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2. EFAS/EAN survey on the influence of the COVID-19 pandemic on European clinical autonomic education and research

Author

Fanciulli, Alessandra, Skorić, Magdalena Krbot, Leys, Fabian, Carneiro, Diogo Reis, Campese, Nicole, Calandra-Buonaura, Giovanna, Camaradou, Jennifer, Chiaro, Giacomo, Cortelli, Pietro, Falup-Pecurariu, Cristian, Granata, Roberta, Guaraldi, Pietro, Helbok, Raimund, Hilz, Max J., Iodice, Valeria, Jordan, Jens, Kaal, Evert C. A., Kamondi, Anita, Le Traon, Anne Pavy, Rocha, Isabel, Sellner, Johann, Senard, Jean Michel, Terkelsen, Astrid, Wenning, Gregor K., Moro, Elena, Berger, Thomas, Thijs, Roland D., Struhal, Walter, and Habek, Mario

Published
2023
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11. 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

Author

Cheshire, William P., Freeman, Roy, Gibbons, Christopher H., Cortelli, Pietro, Wenning, Gregor K., Hilz, Max J., Spies, Judith M., Lipp, Axel, Sandroni, Paola, Wada, Naoki, Mano, Akiko, Ah Kim, Hyun, Kimpinski, Kurt, Iodice, Valeria, Idiáquez, Juan, Thaisetthawatkul, Pariwat, Coon, Elizabeth A., Low, Phillip A., and Singer, Wolfgang

Published
2021
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13. Abnormal dopamine transporter imaging in pure autonomic failure: a potential biomarker of central nervous system involvement

Author

Alnasser Alsukhni, Rana, primary, Vichayanrat, Ekawat, additional, Koay, Shiwen, additional, Davis, Laura May, additional, Ingle, Gordon, additional, McNamara, Patricia, additional, Panicker, Jalesh N., additional, Bhatia, Kailash P., additional, Mathias, Christopher, additional, Bomanji, Jamshed, additional, and Iodice, Valeria, additional

Published
2023
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15. The Postural Tachycardia Syndrome : a multi-system condition : clinical features, pathophysiology, genetics and novel treatment

Author

Iodice, Valeria, Low, David, Anand, Praveen, and Mathias, Christopher

Subjects
616.85
Abstract

Autonomic dysfunction is a common presentation of various neurological disorders and has a heterogeneous aetiology and pathophysiology. PoTS is a very common form of orthostatic intolerance characterized by excessive increases in heart rate during orthostatic stress without orthostatic hypotension and is often associated with the Joint Hypermobility Syndrome (JHS); the most common heritable disorder of connective tissue. However, information is still limited in PoTS with regards to the clinical presentation and quality of life, pathophysiology, the responses to treatment and possible genetic contributions. As part of this thesis a novel autonomic function scoring scale was generated and validated to quantify the degree of autonomic impairment (CAF score), which was able to differentiate patients with different autonomic disorders and quantify the degree of autonomic overactivity in patients with PoTS. An autonomic and quality of life self-administered questionnaire (AQQoL) was also developed in order to assess a range of autonomic symptoms, allied features, familial autonomic dysfunction and the relative quality of life in a large cohort of patients with autonomic disorders. This instrument was found to be helpful in detecting autonomic, non-cardiovascular and quality of life impairments in patients with autonomic disorders and could inform future longitudinal studies in patients with a wide range of autonomic disorders. PoTS might be a genetic disorder with a likely multifactorial and polygenic pathophysiology and possible variable expressivity. Using the AQQoL and further investigations 21 families with PoTS and JHS were described for the first time. In order to further understand the pathophysiology of PoTS and JHS, peripheral small nerve fibre function and morphology, using the skin biopsy technique, were evaluated. A subgroup of patients with PoTS and JHS have an underlying small fibre neuropathy and associated abnormalities of Collagen IV in basement membranes and blood vessels in the skin indicating that multiple pathophysiological mechanisms could coexist in the same patients and that the skin biopsy is a valuable tool to differentiate PoTS sub-groups. Diagnosing PoTS can be challenging and tests, in addition to the traditional orthostatic stressors, such as liquid meal challenge, modified exercise and heat challenge tests, can be of value in the assessment of these patients. In particular, the liquid meal challenge test is also helpful in determining whether drugs such as the somatostatin analogue, Octreotide, can reduce postural tachycardia and symptoms of orthostatic intolerance pre- and post-prandially. Similarly, for the first time, the beneficial effect of 50 mcg of Octreotide on orthostatic hemodynamic responses before and after food ingestion in PoTS was shown. PoTS is a complex multi-system disorder that may cause significant autonomic morbidity and impairment of quality of life. The pathophysiology is heterogeneous and in our patient cohort is likely to be linked to connective tissue disorders, such as JHS and genetic factors. A more extensive autonomic assessment, including the evaluation of hemodynamic responses to daily stimuli, may be important for establishing definitive diagnostic criteria for PoTS. The management of these patients needs a multi-step pharmacological approach and in the most severe cases requires specific targeting, with medications such as Octreotide for example, which might be beneficial in reducing postural tachycardia and orthostatic intolerance.

