What is Dysautonomia?

Jul 28

Dysautonomia is a term that refers to a number of conditions that produce dysfunction of the autonomic nervous system. The autonomic nervous system is responsible for controlling critical unconscious processes including blood pressure, heart rate, respiration, and digestion among others. People living with dysautonomia have difficulty regulating these functions, which can lead to light-headedness and fainting, unstable heart rates and blood pressure, digestive difficulties and more.

Dysautonomia can occur as a primary condition or secondary to other disorders.

Different forms of primary dysautonomia include:

Neurocardiogenic Syncope
Postural Orthostatic Tachycardia Syndrome (POTS)
Familial Dysautonomia
Multiple System Atrophy
Orthostatic Intolerance

Dysautonomia can also develop secondary to conditions including:

Traumatic Brain Injury
Post-Concussion Syndrome
Mast Cell Activation Syndrome
Ehlers-Danlos Syndrome
Chronic Fatigue Syndrome
Joint Hypermobility Syndrome
Multiple Sclerosis
Parkinson’s Disease
Rheumatoid Arthritis
Diabetes
Lupus
Celiac Disease
Lyme Disease

How Common is Dysautonomia?

Dysautonomia is a relatively common disorder. Over 70 million people worldwide suffer from some form of dysautonomia (1). Despite this, many medical professionals lack awareness of dysautonomia. This can result in it taking years and seeing multiple providers before someone living with dysautonomia receives a proper diagnosis.

There is no one cure for dysautonomia, and most therapy is geared towards managing symptoms.

What are the Symptoms of Dysautonomia?

People living with dysautonomia tend to struggle with headaches, fatigue, fainting or syncope, light and sound sensitivity, elevated or unstable heart rates, unstable blood pressure, dizziness, vertigo, feelings of nausea, brain fog, and cognitive difficulties.

They can also experience balance problems, chest pain, constipation and diarrhea, frequent urination, erectile dysfunction, exercise intolerance, shortness of breath, sleep problems, swallowing difficulty, tremors, mood swings, anxiety, and depression.

Symptoms of dysautonomia will vary between patients, and will tend to wax and wane over time. No two cases of dysautonomia are alike.

Dysautonomia symptoms can be provoked by heat, fatigue, dehydration, alcohol consumption, exertion, and emotional stress. The connection with emotional stress unfortunately leads to many people living with dysautonomia being misdiagnosed as having psychogenic conditions.

What Causes Dysautonomia?

Dysautonomia can be caused by an array of different insults and conditions. It may be a primary condition, a feature of a neurodegenerative condition, or be acquired secondary to something like a viral infection, toxic exposure, or traumatic injury. There is no single cause for dysautonomia.

How is Dysautonomia Diagnosed?

Dysautonomia is usually diagnosed with a tilt table test. A patient lays on a motorized table that can elevate to different angles while their heart rate and blood pressure is monitored. Inappropriate changes in heart rate and blood pressure between lying and standing confirm the presence of dysautonomia.

It is important to understand that many people with secondary dysautonomia often pass a tilt table test. There are specific criteria that must be met to fail this test, and these values are derived from primary dysautonomias. For example, a patient would be expected to have an excessive (greater than 30 beats per minute) increase in heart rate when elevated from the lying position, with only a small (less than 20 mm Hg) increase in blood pressure (20). When dysautonomia develops secondary to a concussion, an autoimmune disease, or some other condition, the changes in autonomic function may not reach the level needed for a primary dysautonomia diagnosis and yet still be a major cause of a person’s symptoms.

What is Going on in the Nervous System with Dysautonomia?

Normally we don't have to think about the act of breathing, or have to be aware of the digestion of our last meal. These functions are controlled by the autonomic nervous system, or ANS. The ANS is responsible for regulating all of our critical unconscious functions. It allows us to maintain steady blood pressure, controls our breathing, regulates our body temperature, and controls heart rate. It also controls digestion, sexual function, pupil dilation, and a host of other secondary functions. All of our vital functions are under autonomic control (15).

The autonomic nervous system is responsible for ensuring that blood is properly supplied to the entire body. In order to do so, it needs to understand where the body is in space, and where the body and head are in relation to gravity.

When we stand up, gravity pulls blood down towards the ground. The ANS needs to sense the change in blood pressure so that it can properly adjust blood flow to the brain and body. It senses changes in blood pressure through stretch receptors in the aortic arch and carotid arteries called baroreceptors. When blood pressure drops, baroreceptor stretch decreases, and this tells the ANS to constrict other blood vessels to shunt blood back up to the brain (13).

