Your autonomic nervous system controls functions in your body that take place without conscious control, such as bladder function, blood pressure, body temperature, digestion, heart rate, sexual function, and sweating.
At Stanford Health Care’s Autonomic Disorders Program, our experts provide complete diagnosis, treatment, and support for conditions associated with the autonomic nervous system. We offer all of the specialists and expertise you need in one hospital to manage your full range of care needs and lifelong continuity of care.
Our experienced team diagnoses and treats autonomic disorders, including:
Amyloidosis
Amyloidosis occurs when proteins (amyloids) build up abnormally in various organs in your body.
Autoimmune autonomic ganglionopathy
Autoimmune autonomic ganglionopathy happens when your immune system attacks and damages your autonomic nervous system.
Autoimmune neuromuscular conditions with prominent autonomic manifestations
Neuromuscular conditions affect the way your nerves interact with your muscles. The following neuromuscular conditions impact your autonomic nervous system, causing problems with controlling blood pressure, heart rate, secretion, sweating, digestion, and other body functions:
- Acquired neuromyotonia (Isaacs’ syndrome), when your nerves fire too much, resulting in muscle cramps, stiffness, and twitching
- Guillain-Barré syndrome, when your immune system attacks your nerves, causing numbness, pain, and weakness in your hands, feet, arms, and legs
- Lambert-Eaton myasthenic syndrome (LEMS), when your immune system attacks your muscle tissue, causing muscle weakness
- Limbic encephalitis, when limbic areas of your brain (amygdala and hippocampus) become inflamed, causing confusion, memory loss, seizures, and sleep disturbances
- Morvan syndrome, when a rare neurological disorder affects the brain (encephalopathy), causing muscle cramps, stiffness, and twitches (peripheral nerve hyperexcitability) and nerve damage (autonomic neuropathy)
- Faciobrachial dystonic seizure, when short, frequent seizures mainly affect your arms and face
Autonomic dysfunction/failure (dysautonomia)
Autonomic dysfunction/failure (dysautonomia) occurs when your autonomic nervous system is not functioning properly, affecting heart rate and blood pressure, digestion, temperature control, sweating, urination, and sexual function.
Autonomic neuropathy
Autonomic neuropathy results from damage to nerves that help with organ and organ system functioning.
Diabetic autonomic neuropathy
This nerve disorder is a complication of diabetes that affects involuntary body functions, including heart rate, blood pressure, perspiration, and digestion.
Hereditary, sensory, and autonomic neuropathies (HSAN)
These rare inherited conditions mainly affect fibers of the nerves outside your brain and spinal cord (peripheral nerves). Symptoms include insensitivity to pain, sweating problems, and, sometimes, autonomic failure. Examples of HSAN include familial dysautonomia (Riley-Day syndrome) and congenital insensitivity to pain with anhidrosis (CIPA).
Holmes-Adie syndrome
This neurological disorder causes a pupil larger than normal in one eye, which constricts more slowly in bright light.
Horner's syndrome
This rare disorder occurs when certain nerves that travel from your brain to your eyes and face become damaged. Horner’s syndrome usually affects only one side of the face.
Lewy body dementia with orthostatic hypotension
Lewy body dementia with orthostatic hypotension happens when proteins (Lewy bodies) build up in your brain. This condition shares characteristics with both Alzheimer's disease and Parkinson's disease.
Multiple system atrophy (MSA)
Multiple system atrophy (MSA) includes symptoms that affect both your autonomic nervous system, such as blood pressure and bladder control, and your ability to move.
Orthostatic hypotension (postural hypotension)
Orthostatic hypotension (postural hypotension) is a form of low blood pressure that happens when you stand up from sitting or lying down. This condition causes dizziness or fainting.
Orthostatic intolerance
Orthostatic intolerance means that you develop symptoms such as lightheadedness, dizziness, or fainting when you stand upright. These symptoms usually go away when you sit back down again.
Parkinson's disease-related autonomic failure
This complication of Parkinson's disease causes the autonomic nervous system to not function properly.
Paraneoplastic autonomic syndromes
These nervous system syndromes may occur when cancer-fighting agents of your immune system attack nerve or muscle cells. Paraneoplastic autonomic syndromes are commonly associated with breast cancer, lung cancer, and ovarian cancer.
Post-infectious autonomic dysfunction
These disorders occur when your autonomic nervous system is not functioning properly as a result of infection.
Postural orthostatic tachycardia syndrome (POTS)
Postural orthostatic tachycardia syndrome (POTS) causes your heart rate to raise significantly in response to changing position from lying down to standing, or from sitting to standing.
Pure autonomic failure
Pure autonomic failure causes progressive symptoms of autonomic failure, such as difficulty with urination, dizziness or lightheadedness when standing, fainting (syncope), impotence, and sweating.
Refractory or labile hypertension due to baroreflex failure or neurogenic supine hypertension
Autonomic disorders can cause blood pressure that remains high despite treatment (refractory hypertension) or blood pressure that constantly changes between normal and high (labile hypertension). This can include changes in blood pressure with periods of very high blood pressure (baroreflex failure) or high blood pressure when lying down (neurogenic supine hypertension).