Published
2014
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17. Abnormal dopamine transporter imaging in pure autonomic failure: a potential biomarker of central nervous system involvement.

Author

Alnasser Alsukhni, Rana, Vichayanrat, Ekawat, Koay, Shiwen, Davis, Laura May, Ingle, Gordon, McNamara, Patricia, Panicker, Jalesh N., Bhatia, Kailash P., Mathias, Christopher, Bomanji, Jamshed, and Iodice, Valeria

Subjects
DOPAMINERGIC imaging, ORTHOSTATIC hypotension, CENTRAL nervous system, MULTIPLE system atrophy, FAILURE (Psychology), MAGNETIC resonance imaging, PARKINSON'S disease
Abstract

Background and purpose: Pure autonomic failure (PAF) is a rare progressive neurodegenerative disease characterized by neurogenic orthostatic hypotension at presentation, without other neurological abnormalities. Some patients may develop other central neurological features indicative of multiple system atrophy or a Lewy body disorder. There are currently no biomarkers to assess possible central nervous system involvement in probable PAF at an early stage. A possibility is to evaluate the nigrostriatal dopaminergic degeneration by imaging of dopamine transporter with DaTscan brain imaging. The objective was to evaluate subclinical central nervous system involvement using DaTscan in PAF. Methods: We retreospectively reviewed pure autonomic failure patients who were evaluated at the Autonomic Unit between January 2015 and August 2021 and underwent comprehensive autonomic assessment, neurological examination, brain magnetic resonance imaging and DaTscan imaging. DaTscan imaging was performed if patients presented with atypical features which did not meet the criteria for Parkinson's disease or multiple system atrophy or other atypical parkinsonism. Results: In this cohort, the median age was 49.5 years at disease onset, 57.5 years at presentation, and the median disease duration was 7.5 years. Five of 10 patients had an abnormal DaTscan without neurological features meeting the criteria of an alternative diagnosis. Patients with abnormal DaTscan were predominantly males, had shorter disease duration and had more severe genitourinary symptoms. Discussion: Degeneration of nigrostriatal dopaminergic neurons measured using DaTscan imaging can present in patients with PAF without concurrent signs indicating progression to widespread α‐synucleinopathy. It is advocated that DaTscan imaging should be considered as part of the workup of patients with emerging autonomic failure who are considered to have PAF. [ABSTRACT FROM AUTHOR]

Published
2024
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18. Impact of the <scp>COVID</scp> ‐19 pandemic on clinical autonomic practice in Europe: a survey of the European Academy of Neurology and the European Federation of Autonomic Societies

Author

Fanciulli, Alessandra, Leys, Fabian, Krbot Skorić, Magdalena, Reis Carneiro, Diogo, Calandra‐Buonaura, Giovanna, Camaradou, Jennifer, Chiaro, Giacomo, Cortelli, Pietro, Falup‐ Pecurariu, Cristian, Granata, Roberta, Guaraldi, Pietro, Helbok, Raimund, Hilz, Max J., Iodice, Valeria, Jordan, Jens, Kaal, Evert C. A., Kamondi, Anita, Pavy Le Traon, Anne, Rocha, Isabel, Sellner, Johann, Senard, Jean Michel, Terkelsen, Astrid, Wenning, Gregor K., Moro, Elena, Berger, Thomas, Thijs, Roland D., Struhal, Walter, Habek, Mario, Adamec, Ivan, Aerts, Arnaud, Campese, Nicole, Canta, Leo L. R., Delamont, Robert Shane, de Lange, Frederik, Del Sorbo, Francesca, Devigili, Grazia, Di Leo, Rita, Dinh, Trang, Fortrat, Jacques‐Olivier, Gierthmühlen, Janne, Hemels, Martin, Köhn, Julia, Krøigård, Thomas, Lipp, Axel, Maier, Andrea, Marinelli, Lucio, Mazzeo, Anna, Milenkovic, Ivan, Motyl, Maciej, Sora, Maria Grazia Natali, Navarro‐Otano, Judith, Nilsen, Kristian Bernhard, Oliveira, Mario, Omland, Petter Moe, Pelliccioni, Giuseppe, Pereon, Yann, Resch, Roland Josef, Rocchi, Camilla, Roche, Frederic, Rutten, Joost, Tijero‐Merino, Beatriz, Tutaj, Marcin, van der Heijden‐Montfroy, A. M. H. G., van Hoeve, Bas J. A., van Orshoven, Narender, Wang, Ruihao, Graggen, Werner J. Z’., and the Collaborators of European Network of Neurological ANS laboratories

