Autonomic symptoms and signs in autoimmune disorders

Abstract

The autonomic nervous system is involved in regulating the immune system, however, it is often impaired by an autoimmune mechanism in autoimmune neurological diseases. Autonomic symptoms and signs are presented in diseases that selectively impair the autonomic nervous system, as seen in autoimmune autonomic ganglionopathy, or cause autonomic lesions as a subset of neurological lesions, as seen in multiple sclerosis and autoimmune encephalitis. The lesion sites include: the central autonomic nervous system (the brain and spinal cord) which is impaired in multiple sclerosis; peripheral autonomic nerves which are impaired in autoimmune autonomic ganglionopathy; peripheral autonomic nerve endings which are impaired in Lambert-Eaton syndrome; and effectors which are impaired in idiopathic acquired generalized anhidrosis, a sweat gland disorder. From the aspect of diagnosis, characteristic autonomic symptoms, such as area postrema syndrome, seen in neuromyelitis optica, may indicate certain neurological diseases. The autonomic symptoms and signs in autoimmune neurological diseases and their pathogenesis are explained.