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What Causes Autonomic Neuropathy And Sudomotor Dysfunction?

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Posted on Fri, 10 Jun 2016
Question: Can you explain what is autonomic peripheral neoropath and sudimotor dysfunction?...after 19 months of being treated for POTS
doctor
Answered by Dr. Dariush Saghafi (35 minutes later)
Brief Answer:
Definition of peripheral neuropathy of the autonomic system

Detailed Answer:
Good morning.

Autonomic peripheral neuropathy can be restated in the following way which may make it a bit easier to give a plain English explanation:

NEUROPATHY of the Autonomic Nervous System. In actuality the word "peripheral" is an overstatement of the facts since by DEFINITION when we say AUTONOMIC system we are already in a subdivision of the PERIPHERAL nervous system. There are higher control centers in the brain and so forth but again, I didn't make these definitions up...smarter people did! LOL....

So, NEUROPATHY of the Autonomic Nervous System is what we shall define for you.

NEUROPATHY- Malfunctioning Nerve(s).

Autonomic Nervous System- That portion of the peripheral nervous system in the human body comprised of nerve cells and their component parts responsible for activating (stimulating) or deactivating (inhibiting) functions of the body not under voluntary control (eg. heartrate, blood pressure, sweating, GI motility, piloerection, pupillary reactions to light, etc.).

In fact, SUDOMOTOR DYSFUNCTION very nicely fits into this rubrick of autonomic neuropathy since it is another way of saying SWEATING problems.

So there you have it....

Autonomic neuropathy is the MALFUNCTION of nerves that control automatic bodily functions. Those functions can either be to stimulate things such as heart rate, elevate blood pressure, increased sweating....OR they can be nerve signals that cause all the reverse to occur. You've heard of the FIGHT OR FLIGHT mode that your body takes when it's in danger or perceived danger? Well, it's precisely the Autonomic Nervous System that takes over what happens to bodily functions when you are in that split second decision making process of what to do....stand and defend your ground...or turn tail and run.

And as I said, sudomotor dysfunction is a part of autonomic neuropathy since it refers to SWEATING PROBLEMS. The sweat system doesn't respond as it normally should to either stress situations or what have you...and people can profusely sweat when they don't want to or when there's really no need...or the reverse which is NOT SWEAT when they absolutely should or need to based on environmental conditions,etc. It does not ALWAYS have to be involved in autonomic neuropathy but is often tested when looking at the overall integrity of the system.

So someone with POTS as in your case who has an exaggerated response to heart rate or inappropriate response when it comes to blood pressure associated with postural changes, etc. may be suffering from an AUTONOMIC NEUROPATHY and must be tested. There are a whole battery of tests that are performed with sudomotor testing (sweat testing) being one of them. If that test reveals DYSFUNCTION then, it tells us that your sweat system (part of your autonomic system) is not working properly. Then, the cause needs to be searched for and treated or eliminated if possible.

If I have satisfactorily addressed your questions or concerns would you do the kind favor of CLOSING THIS QUERY and be sure to include some fine words of feedback on your opinion as to our transaction?

Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 24 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (53 minutes later)
Hello and thank you Dr. Saghafi,

Not named and defined by people smarter, named by people trying to sound more intelligent. LOL
At the moment, I'm feeling pretty stupid but that happens a lot since the accident caused the TBI. My brain goes completely blank when it is very close to putting all the information with something together. My cognitive processes shut down because it cannot put the final piece together. This time is was just eliminate the peripheral and run with Autonomic Neuropathy and I would of had complete understanding.

Dr's are planning on running a QSART test soon. I already know what the results will be, positive. I don't sweat, not even in a sauna. So how is that treated.or can it? Spring has just started and I've already have had my AC on for over a week.

Right now my biggest problem seems to be the tachycardia. At most I can stand.for four in half.minutes because my HR will drop into the 20's, it only takes seconds after my therapist make me sit down that my HR will raise, sadly it over compensates and will go between 140-190's, then we wait for it to get down into the 80's before we resume therapy....I know, I'm going to.need a pacemakers, not happy about it and don't even know if I can get myself to do it....would be dead, if CA didn't have a law where they could get an emergency court order to do surgery when I was having an appendicitis.

So other than putting me on meds to raise my BP, pacemaker, drink a.lot.of water and consume tons of sodium, How is this treated differently than POTS?