Subjects
orthostatic hypotension, COVID-19 infection, vaccination, POTS, autonomic nervous system, postural orthostatic tachycardia syndrome, syncope, telemedicineCOVID-19 infection, COVID-19 vaccination, Neurology, telemedicine, Neurology (clinical)
Abstract

Background and purpose: The objective was to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on European clinical autonomic practice. Methods: Eighty-four neurology-driven or interdisciplinary autonomic centers in 22 European countries were invited to fill in a web-based survey between September and November 2021. Results: Forty-six centers completed the survey (55%). During the first pandemic year, the number of performed tilt-table tests, autonomic outpatient and inpatient visits decreased respectively by 50%, 45% and 53%, and every third center reported major adverse events due to postponed examinations or visits. The most frequent newly diagnosed or worsened cardiovascular autonomic disorders after COVID-19 infection included postural orthostatic tachycardia syndrome, orthostatic hypotension and recurrent vasovagal syncope, deemed to be likely related to the infection by ≥50% of the responders. Forty-seven percent of the responders also reported about people with new onset of orthostatic intolerance but negative tilt-table findings, and 16% about people with psychogenic pseudosyncope after COVID-19. Most patients were treated non-pharmacologically and symptomatic recovery at follow-up was observed in ≥45% of cases. By contrast, low frequencies of newly diagnosed cardiovascular autonomic disorders following COVID-19 vaccination were reported, most frequently postural orthostatic tachycardia syndrome and recurrent vasovagal syncope, and most of the responders judged a causal association unlikely. Non-pharmacological measures were the preferred treatment choice, with 50%–100% recovery rates at follow-up. Conclusions: Cardiovascular autonomic disorders may develop or worsen following a COVID-19 infection, whilst the association with COVID-19 vaccines remains controversial. Despite the severe pandemic impact on European clinical autonomic practice, a specialized diagnostic work-up was pivotal to identify non-autonomic disorders in people with post-COVID-19 orthostatic complaints.

Published
2023

19. Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension

Author

Cheema, Sanjay, primary, Anderson, Jane, additional, Angus-Leppan, Heather, additional, Armstrong, Paul, additional, Butteriss, David, additional, Carlton Jones, Lalani, additional, Choi, David, additional, Chotai, Amar, additional, D'Antona, Linda, additional, Davagnanam, Indran, additional, Davies, Brendan, additional, Dorman, Paul J, additional, Duncan, Callum, additional, Ellis, Simon, additional, Iodice, Valeria, additional, Joy, Clare, additional, Lagrata, Susie, additional, Mead, Sarah, additional, Morland, Danny, additional, Nissen, Justin, additional, Pople, Jenny, additional, Redfern, Nancy, additional, Sayal, Parag P, additional, Scoffings, Daniel, additional, Secker, Russell, additional, Toma, Ahmed K, additional, Trevarthen, Tamsin, additional, Walkden, James, additional, Beck, Jürgen, additional, Kranz, Peter George, additional, Schievink, Wouter, additional, Wang, Shuu-Jiun, additional, and Matharu, Manjit Singh, additional

Published
2023
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20. Phosphorylated α-Synuclein Deposits in Cutaneous Nerves of Early Parkinsonism

Author

Nolano, Maria, primary, Caporaso, Giuseppe, additional, Manganelli, Fiore, additional, Stancanelli, Annamaria, additional, Borreca, Ilaria, additional, Mozzillo, Stefania, additional, Tozza, Stefano, additional, Dubbioso, Raffaele, additional, Iodice, Rosa, additional, Vitale, Floriana, additional, Koay, Shiwen, additional, Vichayanrat, Ekawat, additional, da Silva, Fernanda Valerio, additional, Santoro, Lucio, additional, Iodice, Valeria, additional, and Provitera, Vincenzo, additional

Published
2022
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22. Clinical autonomic nervous system laboratories in Europe

Author

Habek, Mario, Leys, Fabian, Krbot Skorić, Magdalena, Reis Carneiro, Diogo, Calandra‐Buonaura, Giovanna, Camaradou, Jennifer, Chiaro, Giacomo, Cortelli, Pietro, Falup‐Pecurariu, Cristian, Granata, Roberta, Guaraldi, Pietro, Helbok, Raimund, Hilz, Max J., Iodice, Valeria, Jordan, Jens, Kaal, Evert C. A., Kamondi, Anita, Pavy Le Traon, Anne, Rocha, Isabel, Sellner, Johann, Senard, Jean Michel, Terkelsen, Astrid, Wenning, Gregor K., Berger, Thomas, Thijs, Roland D., Struhal, Walter, and Fanciulli, Alessandra

