hypotension (partial
dysautonomia);
Orthostatic tachycardia syndrome (sympathicotonic
orthostatic hypotension);
Postural orthostatic tachycardia syndrome (mitral
valve prolapse syndrome);
Postural tachycardia syndrome (soldier's heart);
Hyperadrenergic postural hypotension
(vasoregulatory asthenia);
Sympathotonic orthostatic hypotension
(neurocirculatory asthenia);
Hyperdynamic beta-adrenergic state (irritable heart
syndrome); And
Idiopathic hypovolemia (orthostatic anemia).

12. Milderformsofautonomicdysfunctionsuchas
orthostaticintoleranceaffectanestimated
500,000peopleintheUnitedStates.
Orthostaticintolerancemorefrequentlyaffects
women;female-to-maleratioisatleast4:1.
Itismostcommoninpeoplelessthan35years
ofage.
Moresevereformsofdysautonomiasuchas
multiplesystematrophyoftenoccurlaterinlife
(averageageofonset60years)andaffectmen
fourtimesasoftenaswomen.
DEMOGRAPHICS

13. Symptomsoftheautonomicdysfunctionof
orthostaticintoleranceincludelightheadedness,
palpitations,weakness,andtremorswhen
attemptingtoassumeanuprightposture.
Lessfrequently,patientsexperiencevisual
disturbances,throbbingheadaches,andoften
complainoffatigueandpoorconcentration.
Somepatientsreportfaintingwhenattempting
tostand.
Thecauseoflightheadedness,fainting,and
similarsymptomsisalackofadequateblood
pressureinthecerebralcirculatorysystem.
CAUSES AND SYMPTOMS

14. Inadditiontoorthostatichypotensionand
Parkinson-typesymptoms,personswith
multiplesystemsatrophymayhavedifficulty
articulatingspeech,sleepapneaandsnoring,
paininthebackoftheneck,andfatigue.
Eventually,cognitive(mentalreasoning)ability
declinesinabout20%ofcases.
Multiplesystemsatrophyoccurssporadically
andthecauseisunknown.

15. Diagnosisoforthostaticintoleranceismade
whenapatientexperiencesadecreaseofblood
pressure(notexceeding20/10mmHg)when
attemptingtostandandaheartrateincreaseof
lessthan30beatsperminute.
Diagnosisofothertypesofdysautonomiais
difficult,asthedisordersarevariedandmimic
otherdiseasesofthenervoussystem.
AsParkinsonism(slowedmovement,rigidity)
isthemostfrequentmotordeficitseenin
multiplesystemsatrophy,itisoften
misdiagnosedasParkinson'sdisease.
DIAGNOSIS

16. Magneticresonanceimaging(MRI)ofthebrain
cansometimesdetectabnormalitiesofstriatum,
cerebellum,andbrainstemassociatedwith
multiplesystemsatrophy.
Atestwiththedrugclonidinehasalsobeen
usedtodifferentiateParkinson'sdiseasefrom
multiplesystemsatrophy,ascertainhormone
levelsinthebloodwillincreaseinpersonswith
Parkinson'sdiseaseafterclonidine
administration,butnotinpersonswithmultiple
systemsatrophy.

17. Symptomssuchasseveredysarthria(difficulty
articulatingspeech)andstridor(noisyinspiration)
alertthephysiciantothepossibilityofmultiple
systemsatrophy,astheyoccurinthedisorder,but
arerareinParkinson'sdisease.
Notestcandiagnosemultiplesystematrophy.
Aneurologistmakesthediagnosisbasedonthe
historyofsymptoms,aphysicalexaminationand
byrulingoutothercauses.
Teststhatmayhelpconfirmthediagnosisinclude
checkingplasmanorepinephrinelevelsand
breakdown,andanMRI(magneticresonance
imaging)oftheheadtoruleoutothercauses.

