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Sentara Neuromuscular and Autonomic Center 

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Sentara Neuromuscular and Autonomic Center

The Sentara Neuromuscular and Autonomic Center takes a comprehensive approach to diagnosing and treating conditions caused by a dysfunction of the autonomic nervous system (ANS), peripheral nerves and neuromuscular disorders.

Autonomic Program
Sentara has one of a few centers in the United States and the world that specialize in autonomic nervous system. It is led by an Autonomic Neurologist surrounded by a multidisciplinary team of physicians and healthcare professionals.

Autonomic disorders refer to the part of our nervous system that we don’t consciously control or really think about. They are nerve disorders that affect involuntary body functions, including heart rate, blood pressure, sweat, and digestion. Autonomic disorders can be caused by a large number of diseases and conditions or can be a side effect of treatment for diseases unrelated to the nervous system.

The diagnosis of disorders of the ANS relies strongly on testing of autonomic function. This is achieved through autonomic testing. Our Center boasts a fully equipped autonomic laboratory, featuring state-of-the-art technology including Thermoregulatory Sweat Testing (TST) and is one of 7 known locations that provide a similar service in the United States and the only one in the mid-Atlantic region.

Autonomic conditions we treat:
Autonomic failure 
Orthostatic hypotension
Orthostatic intolerance
Autonomic and small fiber neuropathy
Postural orthostatic tachycardia syndrome (POTS)
Sweat disorders, such as anhidrosis and hyperhidrosis
Certain degenerative diseases, such as multiple system atrophy and autonomic failure Parkinson disease

Symptoms of an Autonomic Disorder:
Signs and symptoms of autonomic disorders vary, depending on which parts of your autonomic nervous system are affected. They may include:
Dizziness and fainting upon standing, caused by a drop in blood pressure 
 Urinary problems, an inability to completely empty your bladder, and urinary tract infections
Sexual difficulties, including problems achieving or maintaining an erection or ejaculation problems in men, and vaginal dryness and difficulties with arousal and orgasm in women
Difficulty digesting food, due to abnormal digestive function and slow emptying of the stomach. (This can cause a feeling of fullness after eating little, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn.)
Sweating abnormalities, such as excessive or decreased sweating, which affects the ability to regulate body temperature
Sluggish pupil reaction, making it difficult to adjust from light to dark and causing problems with driving at night
Exercise intolerance, which may occur if your heart rate remains unchanged instead of appropriately increasing and decreasing in response to your activity level

Advanced Diagnosis of Autonomic Disorders at Sentara Neuromuscular and Autonomic Center
It is very important to accurately diagnose the symptoms of an autonomic disorder. This is accomplished by a physical examination focused on the autonomic nervous system and a careful review of your medical history.

Special testing of the autonomic nervous system may be conducted to:
Assess how well you autonomic nervous system controls blood pressure 
Determine your heart rate during different maneuvers and deep breathing exercises
Measure the volume of sweat you produce
Measure your ability to feel vibration and temperature sensation

Autonomic testing is designed to determine how well your body is regulating one’s blood pressure, heart rate and other functions related to the autonomic nervous system.

Tests include: 
 Heart Rate Variability to Deep breathing - Tests the integrity of the cardiac parasympathetic system. 
 Valsalva Maneuver - Tests the integrity of the cardiovascular sympathetic and parasympathetic systems. 
 The Tilt Table Test - Tests cardiovascular responses in the supine and upright positions. 
 Quantitative Sudomotor Axon Reflex Test (QSART) - Tests the small fiber system of the ANS that controls sweat glands. 
 Thermoregulatory Sweat Testing (TST) - Tests the total sudomotor (sweat-producing) system diagnosed by different sweat patterns in a monitored heated environment. 
 Infrared Dynamic Pupillometry (IDP) – Tests the integrity of the sympathetic and parasympathetic branches of the ANS at the pupil of the eye. 
 Laser Doppler Flowmetry (LDF) – Tests the subcutaneous blood flow through small-sized arteries and the capillary system, under the influence of the ANS.

Neuromuscular Program
Sentara offers an integrated system of care focusing specifically on neuromuscular and peripheral nerve disorders. Our neuromuscular physicians are board-certified, fellowship-trained neurologists who diagnose and treat a number of disorders of the peripheral nerves, neuromuscular junction and muscles.

Tests include: 
 Electrodiagnostic Testing (formerly known as Electromyography-Nerve Conduction Tests EMG/NCS) – Tests the muscles and nerves to determine where and to what extent damage has occurred. This test aids in the clinic diagnosis of neuromuscular diseases such as: Carpal Tunnel Syndrome, Muscular Dystrophies, and ALS (Lou Gehrig’s Disease) among many others. 
 Skin Biopsy – Tests for the amount and morphology of small fibers in the skin and around sweat glands. This state-of-the-art technique helps diagnosing disorders of the small fiber system such small fiber neuropathies and autonomic neuropathies.

Treating Autonomic and Neuromuscular Disorders at Sentara
We deliver highly personalized based on the specifics of your autonomic and neuromuscular disorders. For example, if the underlying cause is diabetes, you'll need to control your blood sugar to keep it as close to normal as possible. Treating the underlying disease can help stop autonomic neuropathy from progressing.

Clinical Team 
Kamal Chémali, MD
Medical Director, Sentara Neuromuscular and Autonomic Center

Kevin McNeeley
Autonomic Lab Coordinator

Sentara Neuromuscular and Autonomic Center
Sentara Heart Hospital
6th Floor, Suite 8630
600 Gresham Drive
Norfolk, VA 23507

Contact Us
Make an appointment with our center today. Or, call us at (877) 310-8713 for more information.

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