Electrodiagnostic assessment of the autonomic nervous system: A consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology
Electrodiagnostic assessment of the autonomic nervous system: A consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology
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DOI：
10.1016/j.clinph.2020.11.024
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发表时间：
2021-02-08
影响因子：
4.7
通讯作者：
Singer, Wolfgang
中科院分区：
文献类型：
--
作者：
Cheshire, William P.;Freeman, Roy;Singer, Wolfgang
自主神经系统疾病的评估既是一门艺术，也是一门科学，需要医生最敏锐的临床技能以及自主神经学和生理学的知识。在过去的三十年里，非侵入性的临床测试，评估自主神经的功能，这些测试的验证和标准化，以及大量的文献的增长，在自主神经疾病患者的测试结果的特点，配备了临床实践进一步与一套有价值的客观工具，以协助诊断和预后。这篇综述，根据目前的证据，概述了一个国际专家共识的建议，以指导临床电诊断自主神经测试。自主神经功能障碍的分级和定位结合了交感心血管肾上腺素能、副交感心迷走神经和泌汗测试的评分，因为没有单独的测试足以诊断自主神经功能衰竭的程度或分布。复合自主神经严重性评分（卡斯）是一种有用的自主神经功能衰竭评分，其根据年龄和性别进行标准化。自主神经测试的有效适应症包括全身性自主神经衰竭、自主神经损伤的局部或选择性系统综合征、周围自主神经病变和神经节病变、小纤维神经病变、直立性低血压、直立性不耐受、晕厥、神经退行性疾病、自主神经功能亢进和无汗症。(c)2020国际临床神经生理学联合会。由爱思唯尔公司出版
Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upon the physician's most astute clinical skills as well as knowledge of autonomic neurology and physiology. Over the last three decades, the development of noninvasive clinical tests that assess the function of autonomic nerves, the validation and standardization of these tests, and the growth of a large body of literature characterizing test results in patients with autonomic disorders have equipped clinical practice further with a valuable set of objective tools to assist diagnosis and prognosis. This review, based on current evidence, outlines an international expert consensus set of recommendations to guide clinical electrodiagnostic autonomic testing. Grading and localization of autonomic deficits incorporates scores from sympathetic cardiovascular adrenergic, parasympathetic cardiovagal, and sudomotor testing, as no single test alone is sufficient to diagnose the degree or distribution of autonomic failure. The composite autonomic severity score (CASS) is a useful score of autonomic failure that is normalized for age and gender. Valid indications for autonomic testing include generalized autonomic failure, regional or selective system syndromes of autonomic impairment, peripheral autonomic neuropathy and ganglionopathy, small fiber neuropathy, orthostatic hypotension, orthostatic intolerance, syncope, neurodegenerative disorders, autonomic hyperactivity, and anhidrosis. (c) 2020 International Federation of Clinical Neurophysiology. Published by Elsevier B.V.