Autonomics

The autonomic nervous system (ANS) is comprised of the sympathetic (fight or flight response) and parasympathetic (rest and digestion) nervous systems. The ANS innervates every end organ in the body: such as skin, heart,  bladder and bowels;  and is very important in the control of bodily functions, such as regulation of sweating, blood pressure, heart rate, digestion and sexual function.  Individuals with autonomic disorders may have many disabling symptoms, such as lightheadedness or fainting, constipation, bladder control problems, and sexual dysfunction.

The Autonomic & Neurovascular Medicine Unit provides a highly specialised diagnostic service for a wide variety of autonomic disorders. We have two state of the art laboratories incorporating the latest advances in non-invasive technology. Autonomic investigations play a key role in aiding the doctors in the diagnosis of autonomic disorders and are also important in tailoring an individual treatment and management plan. The team aim to help people with autonomic symptoms, some of which are multiple and complex, to successfully manage their daily lives.

Autonomic dysfunction is usually a multi-system disorder and we work closely with other departments within the Hospital of St John & St Elizabeth and other leading consultants: including Hypermobility Unit, Cardiology, Imaging, Physiotherapy, Gastroenterology, Urology, Gynaecology and Immunology.

Autonomics Consultant

Professor Christopher Mathias leads our autonomics team.

Name: Professor Christopher Mathias

Qualifications: MBBS DPhil DSc FRCP FMedSci

Expertise: Hypotension, Labile Hypertension, Impaired Blood Pressure Control, Postural Tachycardia Syndrome (PoTS), Fainting, Syncope (to include Vasovagal, Carotid Hypersensitivity and Situational), Excessive sweating (Hyperhidrosis) and Temperature regulation disorders, Autonomic Dysfunction in various conditions–such as Parkinson’s Disease, Multiple System Atrophy, Spinal Cord Injury, Diabetes Mellitus

Mailing Address: Autonomic & Neurovascular Medicine Unit, Hospital of St John & St Elizabeth, 60 Grove End Road, St John’s Wood, London, NW8 9NH.

Autonomics Team

Mr Michael Peche – Lead Clinical Autonomic Scientist & Deputy Service Manager

Miss Kiran Sheri – Senior Clinical Autonomic Scientist

Miss Britney Powell – Clinical Autonomic Scientist

Miss Seema Maru – Bank Clinical Autonomic Scientist

Miss Vanessa Ponnusamy – Bank Clinical Autonomic Scientist

Conditions Treated By Autonomics Team

• Acute/subacute dysautonomia
• Amyloidosis (familial and primary)
• Anhidrosis
• Autonomic mediated syncope (vasovagal, micturition, cough, swallow and other situational forms, carotid sinus hypersenstivity)
• Congenital autonomic failure
• Diabetic autonomic neuropathies
• Dysreflexia due to spinal cord injury
• Guillain-Barré syndrome
• Holmes-Adie syndrome
• Hyperhidrosis (essential and gustatory)
• Immune-mediated autonomic neuropathies
• Orthostatic (postural) hypotension
• Primary autonomic failure (Pure Autonomic Failure, Multiple system atrophy)
• Pheochromocytoma
• Postural tachycardia syndrome (PoTS)

Autonomic Diagnostic Investigations

Core autonomic diagnostic testing

• Autonomic function screening tests
• Plasma Catecholamine blood samples
• Head up tilt test
• Liquid meal challenge
• Modified exercise test
• 24 hour ambulatory blood pressure monitoring
• 24 hour continuous heart rate monitoring

Other autonomic diagnostic testing:

• 24 hour urinary catecholamine samples
• Acetylcholine alpha 3 nicotinic receptor antibodies
• Autonomic dysreflexia test
• Cardiovascular autonomic responses to cervical head and neck movements
• Cardiovascular autonomic responses to arm movements
• Cardiovascular autonomic responses to sildenafil
• Carotid sinus massage
• Liquid meal challenge with Octreotide
• Liquid meal challenge with Pyridostigmine
• Plasma Metaenphrine blood samples

Important information for autonomic testing appointments:

If you have any questions before attending your autonomic testing appointments you can download our patient guide.

Autonomic Function Tests

For more information on our autonomic function tests please click on the tests below.

Plasma catecholamine / metanephrine blood samples

Head up tilt test

Liquid meal test

Modified exercise test

24hr BP and HR monitoring using the autonomic protocol

Any patients that have been requested for a 24 hour Blood pressure and heart rate monitoring can download our patient guide to find out more information.