2025 Workshop Handout Bundle-W02B Autonomic Testing Using Live Demonstration Chawla

W02B Autonomic Testing Using Live Demonstration Chawla

Pdf Summary

The 2025 workshop "Autonomic Testing Using Live Demonstration," led by neurologist Jasvinder PS Chawla, M.D., MBA, FAAN, FAANEM at Midwestern University School of Medicine, focuses on quantitative autonomic function tests and their application in electrodiagnostic (EDX) practice. The session covers three main tests: Quantitative Sudomotor Axon Reflex Test (QSART), Heart Rate Variability (HRV) studies, and the Valsalva Maneuver.<br /><br />Autonomic nerve disorders involve dysfunction of the autonomic nervous system, which controls involuntary bodily functions such as heart rate, blood pressure, temperature, sweating, and bowel/bladder activity. Two clinical cases illustrate typical presentations: a 39-year-old man with diabetic neuropathy symptoms including burning feet and erectile dysfunction, and a 61-year-old woman with hypertension, coronary artery disease, and type 2 diabetes experiencing orthostatic hypotension and sensory loss.<br /><br />QSART is highlighted as a sensitive test of postganglionic sudomotor (sweat gland) function, using acetylcholine iontophoresis to stimulate sweat output measured from specific skin sites on the forearm, leg, and foot. However, normal QSART does not exclude small fiber neuropathy, and abnormalities can occur in other conditions like dysautonomias or skin disorders.<br /><br />Cardiovascular parasympathetic function is assessed by heart rate responses to deep breathing and the Valsalva maneuver. HR variability during deep breaths reflects vagal tone; normal values depend on age. The Valsalva maneuver, involving forced expiration against resistance, tests adrenergic (sympathetic) cardiovascular responses, with specific phases reflecting blood pressure and heart rate changes. Abnormal Valsalva responses indicate adrenergic failure.<br /><br />The workshop provides clinical insight into autonomic testing's interpretation, utility, and limitations, supported by literature references. Participants are encouraged to apply these methods to standard diagnostic protocols for autonomic neuropathies. Feedback and CME credit procedures for attendees are facilitated through the AANEM app.

Keywords

Autonomic Testing

Quantitative Sudomotor Axon Reflex Test

QSART

Heart Rate Variability

HRV

Valsalva Maneuver

Autonomic Nerve Disorders

Electrodiagnostic Practice

Diabetic Neuropathy

Adrenergic Failure