Electrodiagnostic assessment of the autonomic nervous system: A consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology

William P. Cheshire, Roy Freeman, Christopher H. Gibbons, Pietro Cortelli, Gregor K. Wenning, Max J. Hilz, Judith M. Spies, Axel Lipp, Paola Sandroni, Naoki Wada, Akiko Mano, Hyun Ah Kim, Kurt Kimpinski, Valeria Iodice, Juan Idiáquez, Pariwat Thaisetthawatkul, Elizabeth A. Coon, Phillip A. Low, Wolfgang Singer

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations

Abstract

Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upon the physician's most astute clinical skills as well as knowledge of autonomic neurology and physiology. Over the last three decades, the development of noninvasive clinical tests that assess the function of autonomic nerves, the validation and standardization of these tests, and the growth of a large body of literature characterizing test results in patients with autonomic disorders have equipped clinical practice further with a valuable set of objective tools to assist diagnosis and prognosis. This review, based on current evidence, outlines an international expert consensus set of recommendations to guide clinical electrodiagnostic autonomic testing. Grading and localization of autonomic deficits incorporates scores from sympathetic cardiovascular adrenergic, parasympathetic cardiovagal, and sudomotor testing, as no single test alone is sufficient to diagnose the degree or distribution of autonomic failure. The composite autonomic severity score (CASS) is a useful score of autonomic failure that is normalized for age and gender. Valid indications for autonomic testing include generalized autonomic failure, regional or selective system syndromes of autonomic impairment, peripheral autonomic neuropathy and ganglionopathy, small fiber neuropathy, orthostatic hypotension, orthostatic intolerance, syncope, neurodegenerative disorders, autonomic hyperactivity, and anhidrosis.

Original languageEnglish (US)
Pages (from-to)666-682
Number of pages17
JournalClinical Neurophysiology
Volume132
Issue number2
DOIs
StatePublished - Feb 2021

Keywords

  • Autonomic
  • Autonomic nervous system diseases
  • Denervation
  • Diabetic autonomic neuropathy
  • Hypotension
  • Orthostatic
  • Tilt table test
  • Valsalva Maneuver

ASJC Scopus subject areas

  • Sensory Systems
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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