The Stanford Autonomic Disorders Program

The autonomic nervous system plays an important role interfacing the organism internal and external milieu, ensuring body homeostasis and balance: cardiovascular and respiratory control, body temperature regulation, gastrointestinal motility, urinary function, sexual function, and metabolic and endocrine physiology.  The autonomic system also produces the adaptive responses to stress, and is important in integrating the behavioral and physiologic responses.

Autonomic symptoms are common, and as might be expected, can be quite debilitating.  For instance, it is estimated that autonomic dysfunction leading to positional related symptoms of dizziness, lightheadedness and fainting, termed orthostatic intolerance, affects at least 2-3% of the USA population in general, and at least 4% of all children and adolescents.  In the elderly, autonomic dysfunction is a significant contributor to the imbalance and dizziness, leading to risky falls.  Other common and disabling conditions associated with autonomic disorders include: impaired gastrointestinal motility (gastroparesis, cyclic vomiting, irritable bowel syndrome); disorders of regulation of body temperature; sweating disorders, both excessive and lack of sweating; frequent urinary urgency or inability to urinate; a variety of sleep-related disturbances including abnormal breathing: and certain painful conditions such as painful neuropathies and reflex sympathetic dystrophy.  However, a shortcoming in this field has been the difficulty in devising relatively non-invasive methods for reliable testing and integrating the findings with the patient’s clinical symptoms and signs to reach a comprehensive diagnostic approach and management.

We are a leading multidisciplinary autonomic program on the West Coast and in the USA. While other academic centers have nowadays the capacity to perform autonomic testing, we pride ourselves in our large, multidisciplinary approach, involving Neurology, Cardiology, Gastroenterology, Pain Medicine, Rheumatology, Immunology, Hematology, Dermatology, Psychiatry and Pathology. Within the department, we have close integration with Neuromuscular Disorders, Movement Disorders, Headache, Epilepsy, and Sleep. We are also the only Program on the West Coast that evaluates children, adolescents and adults.

We evaluate a large number of patients referred for various autonomic conditions. As expected, syndromes of orthostatic intolerance, mainly orthostatic hypotension and POTS dominate the referrals. But we also see patients with gastrointestinal motility disorders, neurogenic bladder disorders and body temperature dysregulation and sweating disorders.

We are currently involved in many projects. These include new drugs used for the treatment of Neurogenic Orthostatic hypotension.  We have an ongoing longitudinal study looking at sleep disorders in patients with POTS, as well as REM behavior disorder in Alpha Synucleinopathies. We are evaluating sudomotor function in various degenerative conditions, and correlating it with skin biopsy findings. We have a large series of patients with autoimmune mediated autonomic disorders, as well as autoimmune small fiber neuropathy. We are working toward establishing a premier Neurogastroenterology center.

Our autonomic suite has 2 full functioning outpatient labs, one inpatient lab and a thermoregulatory sweat test chamber. We are staffed with 2 full-time neurophysiology technicians, and 2 part-time technicians. We have 2 nurses, one physician assistant and 2 medical assistants. We also have one biomedical engineer who assists us with troubleshooting, and have a full-time research coordinator who assist in our various research projects.

Autonomic Disorders Patient Care

Stanford Health Care  provides expert diagnosis and treatment for autonomic nervous system disorders.