The Autonomic Section of the Neuromuscular Center at Cleveland Clinic is dedicated to providing complete care for patients with autonomic nervous system disorders, including safe, non-invasive and accurate testing of the autonomic nervous system.

Diagnosis

Care begins with an accurate diagnosis of the presenting symptoms. This is accomplished by a thorough history and physical examination focused on the autonomic nervous system. Often, special testing of the autonomic nervous system is needed to assist in the diagnosis. The Autonomic Section offers a comprehensive panel of cardiovascular and sudomotor tests to assess the full spectrum of autonomic disorders.

  • The Cardiovascular Autonomic Test with Tilt assesses how well a patient’s autonomic nervous system controls blood pressure and heart rate during different maneuvers: deep breathing, the Valsalva maneuver and head-up tilt. These tests are particularly helpful in assessing patients with fainting or syncope.
  • The Quantitative Sudomotor Axon Reflex Test (QSART) measures the autonomic nerves that control sweating. This test utilizes a method to stimulate sweat glands and measure the volume of sweat that is produced. The QSART is useful in assessing many autonomic disorders, especially autonomic and small fiber neuropathies as well as some types of pain disorders. The QSART also is helpful in localizing the site of the autonomic disorder to the peripheral or central autonomic nervous system.
  • The Quantitative Sensory Test (QST) measures a patient’s ability to feel vibration and temperature sensation. This test is useful in the assessment of patients with polyneuropathy, especially small fiber neuropathy.
  • The Thermoregulatory Sweat Test (TST) is a measure of a patient’s ability to sweat when stimulated by a warm and humid environment. This test assesses both the central and peripheral autonomic nervous system’s control of sweating and body temperature regulation (thermoregulation). The pattern of sweating abnormality detected by this test can be helpful in diagnosing a variety of neurological and autonomic disorders that may cause reduced sweating (anhidrosis) or excessive sweating (hyperhidrosis). These disorders include small fiber and autonomic neuropathies, radiculopathies, and central autonomic disorders including multiple system atrophy, Parkinson’s disease with autonomic dysfunction, and pure autonomic failure.

Treatment

Care for autonomic disorders is highly individualized and is based on the specific autonomic disorder and the particular medical condition of the patient.

Conditions treated include:

  • Autonomic failure
  • Orthostatic hypotension
  • Orthostatic intolerance
  • Autonomic and small fiber neuropathy
  • Postural orthostatic tachycardia syndrome (POTS)
  • Sweat disorders, such as anhidrosis and hyperhidrosis
  • Certain degenerative diseases, such as multiple system atrophy and autonomic failure in Parkinson disease