The treatment of autonomic dysfunction

Area of Science:

• Neurology
• Autonomic Nervous System Disorders

Background:

• Autonomic dysfunction is a major cause of morbidity in neurological conditions like Parkinson's disease and multiple sclerosis.
• It also affects rarer primary autonomic nervous system degenerations.
• Symptoms frequently encountered by neurologists include orthostatic hypotension, urinary issues, and bowel dysmotility.

Purpose of the Study:

• To review the treatment of common autonomic dysfunctions presenting to neurologists.
• To discuss the pathophysiology underlying these conditions to inform rational therapeutic approaches.
• To provide an overview of current therapeutic options for specific autonomic symptoms.

Main Methods:

• Literature review focusing on therapeutic strategies for autonomic dysfunction.
• Discussion of pathophysiology linked to treatment rationales.
• Categorization of treatments based on the specific autonomic symptom addressed.

Main Results:

• Orthostatic hypotension management involves mineralocorticoids, sympathomimetics, pressors, dopamine blockers, and vasopressin agonists.
• Urinary incontinence and retention treatments focus on drugs affecting bladder contractility and outlet resistance.
• Bowel dysmotility syndromes (gastroparesis, diarrhea, fecal incontinence) are managed with bulk agents, laxatives, prokinetics, and antidiarrheals.

Conclusions:

• Effective management of autonomic dysfunction in neurological disorders requires understanding pathophysiology.
• A range of pharmacological agents are available for treating orthostatic hypotension, urinary dysfunction, and bowel dysmotility.
• Targeted therapies can significantly improve patient morbidity associated with these autonomic symptoms.