18. Parkinsonism(tremors,musclerigidity)
Cerebellarorcorticospinalsigns(balanceand
movementdifficulties)
Orthostatichypotension(dropsinblood
pressurewhenbodypositionchanges,leading
todizziness,headache,cloudingofvision,or
fainting)
Impotence
Urinaryincontinenceorretention,usually
precedingorwithintwoyearsaftertheonsetof
themotorsymptoms
SYMPTOMS

19. Reducedsweating,leadingtoheatintolerance
Doublevisionorothervisionproblems
Speechproblems
Difficultyswallowing
Difficultybreathing

20. Atpresentthereisnocureforsevereautonomic
dysfunction.
Thegoaloftreatmentistomakethepatient
morecomfortableandpreservebodily
functionsaslongaspossible.
Thefluctuatingbloodpressurethatisa
hallmarkofthedisordercanmakethecondition
difficulttotreat,butmedicationscanbeusedto
controlsomesymptoms.
Dietarychanges,suchasincreasingsaltand
fluidintake,mayhelpelevatebloodpressure.
TREATMENT

21. Abreathingorfeedingtubemayhavetobe
surgicallyinsertedtomanageswallowingand
breathingdifficulties.
Treatmentiscenteredontheremediationof
symptoms,patientsupport,andthetreatmentof
underlyingdiseasesanddisordersincasesof
secondaryautonomicdysfunction.
Inmanycases,cureoranimprovementinthe
underlyingdiseaseordisorderimprovesthe
patientprognosiswithregardtoremediationof
autonomicdysfunctionsymptoms.

22. Withregardtoorthostatichypotension,drug
treatmentincludesfludrocortisone,ephedrine,
ormidodrine.
Medicationsareaccompaniedbyposturalrelief
suchaselevationofthebedattheheadandby
dietarymodificationstoprovidesomerelieffor
thesymptomsofdizzinessandtunnelvision.
Inmultiplesystemsatrophy,anti-Parkinson
medicationssuchasSinemetoftenhelpwith
someofthesymptomsofmusclerigidityand
tremor,andcreateanoverallfeelingofwell-
being.

23. Medicationsusedinthetreatmentoforthostatic
hypotensiontendtonotperformaswellinthis
group;althoughtheyelevatethebloodpressure
whilestanding,theydecreasetheblood
pressurewhilereclining.

25. Recoveryfromsomedysautonomiascanbe
complicatedbysecondaryconditionssuchas
alcoholism,diabetes,orParkinson'sdisease.
Someconditionsimprovewithtreatmentofthe
underlyingdisease,whileonlyhaltingofthe
progressionofsymptomsisaccomplishedin
others.
Somemilddysautonomiasstabilizeand,with
treatment,causefewlimitationstodaily
activities.
RECOVERY AND REHABILITATION

26. Overall,astherearenocuresformostsevereor
progressivedysautonomias,theemphasisis
insteadplaceduponmaintainingmobilityand
functionforaslongaspossible.
Aidsforwalkingandreaching,positioning
devices,andstrategiesformaintainingposture,
balance,andbloodpressurewhilerisingcanbe
providedbyphysicalandoccupational
therapists.
Speechandnutritionaltherapistscandevise
dietsandsafestrategiesforeating,and
recommendtubefeedingsifnecessary.

27. Theprognosisforpersonssufferingautonomic
dysfunctionisvariableanddependsonspecific
dysfunctionandontheseverityofthe
dysfunction.
Autonomicdysfunctionscanpresentasacuteand
reversiblesyndromecanpresentinmorechronic
andprogressiveforms.
Personswithorthostaticintolerancecanusually
maintainanormallifespanandactivelifestyle
withtreatmentandminimalcopingmeasures,
whilepersonswithmultiplesystemsatrophy
usuallyhavealifespanofabout5–7yearsafter
diagnosis.
PROGNOSIS

28. Homeopathy
Ayurvedic
Herbs
Naturopathy
Diet
Reiki
Acupuncture
Cognitivetherapy
OTHER THERAPIES

29. YOGA PRACTICES
YOGA IS BALANCE (SAMATVAM)
I TCORRECTS IMBALANCES
AIMS :
•STRESS REDUCTION
•RELIEF OF PAIN
•MEDICATION REDUCTION