Neuropathic dysfunction of the autonomic nervous system

Abstract

The autonomic nervous system is divided into 2 systems, both the sympathetic, whose function is to prepare the body for an emergency, and the parasympathetic, which is aimed at the conservation and recovery of energy. Both are composed of afferent and efferent fibers that allow communication from the higher centers of the central nervous system to the rest of the body, they are represented as antagonistic actions with each other in order to generate balance in the internal environment and also control a series of responses in the organism that ensures our survival. Its actions are directed at anatomical structures such as glands, blood vessels, conduction system at the cardiac level, organs of the gastrointestinal and urinary tract, including participating in the mechanisms of genital erection and ejaculation as well as on the skin and pupillary reflexes. However, this balance is lost when there is direct involvement in the nerve pathways that modulate these fibers known as dysautonomia, among its causes are neurodegenerative diseases such as Parkinson's disease, infectious, inflammatory or hereditary neuropathies and metabolic diseases, being the main cause and Diabetes mellitus is currently the most prevalent worldwide. This loss of balance results in various anatomical and functional alterations, including cardiac disorders such as orthostatic tachycardia syndrome, orthostatic hypotension and even silent infarctions, gastroparesis or motility disorders such as constipation or diarrhea are manifested at the gastrointestinal level. Urinary level hypo or hyperactive neurogenic bladder, among others, there are currently several studies for a diagnostic evaluation such as cardiac monitoring, sudomotor or pilomotor test and even biopsy. Dysautonomia presents different manifestations depending on the nerve fibers that are affected, it requires a high index of suspicion for its diagnosis, so it is essential to know the clinical presentations.