Small fiber neuropathy
Small fiber neuropathy is a painful type of nerve damage (neuropathy) that causes severe sharp or burning pain in your hands or feet. This condition can be difficult to detect or diagnose.
Striatonigral degeneration
This progressive neurodegenerative disorder is a type of multiple system atrophy (MSA). It is caused by a disruption in the connection between two areas of your brain involved in movement, the striatum and the substantia nigra. This disruption leads to symptoms similar to Parkinson’s disease, like tremors and a lack of balance.
Sweat disorders
Sweat disorders include lack of sweating (anhidrosis), excessive sweating (hyperhidrosis), and inflammation of sweat glands (hidradenitis).
Vasovagal syncope (fainting)
This common cause of fainting can occur when your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress. Vasovagal syncope leads to a sudden drop in heart rate and blood pressure.
Treatments for Autonomic Disorders
Stanford Health Care Autonomic Disorders Program doctors are renowned for their highly specialized expertise and experience in treating autonomic disorders, a rare specialty. Only about 150 doctors worldwide have the expertise level needed to diagnose and treat autonomic disorders.
INNOVATION HIGHLIGHTS
- We’re the only hospital in California with a comprehensive autonomic testing laboratory.
- Our expert diagnosticians have experience with challenging diagnoses and rare conditions, including those affecting multiple systems of the body.
- We provide same-day autonomic testing and consultation for out-of-state patients.
- We bring together specialists across many disciplines for seamless, coordinated care.
- We’ve partnered with the Stanford Post-Acute COVID Syndrome (PACS) multidisciplinary clinic to help treat patients with long COVID.
Autonomic Testing
Autonomic testing measures how your autonomic nervous system reacts to stimuli to determine which portions of it are and are not functioning as they should. The Autonomic Testing Laboratory at Stanford Health Care is one of only a few comprehensive autonomic testing laboratories on the West Coast.
During autonomic testing, you lie on a long, flat examination table with a foot board and an electrocardiogram (EKG). Your doctor places respiration monitors on your torso. We put a blood pressure monitor on your finger that squeezes and releases to take a continuous reading for the duration of the test. These testing procedures provide information about your autonomic nervous system, including what is working well and what is not working well.
Cardiovascular Testing with Head-Up Tilt
This autonomic test measures your heart rate and blood pressure as you change positions. The table you are lying on is tilted slowly to a semi-upright position of 70 degrees to see how your body responds.
Deep Breathing
We will ask you to breathe in and out for one minute as we record your blood pressure, chest expansion, and heart rate.
Quantitative Sudomotor Axon Reflex Test (QSART)
QSART measures your sweating ability through your autonomic nerves using a unique device called a sudorometer. We see how your nerves and sweat glands respond to a painless electrical current passing through your arms, legs, and feet.
Thermoregulatory Sweat Test (TST)
TST measures your temperature regulation and sweating ability in a specialized room with controlled temperature, humidity, and air flow capabilities. Stanford Health Care has the only lab on the West Coast with a first-of-its-kind, custom-built TST room.
Valsalva Maneuver
We will ask you to breathe out forcefully through a mouthpiece, with your nose pinched shut, to look for changes in your blood pressure and heart rate.
Gastrointestinal Tests
If you have problems with digestion, we may suggest gastric-emptying tests to see how fast food leaves your stomach or colonic tests to see how fast food leaves your body.
Urine and Bladder Tests
If you have bladder or urinary symptoms, we can look at your bladder and urinary tract functions with tests that look at how your lower urinary tract works (urodynamic tests), urine tests (urinalysis), or ultrasound.
Treatment Options
We first aim to treat your underlying condition and to help you to manage your symptoms. We customize your plan based on your condition, needs, and health goals. Treatments you receive may include:
Diet and Lifestyle Modification
In addition to medical treatment, our doctors may recommend changes to your diet and lifestyle to help you control your symptoms.
Diet modifications can be particularly helpful if you have orthostatic hypotension. Our dietitians will work with you on a personalized plan to increase fiber, fluid, or salt intake, if needed. If you have autonomic disorders related to diabetes, we’ll help you control your blood sugar to prevent further nerve damage.
Your care team also supports you in making other lifestyle changes that can help reduce your symptoms. Depending on your condition, these changes may include:
- Raising the head of your bed to lower blood pressure at night
- Following an exercise regimen appropriate for your condition
- Using a walking device to prevent falls
- Wearing compression stockings or a waist binder to help with blood flow
Medications
Depending on your condition and symptoms, we may recommend medications to:
- Allow you to empty your bladder or decrease an overactive bladder
- Decrease or improve sweating
- Help with digestive problems
- Improve sexual symptoms, such as erectile dysfunction or vagin*l dryness
- Manage your blood pressure
- Reduce nerve pain
- Regulate your heart rate
- Treat Parkinson’s disease symptoms
Whole-Person Care
Care for autonomic disorders goes beyond medical treatments. We encircle you and your family with supportive services to help treat your mind, body, and soul.
