2023 Workshop Handout Bundle-Autonomic Testing Using Live Demonstration (Dr. Chawla)

Autonomic Testing Using Live Demonstration (Dr. Chawla)

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Dr. Jasvinder Chawla's presentation for the 2023 AANEM Annual Meeting in Phoenix, AZ on "Autonomic Testing Using Live Demonstration" aims to elucidate the procedure and significance of various autonomic function tests. Autonomic nerve disorders impact the autonomic nervous system, which controls involuntary functions like heart rate, blood pressure, body temperature, perspiration, and bowel and bladder functions.<br /><br />**Objectives:** <br />1. Perform quantitative sudomotor axon reflex testing (QSART), heart rate variability studies, and the Valsalva Maneuver.<br />2. Apply these techniques in standard electrodiagnostic (EDX) practices.<br /><br />**Case Studies:**<br />- **Case 1:** A 39-year-old man with type 1 diabetes mellitus (DM) for 16 years experiences a burning sensation in his feet for six months. Results indicate length-dependent sudomotor dysfunction, consistent with small fiber autonomic neuropathy and mild cardiovagal dysfunction.<br />- **Case 2:** A 61-year-old woman with hypertension (HTN), coronary artery disease (CAD), and type 2 DM for seven years suffers from postural dizziness and falls. Testing shows orthostatic hypotension with adrenergic dysfunction but normal sudomotor and cardiovagal functions.<br /><br />**Tests:**<br />- **QSART:** Measures postganglionic sudomotor function by assessing sweat output in response to acetylcholine iontophoresis. Several body sites are tested for sweat production to evaluate the extent and distribution of autonomic dysfunction.<br />- **Valsalva Maneuver:** Assesses cardiovascular responses to a standardized pressure held against the chest and abdomen. Abnormal responses indicate adrenergic failure.<br />- **Heart Rate Variability:** Measures the heart rate response to deep breathing, highlighting parasympathetic function.<br /><br />**Process and Importance:**<br />Tests are non-invasive and provide quantitative assessments. QSART is particularly sensitive for detecting peripheral autonomic neuropathies but cannot exclude suspected small fiber neuropathy if results are normal. Other tests like deep breathing responses and the tilt table test are included to assess cardiovascular parasympathetic function and orthostatic intolerance.<br /><br />**Key Findings:**<br />- Tests help differentiate types and extents of autonomic failure, offering crucial insights into managing and diagnosing conditions impacting the autonomic nervous system.<br />- Abnormal responses in the Valsalva Maneuver or heart rate variability can be early indicators of specific neuropathies or systemic conditions like diabetes.<br /><br />The aim is to enhance the utilization of autonomic testing in clinical practice while providing a clear understanding of interpreting these tests accurately.

Keywords

Autonomic Testing

Live Demonstration

Autonomic Nerve Disorders

Quantitative Sudomotor Axon Reflex Testing

Heart Rate Variability

Valsalva Maneuver

Small Fiber Neuropathy

Orthostatic Hypotension

Electrodiagnostic Practices

Peripheral Autonomic Neuropathies