Autonomic Nervous System
The autonomic nervous system regulates functions of your body that happen automatically, such as your heart rate, blood pressure, breathing, digestion, and temperature control. The system is made up of two main divisions: sympathetic and parasympathetic.
The sympathetic system is better known as “fight or flight” and prepares your body for stressful situations. Imagine if you were on a walk and saw an angry bear running toward you. Your heart rate and blood pressure would increase, your muscles would tighten, and you would become very focused on the threat you face. This is your sympathetic nervous system kicking in.
The other division of the autonomic nervous system is the parasympathetic system. This system is referred to as “rest and digest” and controls body processes during normal, everyday situations. It lowers your heart rate and blood pressure, stimulates digestion, and relaxes your muscles.
The sympathetic and parasympathetic systems work well together to bring balance to the body. However, issues can arise when these systems are not functioning properly.
What happens when the autonomic nervous system malfunctions?
Dysautonomia is the term used to describe a dysfunction of the autonomic nervous system. Since this system regulates a large portion of the body’s functions, a variety of symptoms can be felt when it’s not working properly. Physical symptoms include dizziness, fatigue, fainting, chronic pain, headaches, abnormal sweating, shakiness, breathlessness, nausea, vision issues and more. There are many types of dysautonomia, but the most common are postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension and neurocardiogenic syncope.
POTS: Patients with POTS have tachycardia (or a fast heart rate) when standing, due to inadequate blood flow in their bodies. A tilt table test is usually used to diagnosis the syndrome. During the test, the patient lays flat on a table as their heart rate, oxygen levels, and blood pressure is monitored. The table is then tilted slowly up to 90 degrees. Normally your heart rate should increase by around 10 – 20 beats per minute as your body adjusts to standing up. For adults, if your heart rate increases by more than 30 beats than you’re diagnosed with POTS. For children and adolescents, the heart rate would increase by more than 40 beats per minute.
Orthostatic Hypotension: If your blood pressure drops against gravity that is known as orthostatic hypotension. If your systolic, or the top number in your blood pressure, drops more than 20 mmHg or if the diastolic, the bottom number, drops more than 10 mmHg then you meet the criteria to be diagnosed with orthostatic hypotension.
Neurocardiogenic Syncope: Neurocardiogenic syncope (also known as vasovagal syncope) occurs when your heart rate and blood pressure drop and cause you to faint. This could be mild to severe in nature and may cause further issues, such as concussions which are common among people with neurocardiogenic syncope. A tilt table test is also used in the diagnosis of neurocardiogenic syncope.
In all cases of suspected dysautonomia, it is important to first rule out any organic issue with your heart that could be causing these symptoms. If your cardiologist clears you, then the next step is to find a functional neurologist who commonly treats these types of conditions.
Finding an original cause for dysautonomia can be difficult. Some people develop symptoms gradually, while others have them happen suddenly after a specific event. Most commonly, people will develop dysautonomia following a concussion, which may or may not have been previously diagnosed. Other possible causes include infections such as Epstein Barr and Lyme Disease, genetic disorders, diabetes, physical trauma, pregnancy and surgery. Anyone can develop dysautonomia, but studies show that it is more prevalent among women between the ages of 15 and 50.
Unfortunately, many patients are misdiagnosed for years before learning about dysautonomia. Research by Dysautonomia International found that people with POTS see an average of seven doctors and are misdiagnosed for an average of 4.2 years prior to being diagnosed.
How do you treat dysautonomia?
In traditional medicine, medications are commonly prescribed to help regulate your heart rate and blood pressure, and increase serotonin in the brain. Patients are also encouraged to increase fluid and salt intake, wear compression socks, and participate in physical therapy and gradual exercise programs. Functional neurologists have a different approach to treating dysautonomia. Functional neurology focuses on the concept of neuroplasticity, or the brain’s ability to change based on environmental, emotional and physical stimuli. Since dysautonomia patients have issues with their nervous system, functional neurologists are able to combine their knowledge of neuroplasticity with treatments that activate the nervous system and encourage positive, healing changes to take place without the use of medications or surgery. At Carolina Functional Neurology, we commonly see patients that have all of the symptoms of dysautonomia but are told by their doctors that there is nothing wrong. This is often due to the fact that the patient doesn’t meet the full diagnostic criteria for a particular disorder. They may be close to getting a diagnosis but miss by margins and their symptoms continue or worsen. We, unfortunately, see this far too often – where our patients “fly under the radar” and are misdiagnosed (especially with anxiety) and undertreated. We take a different approach and look at the patient as a whole to find the root cause of their symptoms. An initial assessment of a dysautonomia patient includes a comprehensive bedside neurological exam, tilt table test, detailed eye movement exam (video-oculography), balance testing (computerized posturography), and lab work. Through these tests, we’re able to pinpoint areas of the brain or pathways in the brain that are dysfunctional and the root cause of the patient’s symptoms. Once test results are in, we create a customized plan to restore normal autonomic nervous system function. Treatment may include tilt table therapy, neuromodulation to activate different cranial nerves through sensory stimulation (such as the vagus nerve), eye movement exercises, vestibular rehabilitation, interactive metronome, hyperbaric oxygen therapy, nutritional counseling, and cognitive exercises. Through neurological rehabilitation, we are able to correct dysfunctions of the nervous system to greatly decrease or eliminate symptoms. Our goal is to find the root cause of your symptoms, not mask them, and create positive changes in the brain, leaving you with little to no symptoms and back to living a normal, healthy life.
Do you have dysautonomia?
If you are experiencing the symptoms detailed above, you may have dysautonomia. You do not have to keep living with these troubling and debilitating symptoms. Healing is possible and we are here to help.