Subjects
Autonomic Nervous System Diseases, Neurology, Surveys and Questionnaires, Humans, Autonomic Nervous System, Laboratories
Abstract

Background and purpose: Disorders of the autonomic nervous system (ANS) are common conditions, but it is unclear whether access to ANS healthcare provision is homogeneous across European countries. The aim of this study was to identify neurology-driven or interdisciplinary clinical ANS laboratories in Europe, describe their characteristics and explore regional differences. ------ Methods: We contacted the European national ANS and neurological societies, as well as members of our professional network, to identify clinical ANS laboratories in each country and invite them to answer a web-based survey. ----- Results: We identified 84 laboratories in 22 countries and 46 (55%) answered the survey. All laboratories perform cardiovascular autonomic function tests, and 83% also perform sweat tests. Testing for catecholamines and autoantibodies are performed in 63% and 56% of laboratories, and epidermal nerve fiber density analysis in 63%. Each laboratory is staffed by a median of two consultants, one resident, one technician and one nurse. The median (interquartile range [IQR]) number of head-up tilt tests/laboratory/year is 105 (49-251). Reflex syncope and neurogenic orthostatic hypotension are the most frequently diagnosed cardiovascular ANS disorders. Thirty-five centers (76%) have an ANS outpatient clinic, with a median (IQR) of 200 (100-360) outpatient visits/year; 42 centers (91%) also offer inpatient care (median 20 [IQR 4-110] inpatient stays/year). Forty-one laboratories (89%) are involved in research activities. We observed a significant difference in the geographical distribution of ANS services among European regions: 11 out of 12 countries from North/West Europe have at least one ANS laboratory versus 11 out of 21 from South/East/Greater Europe (p = 0.021). ----- Conclusions: This survey highlights disparities in the availability of healthcare services for people with ANS disorders across European countries, stressing the need for improved access to specialized care in South, East and Greater Europe.

Published
2022

23. Survey of healthcare professionals’ knowledge, attitudes and practices regarding spontaneous intracranial hypotension

Author

Cheema, Sanjay, primary, Anderson, Jane, additional, Duncan, Callum, additional, Davagnanam, Indran, additional, Armstrong, Paul, additional, Redfern, Nancy, additional, Ordman, Anthony, additional, D’Antona, Linda, additional, Nissen, Justin, additional, Sayal, Parag, additional, Vaughan-Huxley, Eyston, additional, Lagrata, Susie, additional, Iodice, Valeria, additional, Snape-Burns, Jessica, additional, Joy, Clare, additional, and Matharu, Manjit, additional

Published
2022
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30. Diagnosing Premotor Multiple System Atrophy

Author

Vichayanrat, Ekawat, primary, Valerio, Fernanda, additional, Koay, Shiwen, additional, De Pablo-Fernandez, Eduardo, additional, Panicker, Jalesh, additional, Morris, Huw, additional, Bhatia, Kailash, additional, Chelban, Viorica, additional, Houlden, Henry, additional, Quinn, Niall, additional, Navarro-Otano, Judith, additional, Miki, Yasuo, additional, Holton, Janice, additional, Warner, Thomas, additional, Mathias, Christopher, additional, and Iodice, Valeria, additional

Published
2022
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33. Impact of the COVID‐19 pandemic on clinical autonomic practice in Europe: a survey of the European Academy of Neurology and the European Federation of Autonomic Societies.

Author

Fanciulli, Alessandra, Leys, Fabian, Krbot Skorić, Magdalena, Reis Carneiro, Diogo, Calandra‐Buonaura, Giovanna, Camaradou, Jennifer, Chiaro, Giacomo, Cortelli, Pietro, Falup‐Pecurariu, Cristian, Granata, Roberta, Guaraldi, Pietro, Helbok, Raimund, Hilz, Max J., Iodice, Valeria, Jordan, Jens, Kaal, Evert C. A., Kamondi, Anita, Pavy Le Traon, Anne, Rocha, Isabel, and Sellner, Johann

Subjects
ORTHOSTATIC intolerance, POSTURAL orthostatic tachycardia syndrome, COVID-19 pandemic, EUROPEAN integration, COVID-19, CARDIOVASCULAR diseases
Abstract

