Autonomic neuropathies are a group of diseases and syndromes that affect autonomic neurons, either parasympathetic or sympathetic or both. They can either be hereditary or acquired in nature. The autonomic nervous system has various functions in the body and therefore can present with varied symptoms or isolated symptom affecting only a part of the autonomic nervous system. Autonomic dysfunction can either be subclinical without affecting the patient or clinical that may be disabling for the patient. Some autonomic neuropathies are treatable; therefore, they should be identified at an appropriate time and treated as necessary. Falls and loss of consciousness can lead to increased morbidity; whereas, orthostatic hypotension can be a cause of increased mortality in the elderly. It has a progressive course that leads to poor outcome and sudden death can be caused due to cardiac dysrhythmia.(1)
Various autonomic neuropathies include familial amyloid polyneuropathy, hereditary sensory autonomic neuropathy, Fabry disease, acute intermittent porphyria and variegate porphyria, pandysautonomia, idiopathic distal small fiber neuropathy, Holmes-Adie syndrome and Ross syndrome, chronic idiopathic anhidrosis, amyloid neuropathy, postural orthostatic tachycardia syndrome, diabetic neuropathy, uremic neuropathy, hepatic disease-related neuropathy, vitamin deficiency and nutrition-related neuropathy, toxic and drug-induced autonomic neuropathy, and paraneoplastic autonomic neuropathy. Other conditions associated with autonomic neuropathies include alcohol, Lyme disease, HIV infection, Chagas disease, botulism, diphtheria, leprosy, celiac disease, Sjogren’s syndrome, rheumatoid arthritis, systemic lupus erythematosus, Guillain Barre syndrome, inflammatory bowel disease, and Lambert Eaton myasthenic syndrome.(1)
Home Remedies For Autonomic Neuropathy
The management of autonomic neuropathy in many of the cases starts with conservative therapy. For example, if diabetes mellitus is the underlying cause, then it is best to avoid sugar in the diet and to follow a healthy diet, so that blood glucose is under control. Patients can be advised to make dietary changes, eat smaller frequent meals, increase fiber in the diet and increase fluid intake for gastrointestinal conditions. They should avoid hot temperatures for anhidrosis, practicing strict fluid schedule and bladder training for urogenital dysfunction. It is important to maintain oral hygiene in hyposalivation.(1)
For orthostatic intolerance, patients need to take high fluid and salt intake. It has been noted that simply drinking 1-2 glasses of water can effectively increase the blood pressure by about 30 mm Hg in severe neurogenic orthostatic hypotension. So, just by drinking water there is an increase in blood volume and sympathetic activity. It is also important to avoid alcohol that can lead to dehydration and therefore hypovolemia. Patients should be advised to change body postures slowly and carefully. If patients experience orthostatic symptoms then they should lie or sit down. They can even sleep with the head of the bed elevated at 15-20 degrees. Patients can build up muscle tone and can take classes of water aerobics, water jogging, gentle aerobics, and recumbent bicycle. Compressive stockings are also helpful along with counter maneuvers such as crossing legs, squatting, and tensing leg muscles, buttocks, abdominal muscles or the whole body.(1)
Signs And Symptoms Of Autonomic Neuropathy
Most of the symptoms of autonomic neuropathy are subclinical and chronic in nature; however, some symptoms can be acute such as generalized dysautonomia. Orthostatic hypotension is often the most commonly recognized symptom of autonomic neuropathy that is really debilitating. However, other symptoms may also be present before orthostatic hypotension, which include decreased sweating, urinary incontinence, impotence, or ejaculatory dysfunction. In Sjogren’s syndrome, dry eyes, mouth, and anhidrosis are the presenting symptoms.(1)
Various signs and symptoms of autonomic neuropathy include pallor, anhidrosis, blurring of vision, tunnel vision, blacking out, reduced lacrimation, sensitivity to light, loss of pupillary size over time, palpitations, nausea, tremulousness, lightheadedness, tinnitus, headache, shortness of breath, chest pain, episodic diarrhea, constipation, dysphagia, early satiety, bowel incontinence, increased gastric motility, gastroparesis, Hyposalivation, altered taste, presyncope with urination and defecation, nocturia, lower urinary tract symptoms, impotence, loss of ejaculation, nonspecific sexual dysfunction, anhidrosis, hypohidrosis, hyperhidrosis, hypothermia, hyperpyrexia, burning of feet, pruritus, allodynia, dysesthesia, hyperalgesia, dry skin, loss of distal leg hair, brittle nails, and cold feet.(1)
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