[Autonomic neuropathies]. / Formen autonomer nervenkrankheiten.

Autonomic neuropathies are a heterogeneous group of diseases that involve damage of small peripheral autonomic Aδ- and C-fibers. Causes of autonomic nerve fiber damage are disorders such as diabetes mellitus and HIV-infection. Predominant symptoms of autonomic neuropathy are orthostatic hypotension, gastro-intestinal problems, urogenital dysfunction, and cardiac arrhythmia, which can severely impair the quality of life in affected patients. Furthermore, autonomic neuropathies can be induced by autoimmune diseases such as acute inflammatory demyelinating polyneuropathy, hereditary disorders such as the lysosomal storage disorder Fabry disease and hereditary sensory and autonomic neuropathies, as well as certain toxins and drugs.

[Autonomic neuropathies--diagnosis and evidence based treatment]. / Autonome nervenkrankheiten--früherkennung und leitliniengerechte behandlung.

Among the few well-established techniques to diagnose autonomic dysfunction are head-up-tilt table testing, heart rate variability measurement and axon-reflex based sudomotor testing. Recent research focused on the development of novel techniques to assess autonomic function based on axon-reflex testing in both vasomotor and pilomotor nerve fibers. However, these techniques are clinically not widely used due to technical limitations and the lack of data on their utility to detect autonomic dysfunction in patients with neuropathy. The treatment of autonomic neuropathies should focus on the management of the underlying disease. In addition, symptomatic treatment of autonomic dysfunction should be provided in an individual patient-centered multimodal regimen that may incorporate both pharmacological and non-pharmacological strategies. The use of medication in autonomic dysfunction requires a careful risk-benefit assessment and should be individually adjusted based on both therapeutic success and occurrence of adverse effects.