Autonomic neuropathies are a group of disorders mostly affecting the small or unmyelinated autonomic nerve fibers that leads to autonomic dysfunction. Since the distribution of autonomic nerves is extensive, it involves the autonomic function of the cardiovascular, gastrointestinal, thermoregulatory, urogenital, sudomotor and pupillomotor system. The most common cause of autonomic neuropathy in developed countries is diabetes mellitus. Other conditions that can lead to autonomic neuropathy include amyloid deposition, infectious diseases (Chagas’ disease, HIV neuropathy, botulism, leprosy, diphtheria), neurotoxic therapeutic drugs, certain hereditary conditions (Fabry’s disease, Tangier disease, Triple-A syndrome, type 2b multiple endocrine neoplasia, Navajo Indian neuropathy), immune-mediated and paraneoplastic syndrome.(1)
How Long Will It Take To Recover From Autonomic Neuropathy?
Diabetic Autonomic Neuropathy
Diabetic neuropathy manifests late in the course of diabetes and presents with other symptoms of distal sensorimotor polyneuropathy. The overall mortality and sudden death rates are increased with diabetic autonomic neuropathy. It is estimated that over a 5-10 year period, the mortality associated with cardiovascular autonomic neuropathy is around 27-56%. It can lead to hypoglycemia unawareness, tachycardia, orthostatic hypotension, cardiac arrhythmias, bladder dysfunction, erectile dysfunction, diabetic gastroparesis (nausea, postprandial vomiting, bloating, belching, loss of appetite, early satiety), delayed gastric emptying of solids and liquids, constipation, diarrhea (more common in type 1 than type 2 diabetes), fecal incontinence, thermoregulatory sweating leading to global anhidrosis, and hyperhidrosis.(1)
Autonomic Nervous System
The function of the autonomic nervous system is mainly to maintain homeostasis in the body. It has parasympathetic and sympathetic branches that work opposite to each other to maintain homeostasis. The imbalance between these two systems leads to autonomic dysfunction. Although autonomic dysfunction is treatable, advanced autonomic dysfunction can be hard to treat. The earlier the detection of autonomic dysfunction, easier is the management. Unfortunately, the earlier detection of autonomic dysfunction is not possible and therefore it is mostly diagnosed at an advanced stage and at this stage only treatment of symptoms is possible.(2)
How Long Do The Symptoms Last?
The primary objective of treating autonomic neuropathy is to first manage the treatable conditions. For example, if diabetes mellitus is the underlying cause, blood glucose control should be done to prevent further worsening of the symptoms and if autoimmunity is the primary cause, immunomodulatory drugs should be considered. Although most of the autonomic neuropathies cannot be reversed and can be a lifelong problem, the symptoms can be treated with various therapies.(3)
For orthostatic intolerance, conservative management should be considered first, which includes a high intake of fluid and salt. It is noted that the intake of 1-2 glasses of water can have a significant effect on systolic blood pressure by increasing both blood volume and sympathetic activity. It is important to move bodily parts and postures cautiously and slowly and avoidance of alcoholic is advised. Patients should be encouraged to sit or lie if orthostatic symptoms recur. Compressive stockings are found beneficial along with different maneuvers, such as the crossing of legs, squatting, and tensing of leg muscles, abdominal muscles, buttocks or the whole body. Cases that are not managed with conservation treatment can be managed with pharmacologic therapy such as beta-blockers, volume expansion with fludrocortisone or vasoconstriction with alpha-adrenergic agonist midodrine.(3)
Bladder dysfunction can be managed with strict fluid schedule, bladder training, and medications such as oxybutynin, tolterodine, and bethanechol. For refractory cases, intermittent catheterization or artificial sphincters may be required. Sexual dysfunction may be treated with sildenafil, tadalafil, and vardenafil.(3)
Gastrointestinal conditions can be dealt with dietary changes, small frequent meals, increased fiber ingestion and increased fluid intake. Hyposalivation can be managed with pyridostigmine, whereas, altered taste sensation can be managed with cyproheptadine. Patients with lack of sweat should be educated on the risk of heatstroke and should be told to avoid excessive and prolonged heat exposure. In patients with excessive sweat discharge, botulinum toxin can be used for focal hyperhidrosis; anticholinergics (amitriptyline, glycopyrrolate, scopolamine patch, hyoscyamine and belladonna tincture) can be used for generalized symptoms.
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- Is Autonomic Neuropathy A Serious Condition & Can It Be Reversed?
- What To Eat And Avoid When You Have Autonomic Neuropathy?
- What Are The Symptoms Of Autonomic Neuropathy & How Do You Test For It?
- What Is The Best Treatment For Autonomic Neuropathy?
- Who Is At Risk For Autonomic Neuropathy & Is There A Blood Test For It?