Abstract
This chapter discusses a variety of available approaches for testing the autonomic nervous system and their technical and methodological limitations. The discussion is complete but not exhaustive, and the focus is on techniques that have been used in clinical contexts or show particular promise for clinical use. The current understanding of the clinical relevance of autonomic dysfunction followed the development of autonomic testing and its application to clinical populations. It is now apparent that autonomic testing predicts prognosis in patients with diabetes, identifies some patients with asymptomatic myocardial ischemia, and correlates with fatigue and impaired exertional capacity in a variety of medical and neurological disorders. Several simple clinical tests can also be performed in the EMG laboratory. Simply measuring the blood pressure response to sitting and standing is perhaps the most informative clinical test of autonomic function. Skin wrinkling and pressor response to ice water immersion or handgrip are other simple tests that can provide a rapid screening of autonomic function as well.
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