[Two years' experience in a specific autonomic nervous system service]. / Experiencia de dos años en una consulta específica de sistema nervioso autónomo.

INTRODUCTION: Despite the high incidence and prevalence of pathologies affecting the autonomic nervous system (ANS), this part of neurology has received very little specific attention in clinical care in our country. AIM: To present the experience we have gained over a two-year period in an ANS-specific service. PATIENTS AND METHODS: Our patients were referred to the ANS service by other colleagues, most of whom were neurologists, between April 2006 and April 2008, after proposing a set of eligibility and exclusion criteria. Clinical history, examination and general analysis were performed for all patients. The following tests were also carried out on an individualised basis: Ewing-Clarke test, the Spanish version of the autonomic symptom profile test, tilt table test, holter heart monitor, urodynamic study and reflex sympathetic test, among other complementary studies. RESULTS: Thirty-four first visits and 62 successive visits were registered. The most frequent diagnoses were neurologically mediated syncopes and diabetic autonomic neuropathies, but other less prevalent conditions were also diagnosed. The most cost-effective complementary tests were the Ewing-Clarke test and the autonomic symptom profile test. Apart from benzodiazepines, the most commonly prescribed pharmacological treatments were paroxetine and pyridostigmine. CONCLUSIONS: As expected, neurologically mediated syncopes and diabetic neuropathies with an autonomic component are the most frequent pathologies in an ANS service. Nevertheless, their diagnosis and individualised treatment, together with that of other less prevalent autonomic pathologies, may require specific attention. To our knowledge, this is the first service of its kind in our country.

Experiencia de dos años en una consulta específica de sistema nervioso autónomo / Two years'experience in a specific autonomic nervous system service

Introducción. A pesar de la alta incidencia y prevalencia de la patología del sistema nervioso autónomo (SNA), esta parte de la neurología apenas ha merecido una atención específica en la asistencia clínica de nuestro país. Objetivo. Presentar nuestra experiencia de dos años en una consulta específica de SNA. Pacientes y métodos. Pacientes enviados a la consulta de SNA por otros compañeros, en su mayoría neurólogos, entre abril de 2006 y abril de 2008, tras proponer unos criterios de inclusión y exclusión. A todos los pacientes se les realizó anamnesis, exploración y analítica general. De forma individualizada, se realizaron test de Ewing-Clarke, versión española del test perfil de síntomas autonómicos, test de la mesa basculante, holter cardíaco, estudio urodinámico y test simpático reflejo, entre otros estudios complementarios. Resultados. Se realizaron 34 primeras consultas y 62 sucesivas. Los diagnósticos más frecuentes fueron los síncopes neurológicamente mediados y las neuropatías diabéticas autonómicas, pero se han diagnosticado otras entidades menos prevalentes. Las pruebas complementarias más rentables fueron el test de Ewing-Clarke y el test perfil de síntomas autonómicos. Los tratamientos farmacológicos más prescritos han sido, aparte de las benzodiacepinas, la paroxetina y la piridostigmina. Conclusiones. Como cabía esperar, los síncopes neurológicamente mediados y las neuropatías diabéticas con componente autonómico son las patologías más frecuentes en una consulta de SNA. Sin embargo, su diagnóstico y tratamiento individualizado, así como el de otras patologías autonómicas menos prevalentes, pueden requerir una atención específica. En nuestro conocimiento, se trata de la primera consulta de estas características en nuestro país (AU)

Introduction. Despite the high incidence and prevalence of pathologies affecting the autonomic nervous system (ANS), this part of neurology has received very little specific attention in clinical care in our country. Aim. To present the experience we have gained over a two-year period in an ANS-specific service. Patients and methods. Our patients were referred to the ANS service by other colleagues, most of whom were neurologists, between April 2006 and April 2008, after proposing a set of eligibility and exclusion criteria. Clinical history, examination and general analysis were performed for all patients. The following tests were also carried out on an individualised basis: Ewing-Clarke test, the Spanish version of the autonomic symptom profile test, tilt table test, holter heart monitor, urodynamic study and reflex sympathetic test, among other complementary studies. Results. Thirty-four first visits and 62 successive visits were registered. The most frequent diagnoses were neurologically mediated syncopes and diabetic autonomic neuropathies, but other less prevalent conditions were also diagnosed. The most cost-effective complementary tests were the Ewing-Clarke test and the autonomic symptom profile test. Apart from benzodiazepines, the most commonly prescribed pharmacological treatments were paroxetine and pyridostigmine. Conclusions. As expected, neurologically mediated syncopes and diabetic neuropathies with an autonomic component are the most frequent pathologies in an ANS service. Nevertheless, their diagnosis and individualised treatment, together with that of other less prevalent autonomic pathologies, may require specific attention. To our knowledge, this is the first service of its kind in our country (AU)