Forgot to add. I pretty much live constantly in the flight stage. Is there anyway this can be stopped. As you can probably imagine, it's not a fun stage to constantly be I'm
doctor
Answered by Dr. Dariush Saghafi (20 hours later)
Brief Answer:
SUDOMOTOR DYSFUNCTION

Detailed Answer:
Hi. Thanks for your return response. As in the treatment of any problem in medicine the best way to confront any problem is by knowing the cause. Therefore, if possible your doctors will or have tried to determine the underlying reason that you're not sweating. In general, neuropathies can be caused by metabolic disorders, chronic infections, medications, and compression of autonomic ganglia by things such as tumors, "bad humors" caused by TUMORS caused neuropathic symptoms, hyperglycemia (eg diabetes under poor control), and poor oxygenation chronically. There are other causes but if anything can be determined as being the cause then, clearly a targeted treatment plan can be developed with much more chance of success.

Ways to treat POTS also includes fluid intake....but if you are consuming for than 1/2-3/4 of a gallon then, I'm wondering if that may not be contributing to what your feeling?

If the cause of the primary problem cannot be found then, generic types of treatments may be tried such as calcium channel blockers, low dose beta blockade which actually can RAISE BLOOD PRESSURE, and then, of course, the litany of compression stockings, SALT TABLET fluids, and then, ACE WRAPS to wear when the air compression stockings are not being worn.

I wish you a speedy and healthy recovery.

If I've answered your questions adequately please feel free to CLOSE THE QUERY and make a few brief comments as to the quality of my response. This query required 18 minutes to read, research, and respond to courses of things needed to be done to support normal EKG reads...if possible.

I think that a live counselor for several readjustment period types of accumulation of things beneficial to those with autonomic dysfunction would be a good thing to review and present.

Once again, I appreciate the opportunity to answer your question and so if I have satisfactorily addressed your concerns would you be so kind as to CLOSE THIS QUERY and include a little positive feedback on my responses to your questions?

Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 20 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (32 minutes later)
Thank you, Dr. XXXXXXX

You answered my questions very well. Sadly, I still have no answers. I do not have any of the health issues you mentioned.

As for water, I drink no less than a gallon a day, consume at least 9,000mg of sodium daily.....starting to HATE bullion. I'm on 12 meds, most to treat the symptoms of the POTS and all of them have been picked because they raise BP. I wear 40mmHz waist(diaphragm) high compression stockings, biking shorts, compression shirts, abdominal binder and a thoracic corset brace.

Thank you again. seriously appreciate the time you spent researching and responding to me

XXXX

Hello Dr. XXXXXXX
I have two more question with this topic.

POTS is considered an Autonomic Disorder according to the research I have done. Is something different between POTS and Autonomic Neuropathy? They seem to have the same list of symptoms and affect the body in the same ways, unless I'm missing something with my cognitive issues.

We have talked about the fact I do not sweat but I've been thinking not one Dr. I have seen over the last five years has ever asked me any questions concerning me sweating or not.

My cardiologist started on me seeing someone who treats Autonomic Neuropathy and the QSART test after I emailed him when I got released from the rehab and told him that tachycardia symptoms became more problematic than orthostatic symptoms. Which was not the case for years and seemed to hit over night.... Dr's at the rehab had a few ideas that make sense. Doubt we will ever know which one is correct.

Why would the tachycardia have my cardiologist thinking that I have an Autonomic Neuropathy and not just POTS (which is one unless you explain differently to me), I have spoken to other POTS patients that experienced the same symptom of drastic HR drops, most of them thou had always had more problems with tachycardia aspect of POTS.

XXXX
doctor
Answered by Dr. Dariush Saghafi (46 hours later)
Brief Answer:
2 more questions at your service young lady

Detailed Answer:
Good evening. Please note the following responses as additional information on Autonomic Neuropathy.

Autonomic Neuropathy (previously defined)- Nerve Dysfunction within the AUTONOMIC SYSTEM resulting in functional problems of body organs and systems NOT UNDER VOLUNTARY CONTROL.

POTS (Postural Orthostatic Tachycardic Syndrome)- A specific TYPE of Autonomic Neuropathy IF AND WHEN it is actually caused by that problem.

In other words, POTS can be a specific consequence of autonomic neuropathy but so can many other disease processes. Make sense?

