2024 Workshop Handout Bundle-24W02RTA Autonomic Testing Using Live Demonstration Peltier

24W02RTA Autonomic Testing Using Live Demonstration Peltier

Pdf Summary

The document outlines Dr. Phillip A. Low's presentation at the AANEM 2024 Annual Meeting, focusing on the laboratory evaluation of autonomic function. The American Academy of Neurology underscores the significance of autonomic testing, which complements the clinical autonomic history and examination. Autonomic function tests have aligned with Current Procedural Terminology (CPT) codes and emphasize non-invasive, quantitative methods, particularly those developed at the Mayo Clinic.<br /><br />Indications for autonomic evaluation include generalized conditions like multiple system atrophy (MSA), pure autonomic failure, and various autonomic neuropathies (including diabetic and amyloid neuropathies). The recognition of limited autonomic failure has been crucial in diagnosing conditions such as syncope, distal small fiber neuropathy (DSFN), and postural tachycardia syndrome (POTS), potentially altering disease management strategies.<br /><br />Routine tests undertaken in an autonomic laboratory, often done in a specific sequence, include QSART (Quantitative Sudomotor Axon Reflex Test), heart rate response to deep breathing, the Valsalva maneuver, and head-up tilt tests. These tests evaluate and quantify sudomotor, adrenergic, and cardiovagal functions, essential in detecting autonomic failure and assessing its severity and distribution.<br /><br />The QSART test is detailed, as it evaluates postganglionic sudomotor function using acetylcholine-induced axon-reflex mediation. It’s complemented by cardiovagal function tests such as heart rate response to deep breathing and the Valsalva ratio, which measure the heart's reaction to respiratory phases and a forced exhalation maneuver, respectively. <br /><br />Beat-to-beat blood pressure, recorded during these tests and orthostatic assessments, facilitates understanding of sympathetic and baroreflex functions. The document also references normative data for these tests, highlighting variables like age and gender.<br /><br />The text concludes by identifying equipment essential for an autonomic laboratory and references further details on the American Association of Electrodiagnostic Medicine's website. Dr. Low provides a comprehensive overview that bridges clinical practice and research, emphasizing the importance of autonomic function evaluation in managing and understanding autonomic disorders.

Keywords

autonomic function

Dr. Phillip A. Low

AANEM 2024

autonomic testing

Mayo Clinic

multiple system atrophy

QSART

Valsalva maneuver

head-up tilt tests

autonomic neuropathies