Dysautonomia:A family of misunderstood disorders

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Dysautonomia

From N. Fogoros, M.D.,

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A family of misunderstood disorders

In the 19th and early 20th centuries there used to be a condition

called neurasthenia. People would find themselves suddenly unable to

function, due to a host of inexplicable symptoms, often including

fatigue, weakness, strange pains, dizziness and passing out. Doctors

would not find anything to explain these symptoms, so they were

attributed to a " weak nervous system, " or neurasthenia. Women with

neurasthenia (for men were not given this diagnosis, by and large)

were often confined to their beds, where they would either recover

or, eventually, die. And while nobody knew what caused this

condition, everyone - doctors and laymen alike - took it seriously.

Most modern doctors hearing about this mysterious condition merely

shake their heads in wonder. Few seem to consider the possibility

that " neurasthenia " is still with us. Consequently they are less

capable of recognizing the manifestations of this condition than

were their old-time counterparts, and tend to be far less

sympathetic to its victims.

Yesterday's neurasthenia, today's dysautonomia

People who a century ago would have been called " neurasthenics "

today are given a host of diagnoses. These include chronic fatigue

syndrome (CFS,) vasovagal or neurocardiogenic syncope, panic

attacks, anxiety, inappropriate sinus tachycardia (IST,) irritable

bowel syndrome (IBS,) postural orthostatic tachycardia syndrome

(POTS,) or fibromyalgia. Sufferers of all these conditions tend to

experience an imbalance, and most often a peculiar volatility, in

the autonomic nervous system - an imbalance that we now call

dysautonomia.

The autonomic nervous system controls the " unconscious " bodily

functions, such as heart rate, digestion, and breathing patterns.

The autonomic nervous system consists of two parts: the sympathetic

system and the parasympathetic system. The sympathetic system can

best be thought of as controlling the " fight or flight " reactions of

the body, producing the rapid heart rates, increased breathing, and

increased blood flow to the muscles that are necessary when an

individual is in danger or under stress. The parasympathetic system

controls the " quiet " body functions, for instance, the digestive

system. In short, the sympathetic system gets the body ready for

action, while the parasympathetic system gets the body ready for

rest. And in normal individuals, the parasympathetic and sympathetic

components of the autonomic nervous systems are in perfect balance,

from moment to moment, depending on the body's instantaneous needs.

In people suffering from dysautonomia, the autonomic nervous system

loses that balance, and at various times the parasympathetic or

sympathetic systems inappropriately predominate. Symptoms can

include frequent, vague but disturbing aches and pains, faintness

(or even actual fainting spells), fatigue and inertia, severe

anxiety attacks, tachycardia, hypotension, poor exercise tolerance,

gastrointestinal symptoms such as irritable bowel syndrome,

sweating, dizziness, blurred vision, numbness and tingling, anxiety

and (quite understandably), depression.

Sufferers of dysautonomia can experience all these symptoms or just

a few of them. They can experience one cluster of symptoms at one

time, and another set of symptoms at other times. The symptoms are

often fleeting and unpredictable, but on the other hand they can be

triggered by specific situations or actions. (Some people have

symptoms with exertion, for instance, or when standing up, or after

ingesting certain foods.) And since people with dysautonomia are

usually normal in every other way, when the doctor does a physical

exam he or she often finds no abnormalities.

Page 2 - Evaluating patients with dysautonomia

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