Autonomic dysfunction: recognition, diagnosis, investigation, management, and autonomic neurorehabilitation

The autonomic nervous system (ANS), through its central connections and efferent pathways, innervates every organ in the body, influences their function, and is also involved in a number of integrative systems such as those concerned with maintenance of arterial blood pressure, organ perfusion, and body temperature. Responsive functioning of the ANS is thus needed in a variety of situations; it contributes to well being, and is essential for survival. Autonomic dysfunction may occur in a number of neurological diseases and may complicate various medical disorders. This chapter will provide an outline of the scientific principles, followed by classification of autonomic disorders, an outline of the autonomic investigations, brief accounts of some of the key disorders and the pathophysiological mechanisms involved, and discussion of treatment, emphasizing the importance of non-pharmacological methods and, in particular, the role of autonomic neurorehabilitation.