Background and purpose: The objective was to investigate the impact of the coronavirus disease 2019 (COVID‐19) pandemic on European clinical autonomic practice. Methods: Eighty‐four neurology‐driven or interdisciplinary autonomic centers in 22 European countries were invited to fill in a web‐based survey between September and November 2021. Results: Forty‐six centers completed the survey (55%). During the first pandemic year, the number of performed tilt‐table tests, autonomic outpatient and inpatient visits decreased respectively by 50%, 45% and 53%, and every third center reported major adverse events due to postponed examinations or visits. The most frequent newly diagnosed or worsened cardiovascular autonomic disorders after COVID‐19 infection included postural orthostatic tachycardia syndrome, orthostatic hypotension and recurrent vasovagal syncope, deemed to be likely related to the infection by ≥50% of the responders. Forty‐seven percent of the responders also reported about people with new onset of orthostatic intolerance but negative tilt‐table findings, and 16% about people with psychogenic pseudosyncope after COVID‐19. Most patients were treated non‐pharmacologically and symptomatic recovery at follow‐up was observed in ≥45% of cases. By contrast, low frequencies of newly diagnosed cardiovascular autonomic disorders following COVID‐19 vaccination were reported, most frequently postural orthostatic tachycardia syndrome and recurrent vasovagal syncope, and most of the responders judged a causal association unlikely. Non‐pharmacological measures were the preferred treatment choice, with 50%–100% recovery rates at follow‐up. Conclusions: Cardiovascular autonomic disorders may develop or worsen following a COVID‐19 infection, whilst the association with COVID‐19 vaccines remains controversial. Despite the severe pandemic impact on European clinical autonomic practice, a specialized diagnostic work‐up was pivotal to identify non‐autonomic disorders in people with post‐COVID‐19 orthostatic complaints. [ABSTRACT FROM AUTHOR]

Published
2023
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36. 037 New insight into dysautonomia in GFAP astrocytopathy

Author

Goh, Yee Yen, primary, Koay, Shiwen, additional, Goodall, Jack, additional, Oommens, Grace, additional, Ingle, Gordon, additional, Parris, Victoria, additional, Iodice, Valeria, additional, Swanton, Josephine, additional, and McNamara, Patricia, additional

Published
2022
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39. Clinical autonomic nervous system laboratories in Europe. A joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies

Author

Habek, Mario, Leys, Fabian, Krbot Skorić, Magdalena, Reis Carneiro, Diogo, Calandra‐Buonaura, Giovanna, Camaradou, Jennifer, Chiaro, Giacomo, Cortelli, Pietro, Falup‐Pecurariu, Cristian, Granata, Roberta, Guaraldi, Pietro, Helbok, Raimund, Hilz, Max J., Iodice, Valeria, Jordan, Jens, Kaal, Evert C. A., Kamondi, Anita, Pavy Le Traon, Anne, Rocha, Isabel, Sellner, Johann, Senard, Jean Michel, Terkelsen, Astrid, Wenning, Gregor K., Berger, Thomas, Thijs, Roland D., Struhal, Walter, Fanciulli, Alessandra, Adamec, Ivan, Aerts, Arnaud, Canta, Leo L.R., Delamont, Robert Shane, de Lange, Frederik, Del Sorbo, Francesca, Devigili, Grazia, Di Leo, Rita, Dinh, Trang, Fortrat, Jacques‐Olivier, Gierthmühlen, Janne, Hemels, Martin, Köhn, Julia, Krøigård, Thomas, Lipp, Axel, Maier, Andrea, Marinelli, Lucio, Mazzeo, Anna, Milenkovic, Ivan, Motyl, Maciej, Natali Sora, Maria Grazia, Navarro‐Otano, Judith, Nilsen, Kristian Bernhard, Oliveira, Mario, Omland, Petter Moe, Pelliccioni, Giuseppe, Pereon, Yann, Resch, Roland Josef, Rocchi, Camilla, Roche, Frederic, Rutten, Joost, Tijero Merino, Beatriz, Tutaj, Marcin, van der Heijden‐Montfroy, A.M.H.G., van Hoeve, Bas J.A., van Orshoven, Narender, Wang, Ruihao, Z’Graggen, Werner J., Habek M., Leys F., Krbot Skoric M., Reis Carneiro D., Calandra-Buonaura G., Camaradou J., Chiaro G., Cortelli P., Falup-Pecurariu C., Granata R., Guaraldi P., Helbok R., Hilz M.J., Iodice V., Jordan J., Kaal E.C.A., Kamondi A., Pavy Le Traon A., Rocha I., Sellner J., Senard J.M., Terkelsen A., Wenning G.K., Berger T., Thijs R.D., Struhal W., Fanciulli A., Adamec I., Aerts A., Canta L.L.R., Delamont R.S., de Lange F., Del Sorbo F., Devigili G., Di Leo R., Dinh T., Fortrat J.-O., Gierthmuhlen J., Hemels M., Kohn J., Kroigard T., Lipp A., Maier A., Marinelli L., Mazzeo A., Milenkovic I., Motyl M., Natali Sora M.G., Navarro-Otano J., Nilsen K.B., Oliveira M., Omland P.M., Pelliccioni G., Pereon Y., Resch R.J., Rocchi C., Roche F., Rutten J., Tijero Merino B., Tutaj M., van der Heijden-Montfroy A.M.H.G., van Hoeve B.J.A., van Orshoven N., Wang R., Z'Graggen W.J., Cardiology, ACS - Heart failure & arrhythmias, and Repositório da Universidade de Lisboa

