The Stanford Autonomic Disorders Program
The autonomic nervous system plays an essential role in controlling our body’s automatic and unconscious functions, such as blood pressure, heart rate, temperature regulation, gastrointestinal motility, urination and sexual function, among other essential functions. 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 US 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 orthostatic hypotension (abnormal drop in blood pressure on standing), postural tachycardia syndrome (POTS, abnormal increase in heart rate on standing along with other systemic symptoms), neutrally-mediated syncope (fainting spells), impaired gastrointestinal motility (gastroparesis, cyclic vomiting, irritable bowel syndrome); disorders of sweating or temperature; regulation frequent urinary urgency or inability to urinate, a variety of sleep-related disturbances including abnormal breathing, and certain painful conditions such as autonomic 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 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 Medicine. While we no longer provide continuity of care for children and adolescents, we still perform autonomic testing and limited consultation on this age group.
We evaluate a large number of patients referred for various autonomic conditions. As expected, syndromes of orthostatic intolerance, mainly orthostatic hypotension and POTS, are most commonly seen. We also see patients with gastrointestinal motility disorders and neurogenic bladder disorders who also have more generalized features of autonomic dysfunction, as well as those with body temperature dysregulation and sweating disorders.
We are currently involved in many projects. These include new drugs used for the treatment of orthostatic hypotension and multiple system atrophy, as well as several ongoing trials in patients with POTS and REM sleep behavior disorder. 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. We are also heavily involved in treating patients with post-COVID dysautonomia and have partnered with the Stanford Post-Acute COVID Syndrome (PACS) multidisciplinary clinic to help treat patients with Long-COVID.
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.