Let's not forget that NOT ALL CASES of POTS are caused by neuropathy. Some cases are caused by low circulating blood volume or even central control problems in the brain which have nothing to do with autonomic neuropathy. It can be secondary to diabetes, postviral illnesses, or in association with chronic fatigue syndrome, thyroid and other endocrine problems, or GI processes which result in diarrhea or malaborption. And there there are genetic causes which have nothing to do with autonomic neuropathy.

In other words, there are MANY different causes for POTS which have nothing to do with neuropathies (autonomic or otherwise).

Now, I want to clarify something about what you've said on a couple of occasions and that is LOW HEART RATE in POTS patients or in yourself for that matter. The definition of POTS and its clinical characteristics does not allow for low heart rate (bradycardia) which is defined as less than 60 beats per minute. In other words, POTS as an entity in no way includes a low heart rate UNLESS the low heart rate is secondary to another SEPARATE problem from the POTS such as a cardiac conduction system defect because of heart attack, hemorrhage, traumatic, stroke, or something that causes low heart rate.

Look at it from this direction. What does the acronym stand for?

POTS= Postural Orthostatic TACHYCARDIC Syndrome. Bradycardia (low heart rate) would be entirely contrary to the definition and simply does not occur as part of the syndrome.

I thank you for your questions and am hopeful that you've found these multiple responses satisfying and informative. Would you do me the favor of closing this query and including some good words of feedback on our interactions? I would love to hear as well the outcome of your situation down the road once your cardiologist or whomever checks you out and comes to some conclusion as to the cause of your problems.

Write to me at www.bit.ly/drdariushsaghafi

This query has utilized a total of 92 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2473 Questions

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What Causes Autonomic Neuropathy And Sudomotor Dysfunction?

Brief Answer: Definition of peripheral neuropathy of the autonomic system Detailed Answer: Good morning. Autonomic peripheral neuropathy can be restated in the following way which may make it a bit easier to give a plain English explanation: NEUROPATHY of the Autonomic Nervous System. In actuality the word "peripheral" is an overstatement of the facts since by DEFINITION when we say AUTONOMIC system we are already in a subdivision of the PERIPHERAL nervous system. There are higher control centers in the brain and so forth but again, I didn't make these definitions up...smarter people did! LOL.... So, NEUROPATHY of the Autonomic Nervous System is what we shall define for you. NEUROPATHY- Malfunctioning Nerve(s). Autonomic Nervous System- That portion of the peripheral nervous system in the human body comprised of nerve cells and their component parts responsible for activating (stimulating) or deactivating (inhibiting) functions of the body not under voluntary control (eg. heartrate, blood pressure, sweating, GI motility, piloerection, pupillary reactions to light, etc.). In fact, SUDOMOTOR DYSFUNCTION very nicely fits into this rubrick of autonomic neuropathy since it is another way of saying SWEATING problems. So there you have it.... Autonomic neuropathy is the MALFUNCTION of nerves that control automatic bodily functions. Those functions can either be to stimulate things such as heart rate, elevate blood pressure, increased sweating....OR they can be nerve signals that cause all the reverse to occur. You've heard of the FIGHT OR FLIGHT mode that your body takes when it's in danger or perceived danger? Well, it's precisely the Autonomic Nervous System that takes over what happens to bodily functions when you are in that split second decision making process of what to do....stand and defend your ground...or turn tail and run. And as I said, sudomotor dysfunction is a part of autonomic neuropathy since it refers to SWEATING PROBLEMS. The sweat system doesn't respond as it normally should to either stress situations or what have you...and people can profusely sweat when they don't want to or when there's really no need...or the reverse which is NOT SWEAT when they absolutely should or need to based on environmental conditions,etc. It does not ALWAYS have to be involved in autonomic neuropathy but is often tested when looking at the overall integrity of the system. So someone with POTS as in your case who has an exaggerated response to heart rate or inappropriate response when it comes to blood pressure associated with postural changes, etc. may be suffering from an AUTONOMIC NEUROPATHY and must be tested. There are a whole battery of tests that are performed with sudomotor testing (sweat testing) being one of them. If that test reveals DYSFUNCTION then, it tells us that your sweat system (part of your autonomic system) is not working properly. Then, the cause needs to be searched for and treated or eliminated if possible. If I have satisfactorily addressed your questions or concerns would you do the kind favor of CLOSING THIS QUERY and be sure to include some fine words of feedback on your opinion as to our transaction? Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. This query has utilized a total of 24 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.