Subjects
sweat test, sweat tests, neurological disorders, Autonomic Nervous System, Autonomic Nervous System Disease, (disorders of) autonomic nervous system, cardiovascular autonomic function test, Composite Autonomic Severity Score, orthostatic hypotension, Neurology, syncope, Consciousness, disorders, neurodisparity, Autonomic nervous system, disorders, Surveys and Questionnaire, Neurology (clinical), cardiovascular autonomic function tests, disorders of consciousness (other than epilepsy), neurological disorder, Survey, Laboratorie, Human
Abstract

© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes., Background and purpose: Disorders of the autonomic nervous system (ANS) are common conditions, but it is unclear whether access to ANS healthcare provision is homogeneous across European countries. The aim of this study was to identify neurology-driven or interdisciplinary clinical ANS laboratories in Europe, describe their characteristics and explore regional differences. Methods: We contacted the European national ANS and neurological societies, as well as members of our professional network, to identify clinical ANS laboratories in each country and invite them to answer a web-based survey. Results: We identified 84 laboratories in 22 countries and 46 (55%) answered the survey. All laboratories perform cardiovascular autonomic function tests, and 83% also perform sweat tests. Testing for catecholamines and autoantibodies are performed in 63% and 56% of laboratories, and epidermal nerve fiber density analysis in 63%. Each laboratory is staffed by a median of two consultants, one resident, one technician and one nurse. The median (interquartile range [IQR]) number of head-up tilt tests/laboratory/year is 105 (49-251). Reflex syncope and neurogenic orthostatic hypotension are the most frequently diagnosed cardiovascular ANS disorders. Thirty-five centers (76%) have an ANS outpatient clinic, with a median (IQR) of 200 (100-360) outpatient visits/year; 42 centers (91%) also offer inpatient care (median 20 [IQR 4-110] inpatient stays/year). Forty-one laboratories (89%) are involved in research activities. We observed a significant difference in the geographical distribution of ANS services among European regions: 11 out of 12 countries from North/West Europe have at least one ANS laboratory versus 11 out of 21 from South/East/Greater Europe (p = 0.021). Conclusions: This survey highlights disparities in the availability of healthcare services for people with ANS disorders across European countries, stressing the need for improved access to specialized care in South, East and Greater Europe.

Published
2022

42. Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain

Author

Csecs, Jenny L. L., primary, Iodice, Valeria, additional, Rae, Charlotte L., additional, Brooke, Alice, additional, Simmons, Rebecca, additional, Quadt, Lisa, additional, Savage, Georgia K., additional, Dowell, Nicholas G., additional, Prowse, Fenella, additional, Themelis, Kristy, additional, Mathias, Christopher J., additional, Critchley, Hugo D., additional, and Eccles, Jessica A., additional

Published
2022
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45. Contributors