Baroreceptor pressure is only one part of the dysautonomia equation. In order to properly regulate blood flow, the brain needs to know exactly where the body is in space, and where the head is in relation to gravity. It receives this information from receptors in muscles and joints that create an unconscious sense called proprioception. It also receives input from the vestibular system, where inner ear receptors inform it about the position of the head in relation to gravity and how the head is moving.

There are types of dysautonomia that involve direct damage to baroreceptors (16). There are others that involve the immune system directly attacking ANS nerve fibers. Still others such as Ehlers Danlos Syndrome involve excessive stretch of blood vessels, making it difficult to sustain normal blood pressure.

Virtually all forms of dysautonomia involve poor coordination between the baroreceptor system, the proprioceptive system, and the vestibular system (14).

The brain uses maps to understand where the body is in relation to gravity, what the stresses are on body parts and how they are moving, what the demands for blood flow are to perform a task, and how much blood the brain needs to receive in a given position. There are vestibular maps, visual maps, proprioceptive maps, and vascular maps. When these maps do not properly match, the nervous system is unable to properly send blood where and when it is needed, including to the brain itself (17).

Nearly all of the symptoms of dysautonomia directly result from this problem. Lack of blood flow to the brain creates dizziness, fatigue, and brain fog. Secondary reflexes may kick in to attempt to increase blood flow, such as elevated heart rate. Adrenaline surges can result that lead to anxiety and chest pain (14).

How is Dysautonomia Usually Treated?

There is no current cure for primary dysautonomia. Secondary forms of dysautonomia often improve when their underlying condition is treated.

Treatment is usually geared toward reducing symptoms, and may involve medications to help regulate heart rate and increase blood volume, exercise therapy to build stamina, and counseling to help address the cognitive and emotional challenges from living with the condition.

How Is The NeuroRescue Program Different?

One of the main things your brain does, and maybe even the primary thing, is to help you determine where you are in the world. Your brain uses vestibular inputs from your inner ear to figure out where your head is in relation to gravity and how it is moving. It uses proprioception from your muscles and joints to figure out where your body is in relation to your head and what your body is doing. It uses inputs from your eyes to figure out where your body is within the visual environment.

Your brain needs to put all of these inputs together to make sense of where the world is, and where you are in the world. It needs to be able to localize you in the world so you can respond to the environment properly.

Many of the functional problems with dysautonomia can be linked to an inability for the brain to integrate inputs from visual, vestibular and proprioceptive systems effectively. When this integration fails, the brain is unable to properly regulate blood flow (18, 19).

The NeuroRescue Program is a comprehensive therapeutic approach that strives to address dysfunction in the visual, vestibular, and proprioceptive systems. More importantly, the program is designed to rehabilitate the integration between these systems. By helping restore appropriate communication between the eyes, the inner ear, and the body, with a series of progressive challenges against gravity, we can help restore proper autonomic regulation. No one can ever guarantee results, and we are not attempting to do so. Some types of dysautonomia are harder to treat than others. That said, we regularly see our approach reduce or even resolve the symptoms of dysautonomia.

How Does the NeuroRescue Program Work?

We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.

We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.

Our examination allows us to identify the areas and pathways of your brain that are involved in your unique dysautonomia presentation. We begin by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.

We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance in different sensory conditions.

We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye-tracking and perception of vertical in a virtual reality environment.

We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.

We use this information to identify which parts of your brain are working properly, which systems are struggling, and the precise point at which your systems fatigue.

We can then design a NeuroRescue Program that is unique and specific to your brain and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your brain. It works to improve energy, endurance, and functional capacity within your fragile systems.

Our therapies to treat your dysautonomia may range from specific eye exercises [6], to specific types of vestibular therapy [7], to unique forms of electrical stimulation [8]. We may employ laser and LED photobiomodulation [9], or hyperbaric oxygen therapy (10), or repetitive transcranial magnetic stimulation (11), or even exercises in a virtual reality environment [12]. All of our therapies will be specific to your unique case, based purely on your neurodiagnostic testing data and examination findings.

We use our technologies and procedures to not only see what we need to address but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy and provide metabolic support to improve neurological recovery.

While we cannot bring back neurons that have been lost, your NeuroRescue Program allows us to take the pathways that remain and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to return you to living a healthy, vibrant, and fulfilling life.

Your Next Best Step:

To see if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day. And remember, it’s never too late to start getting better.