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

Autonomic Testing Using Live Demonstration (Dr. Peltier)

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Dr. Amanda Peltier presented on autonomic testing at the 2023 AANEM Annual Meeting, focusing on laboratory evaluations integral to diagnosing autonomic failure, as guided by American Academy of Neurology's position paper and Current Procedural Terminology (CPT) codes (93660, 95922, 95923, 95924, 95943). The Mayo Clinic's approach, emphasizing non-invasive, quantitative tests, significantly informed the presentation.<br /><br />The primary reason for autonomic testing is suspected generalized autonomic failure, connected to multiple system atrophy (MSA), pure autonomic failure (PAF), and autonomic neuropathies such as diabetic autonomic neuropathy, amyloid neuropathy, and Sjogren’s syndrome. Diagnoses can affect prognoses, with autonomic failure worsening outcomes in MSA, diabetes, and amyloidosis.<br /><br />Autonomic testing is also vital for identifying limited autonomic failure conditions, including syncope, postural tachycardia syndrome (POTS), and distal small fiber neuropathy (DSFN). Diagnostic tests like QSART (Quantitative Sudomotor Axon Reflex Test) or TST (Thermoregulatory Sweat Test) reveal these conditions by evaluating sudomotor function. Preparations for these tests limit substances (food, coffee, nicotine, certain drugs) before procedures.<br /><br />Cardiovagal function tests, such as heart rate response to deep breathing (HRDB) and Valsalva ratio (VR), and beat-to-beat blood pressure recordings, alongside QSART, constitute a comprehensive evaluation. These tests evaluate heart rate variability, BP response, and sudomotor function, essential for understanding autonomic dysfunction severity and response to therapy.<br /><br />Clinical applications include differentiating between benign and life-threatening autonomic disorders, managing orthostatic intolerance, and monitoring disease progression or therapy efficacy. Autonomic labs are crucial in both clinical treatment trials and basic research, offering critical data for diagnosing and managing autonomic failure.

Keywords

autonomic testing

Dr. Amanda Peltier

AANEM Annual Meeting 2023

autonomic failure

CPT codes

Mayo Clinic

multiple system atrophy

diabetic autonomic neuropathy

Quantitative Sudomotor Axon Reflex Test

Valsalva ratio