Autonomic dysfunction is known to precede autonomic neuropathy. Autonomic neuropathy can occur with age as autonomic function is proven to decline over time. Further, autonomic dysfunction may also precede the onset of a chronic disease such as diabetes or cardiovascular disease. Whether the autonomic function is primary or secondary to the chronic disease, autonomic dysfunction is usually present. In either case (autonomic dysfunction being primary or secondary), autonomic dysfunction is shown to expedite the complications of such chronic disease if not medically managed.
In the case of patients with diabetes, it is known that diabetic autonomic neuropathy (DAN) leads to the development of cardiac autonomic neuropathy (CAN). Cardiac Autonomic Neuropathy is known to significantly increase the risk of mortality. In fact, a variety of studies indicate that CAN can increase risk of mortality (adverse cardiovascular event) by 1.6 to 2.4 times than those without CAN. Further, other studies indicate that the risk of mortality from CAN is 5 times greater over 5 years. With such great clinical evidence documenting risks from DAN & CAN, clinicians are now more proactive in therapeutic approaches at the onset of symptoms and/or diagnosis. For more details on symptoms, visit diabetic autonomic neuropathy, peripheral autonomic neuropathy & cardiac autonomic neuropathy.
According to the literature, autonomic neuropathy or symptoms of DAN can also occur in patients that are not diabetic. This condition is generally referred to as ‘advanced autonomic neuropathy’. In the cases with the absence of diabetes, the risk of adverse events and mortality are also present. Regardless of the pathology of the autonomic neuropathy, the disease is known to be treatable. For more details, refer to Neuropathy is Treatable – A. Vinik M.D.
It is well established that early stages of autonomic dysfunction present more treatment options for patients than patients with advanced autonomic neuropathy, DAN or CAN. Detection of the onset of such advanced conditions through autonomic nervous system (ANS) testing is proven to prolong or avoid the onset or advancement with the presence of such chronic diseases.
Treatment for autonomic dysfunction / neuropathy is based on maintaining balance (homeostasis) between the two branches of the autonomic nervous system – the sympathetic & parasympathetic systems. The parasympathetic and the sympathetic activity can significantly adjust their input to maintain homeostasis even with the presence of chronic disease or organ dysfunction. It is known in these chronic cases that the input from each brand of the ANS system results in autonomic imbalance which can further affect other organs such as the cardiovascular system. By the time symptoms are present in chronic disease, the autonomic nervous system has been out of balance for a long time.
With the basis of maintain balance to prolong complications of chronic diseases such as diabetes and cardiovascular disease, autonomic balance (sympathovagal balance) is recommended. Some of the possible therapeutic agents to assist are listed in the table below.