Clinical Autonomic Disorders: A Training Protocol

Objective: This Protocol is to facilitate training of Fellows in evaluation of clinical disorders of the autonomic nervous system. The training is necessary to enable Fellows to sit for and pass the certifying examination in autonomic disorders administered by the United Council for Neurologic Subspecialties (UCNS) and to maintain UCNS accreditation of the Fellowship. A secondary objective is to include results of evaluations and testing with those from other Protocols, for future data analyses. Study population: Referred patients with known or suspected abnormalities of one or more components of the autonomic nervous system and healthy adult volunteers. Volunteers will be studied for Fellows to practice and gain normative values for pupillometric function. Design: Clinical physiologic, neuropharmacologic, and neurochemical testing will be performed during outpatient clinic visits or during inpatient admissions, depending on the individual testing schedule. Inpatient testing may be done in conjunction with other Protocols (e.g., 03-N-0004). Most of the testing under this Protocol can be completed in a single outpatient visit over the course of a workday. Testing procedures under this Protocol will be performed as needed for adequate Fellow training. In addition to autonomic medical history and physical examination, clinical testing procedures may include (A) monitoring of hemodynamics, sweating, and other physiologic parameters associated with the Valsalva maneuver, orthostasis, or external temperature manipulation; (B) venous blood sampling for assays of levels of catecholamines and related neurochemicals; (C) administration of autonomic test drugs; (D) skin biopsies; (E) blood volume measurement; (F) pupillometry; (G) gastrointestinal phonography; (H) urinary bladder ultrasound; and (I) neurobehavioral rating scales. Outcome measures: The main outcome measure is competency in clinical and laboratory evaluation of autonomic disorders, based on assessment of the Fellow by the Principal Investigator at approximately 6-month intervals. A secondary outcome measure is results obtained under this Protocol, which may be analyzed and reported as research data along with data from other Protocols.