Author

Aiello, Lloyd Paul, primary, Alatzoglou, Kyriaki S., additional, Alexander, Erik K., additional, Allan, Carolyn A., additional, Allolio, Bruno, additional, Amino, Nobuyuki, additional, Anawalt, Bradley D., additional, Angelos, Peter, additional, Arboleda, Valerie A., additional, Auchus, Richard J., additional, Axelrod, Lloyd, additional, Bahn, Rebecca S., additional, Baker, MD, PhD, FRACP, H.W. Gordon, additional, Barak, Shlomi, additional, Barnes, Randall B., additional, Barthel, Andreas, additional, Bastepe, Murat, additional, Beardsley, Emma K., additional, Beck-Peccoz, Paolo, additional, Bell, Graeme I., additional, Bi, Wenya Linda, additional, Bilezikian, John P., additional, Blum, Manfred, additional, Bonnema, Steen J., additional, Bornstein, Stefan R., additional, Bouillon, Roger, additional, Boulton, Andrew J.M., additional, Braunstein, Glenn D., additional, Bringhurst, F. Richard, additional, Broekmans, Frank J., additional, Bronstein, Marcello D., additional, Brown, Edward M., additional, Brown, Wendy A., additional, Bulun, Serdar E., additional, Burch, Henry B., additional, Burger, Henry G., additional, Burney, Richard O., additional, Burt, Morton G., additional, Cagliero, Enrico, additional, Callender, Glenda G., additional, Avancini Caramori, Maria Luiza, additional, Carey, Robert M., additional, Carling, Tobias, additional, Cavagnini, Francesco, additional, Cavallerano, Jerry D., additional, Challet, Etienne, additional, Chan, Shu Jin, additional, Chang, R. Jeffrey, additional, Chapurlat, Roland D., additional, Chatterjee, V. Krishna, additional, Chiofalo, Francesco, additional, Chiovato, Luca, additional, Cho, Kyung J., additional, Christison-Lagay, Emily, additional, Christophe, Daniel, additional, Chrousos, George P., additional, Cidlowski, John A., additional, Clemmons, David R., additional, Considine, Robert V., additional, Conti, Marco, additional, Copinschi, Georges, additional, Copps, Kyle D., additional, Cowley, Michael A., additional, Cuttler, Leona, additional, Dattani, Mehul T., additional, Davis, Stephen N., additional, De Felice, Mario, additional, De Groot, Leslie J., additional, de Kretser, David M., additional, DeFronzo, Ralph A., additional, Delli, Ahmed J., additional, Demay, Marie B., additional, Dennedy, Michael C., additional, Di Lauro, Roberto, additional, Dineen, Rosemary, additional, Ding, Su Ann, additional, Dinneen, Sean F., additional, Drucker, Daniel J., additional, Dumont, Jacques E., additional, Dungan, Kathleen M., additional, Dunn, Ian F., additional, Econs, Michael J., additional, Ehrmann, David A., additional, Eisenhofer, Graeme, additional, Ergun-Longmire, Berrin, additional, Eugster, Erica A., additional, Farooqi, Sadaf I., additional, Fassnacht, Martin, additional, Fauser, Bart C.J.M., additional, Fenzi, Gianfranco, additional, Ferrannini, Ele, additional, Findlay, David M., additional, Finlayson, Courtney Anne, additional, Fisher, Delbert A., additional, Francis, Isaac R., additional, Freeman, Mason W., additional, Frohman, Lawrence A., additional, Frydenberg, Mark, additional, Fuller, Peter J., additional, Gaglia, Jason L., additional, Galizia, Gianluigi, additional, Gardella, Thomas J., additional, Garvey, Katharine C., additional, Genant, Harry K., additional, German, Michael S., additional, Gevers, Evelien F., additional, Giraldi, Francesca Pecori, additional, Giudice, Linda C., additional, Giustina, Andrea, additional, Glasier, Anna, additional, Glorieux, Francis H., additional, Goldfine, Allison B., additional, Gooren, Louis J., additional, Gordon, David F., additional, Gregerson, Karen A., additional, Grogan, Raymon H., additional, Gross, Milton D., additional, Grossman, Ashley B., additional, Gruber, Matthias, additional, Guimarães, Valeria C., additional, Gurnell, Mark, additional, Haddad, Nadine G., additional, Haisenleder, Daniel J., additional, Handelsman, David J., additional, Hanks, John B., additional, Hannon, Mark J., additional, Harno, Erika, additional, Hebrok, Matthias, additional, Hedger, Mark P., additional, Hegedüs, Laszlo, additional, Heindel, Jerrold J., additional, Hernandez, Arturo, additional, Herndon, Maria K., additional, Ho, Ken K.Y., additional, Horseman, Nelson D., additional, Hughes, Ieuan A., additional, Hupfeld, Christopher J., additional, Hussain, Hero K., additional, Iodice, Valeria, additional, James, Benjamin C., additional, Jameson, J. Larry, additional, Jones, Glenville, additional, Josso, Nathalie, additional, Jüppner, Harald, additional, Juszczak, Agata, additional, Kalish, Jeffrey, additional, Kaplan, Edwin L., additional, Karavitaki, Niki, additional, Karczewska-Kupczewska, Monika, additional, Khattab, Ahmed, additional, Klein, David C., additional, Klein, Ronald, additional, Kleinau, Gunnar, additional, Koontz, Michaela, additional, Kopchick, John J., additional, Kopp, Peter, additional, Kowalska, Irina, additional, Krane, Stephen