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develops when agents of the ANS in the central or peripheral nervous systems are impaired, and this leads to many types of symptoms and damage in the rest of the body. The changes that lead to autonomic dysfunction may vary in each individual. When dysautonomia is a freestanding disorder, its pathophysiology may be unclear. However, when it is a result of some other condition, it is easier to follow the trail back to its causes. Dysautonomia is a common complication of some degenerative neurologic diseases—these are progressive conditions that affect the central nervous system, and ultimately the ANS. Parkinson's disease, Alzheimer's disease, and Lewy body disease may all have this complication. Autoimmune diseases are often associated with dysautonomia, including Sjogren's syndrome, lupus, ankylosing spondylitis, multiple sclerosis, and several others, although the connections between autoimmune dysfunction and dysautonomia isn't clear. Some genetic conditions also tend to have this feature. People with Ehlers-Danlos syndrome and Huntington's disease often have bouts of dysautonomia. And an inherited subtype called familial dysautonomia involves a number of other signs and symptoms, including reduced pain sensation, poor temperature regulation, and dry eyes. Any conditions that cause nerve damage, like diabetes or AIDS, can interrupt autonomic function. Autonomic dysreflexia, a complication of damage related to trauma or tumors in the spinal cord, is a severe and life-threatening form of dysautonomia. Problems with autonomic function may be an adverse effect of certain medications, especially alpha and beta blockers. Dysautonomia also has several common "partners in crime"—conditions that it often accompanies as a comorbidity, although the links between the conditions aren't clear. This is the case with mast cell activation disorders, many autoimmune diseases, and some other situations. DYSAUTONOMIA AND LONG COVID Dysautonomia is probably a factor in the lives of many people with long COVID. Scientists who study long COVID have developed several theories about this connection. The proposed explanations are complex and not terribly relevant to massage therapy clinical decisions, but it is interesting to track the thinking process. Types of Dysautonomia Many types of dysautonomia have been identified, and brief descriptions of some of them are provided here: • Postural orthopedic tachycardia syndrome (POTS): This refers to a group of signs and symptoms that include increased heart rate (tachy = fast + cardia = heart) when a person comes to an upright position (ortho = upright + stasis = state of being). It mainly affects the ability to maintain stable blood pressure, but its impact on many other functions can make it an extremely challenging condition to live with. • Vasovagal syncope: This condition involves unpredictable fainting spells, often in response to a strong emotional reaction (the sight of blood, fear of injury) or a strong environmental response (extreme heat). While it is often mild, it can cause falls and risks for serious injury. • Pure autonomic failure: This describes orthostatic hypotension along with many other autonomic challenges, including digestive problems, urinary retention, decreased sweating and heat intolerance, and sexual dysfunction. • Autoimmune autonomic neuropathy: This is an immune system attack on acetylcholine receptors. It can involve sensory problems along with motor disturbances. • Multiple system atrophy (MSA): Unlike other forms of dysautonomia, MSA affects brain function as well as peripheral nervous system function. This progressive condition has aspects of Parkinson's disease and ataxia (lack of voluntary coordination). MSA usually affects mature people. It is progressive and terminal. • Other types of dysautonomia: Dysautonomia can be a result of long-term toxic exposures, alcoholism, and peripheral nerve trauma that leads to complex regional pain syndrome. Autonomic dysreflexia, cerebral salt wasting syndrome, and familial dysautonomia are other examples of autonomic system failures. Some experts now consider that chronic conditions like fibromyalgia and chronic fatigue syndrome may also have a dysautonomia component. L i s te n to T h e A B M P Po d c a s t a t a b m m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 77

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