TY - JOUR T1 - Autonomic diseases: management JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry SP - iii42 LP - iii47 DO - 10.1136/jnnp.74.suppl_3.iii42 VL - 74 IS - suppl 3 AU - Christopher J Mathias Y1 - 2003/09/01 UR - http://jnnp.bmj.com/content/74/suppl_3/iii42.abstract N2 - The management of autonomic disease encompasses a number of aspects. Of immediate and practical importance is alleviation of symptoms. The ideal is to rectify the autonomic deficit and cure the underlying disorder. Autonomic disease often involves various systems, and principles in relation to management of the major clinical features are provided. Specific aspects will vary in different diseases and always should be directed to the needs of the individual. Orthostatic hypotension Orthostatic (postural) hypotension may cause few symptoms in some but considerable morbidity in others. It may contribute to disability and even death, because of the potential risk of substantial injury. Treatment may be needed even in those who are asymptomatic, as in situations such as fluid depletion or treatment with drugs that have vasodilator effects, there may be pronounced falls in blood pressure with serious sequelae. Understanding the pathophysiological basis of orthostatic hypotension, and the associated disease process that influences it, often is necessary in the individual. Blood pressure maintenance is dependent on beat-by-beat control exerted by the sympathetic nervous system, on cardiac output, on tone in resistance and capacitance vessels (which also is influenced by systemic and local pressor and depressor hormones), and on intravascular fluid volume. No single drug or treatment can effectively mimic the actions of the sympathetic nervous system in different situations and a multipronged approach, combining non-pharmacological and pharmacological measures, usually is needed (table 1). The doctor and patient should be aware of the limitations of treatment. Furthermore, associated deficits (such as cerebellar features in multiple system atrophy) may limit mobility in some, despite effective treatment of orthostatic hypotension.View this table:In this windowIn a new window Table 1 Some of the approaches used in the management of orthostatic hypotension Increasing patient awareness of factors that lower blood pressure is important. Rapid postural change, especially in the morning when getting out of bed, must be avoided … ER -