M., additional, Krohn, Knut, additional, Kronenberg, Henry M., additional, Lamos, Elizabeth M., additional, Lania, Andrea, additional, Lau, Sue Lynn, additional, Laws, Edward R., additional, Lazarus, John H., additional, Learoyd, Diana L., additional, Lebovitz, Harold E., additional, Lenmark, Åke, additional, List, Edward O., additional, Loveland, Kate, additional, Low, David A., additional, Macchia, Paolo E., additional, Maclaren, Noel K., additional, Madeiros-Neto, Geraldo, additional, Maenhaut, Carine, additional, Maes, Christa, additional, Main, Katharina M., additional, Malchoff, Carl D., additional, Malchoff, Diana M., additional, Malik, Rayaz A., additional, Mandel, Susan J., additional, Mantzoros, Christos S., additional, Maratos-Flier, Eleftheria, additional, Marino, Michele, additional, Marshall, John C., additional, Martin, T. John, additional, Martin, Thomas F.J., additional, Mathias, Christopher J., additional, McGee, Elizabeth A., additional, McKenzie, Travis, additional, McLachlan, Robert I., additional, Meier, Juris J., additional, Melmed, Shlomo, additional, Metzger, Boyd E., additional, Meyer-Bahlburg, Heino F.L., additional, Millar, Robert P., additional, Miller, Walter L., additional, Misra, Madhusmita, additional, Molitch, Mark E., additional, Moravek, Molly B., additional, Morris, Damian G., additional, Nagar, Sapna, additional, Nakamoto, Jon, additional, New, Maria I., additional, Nieman, Lynnette K., additional, Nilson, John H., additional, Ntali, Georgia, additional, O’Bryan, Moira, additional, O’Rahilly, Stephen, additional, Öberg, Kjell, additional, Olefsky, Jerrold M., additional, Olson, Matthew T., additional, Pacak, Karel, additional, Pacini, Furio, additional, Padia, Shetal H., additional, Paschke, Ralf, additional, Pasquel, Francisco J., additional, Perry, Katherine Wesseling, additional, Persani, Luca, additional, Philipson, Louis H., additional, Pina, Christian, additional, Pomposelli, Frank B., additional, Potts, John T., additional, Quigley, Charmian A., additional, Quinkler, Marcus O., additional, Quirk, Christine Campion, additional, Rajpert-De Meyts, Ewa, additional, Ravussin, Eric, additional, Ray, David W., additional, Refetoff, Samuel, additional, Retnakaran, Ravi, additional, Rey, Rodolfo A., additional, Rhodes, Christopher J., additional, Ridgway, E. Chester, additional, Risbridger, Gail P., additional, Rizza, Robert A., additional, Robinson, Bruce G., additional, Roger, Pierre P., additional, Rosenfeld, Michael G., additional, Rosenfield, Robert L., additional, Rossing, Peter, additional, Rubin, Robert T., additional, Rubio, Ileana G.S., additional, Ruderman, Neil B., additional, Russo, Jose, additional, Russo, Irma H., additional, Salusky, Isidro B., additional, Santoro, Nanette, additional, Scully, Kathleen M., additional, Sexton, Patrick M., additional, Shulman, Gerald I., additional, Silva, Paolo S., additional, Silverberg, Shonni J., additional, Singer, Frederick R., additional, Skakkebaek, Niels E., additional, Skaznik-Wikiel, Malgorzata E., additional, Skowronska-Krawczyk, Dorota, additional, Smith, Carolyn L., additional, Smith, Philip W., additional, Smith, Roger, additional, Smith, Steven R., additional, Snyder, Peter J., additional, St. Germain, Donald L., additional, St-Arnaud, René, additional, Steiner, Donald F., additional, Stewart, Paul M., additional, Strączkowski, Marek, additional, Strauss, Jerome F., additional, Styne, Dennis M., additional, Swan, Karena L., additional, Swerdloff, Ronald S., additional, Tacon, Lyndal J., additional, Tello, Javier A., additional, Thakker, Rajesh V., additional, Thompson, Christopher J., additional, Timmers, Henri J.L.M., additional, Toppari, Jorma, additional, Traub, Michael L., additional, Tsoukas, Michael A., additional, Udelsman, Robert, additional, Umpierrez, Guillermo E., additional, Van den Berghe, Greet, additional, Vassart, Gilbert, additional, Vernon, Ashley H., additional, Vilain, Eric, additional, Visser, Theo J., additional, Vitti, Paolo, additional, Walford, Geoffrey A., additional, Wang, Christina, additional, Weetman, Anthony P., additional, Weigel, Nancy L., additional, Weir, Gordon C., additional, Weiss, Roy E., additional, White, Anne, additional, White, Kenneth E., additional, White, Morris F., additional, Whyte, Michael P., additional, Wiersinga, Wilmar M., additional, Willenberg, Holger S., additional, Wolfsdorf, Joseph I., additional, Wondisford, Fredric E., additional, Wong, Ka Kit, additional, Wysolmerski, John J., additional, Yau, Mabel, additional, Young, Morag J., additional, Younk, Lisa M., additional, Yu, Run, additional, Yuen, Tony, additional, Zeiger, Martha A., additional, Zinman, Bernard, additional, and Zoeller, R. Thomas, additional

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2016
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