Key Definitions

Chronic Complex Illness – refers to a group of medical conditions that are long-lasting (typically persisting for more than six months) and involve multiple body systems, leading to a complex array of symptoms and health challenges. These illnesses often require comprehensive and coordinated care due to their multifaceted nature. Key characteristics of chronic complex illnesses include:

•  Multisystem Involvement: These conditions affect more than one organ system, leading to a wide range of symptoms that can be difficult to manage and diagnose.  Often involving disorders of the autonomic nervous system. 
• Persistent Symptoms: Symptoms are ongoing and can fluctuate in severity, often impacting the individual’s quality of life and daily functioning.
• Complex Management Needs: Due to the involvement of multiple systems, treatment often requires a multidisciplinary approach, including various healthcare professionals such as physicians, specialists, physical therapists, and mental health providers. Requires key coordination and continuity of care by a primary care provider. 
• Potential for Comorbidities: Individuals with chronic complex illnesses often have other coexisting conditions, which can complicate diagnosis and treatment.

Chronic complex illnesses almost always present with symptoms of dysautonomia.  In addition to the examples of post viral Illness (including Long COVID),  Postural Tachycardia Syndrome (POTS), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) noted above, other common examples include Post Concussion Syndrome, Fibromyalgia and autoimmune-related disorders like Lupus and multiple sclerosis. Some are genetically inherited, such as Ehlers-Danlos Syndrome. Many of these conditions overlap and are not mutually exclusive. Managing these illnesses typically involves a combination of medication, lifestyle modifications, psychological support, and sometimes alternative therapies. Where cures are effectively absent, the goal of treatment is chiefly to manage symptoms, improve quality of life, and maintain the highest level of function possible over the long term. 

Autonomic Disorders – is a neurology subspecialty accredited by the United Council of Neurologic Subspecialties (UCNS), dedicated to the care of complex and often chronic medical conditions involving the Autonomic Nervous System (ANS). This field is also known as Autonomic Medicine. Although it is a neurology subspecialty, it is inclusive of all specialties, including board-certified practitioners in primary care, internal medicine, pediatrics, cardiology, gastroenterology, urology, and obstetrics/gynecology, among others. Dysautonomia knows no boundaries, as all these disciplines encounter and treat problems involving dysfunction of the autonomic nervous system daily.  Certified Autonomic Disorders Specialists care for a variety of conditions under the umbrella of dysautonomia, representing some of the most severe chronic complex illnesses.

Some of the disorders managed include:

1. 1. Postural Orthostatic Tachycardia Syndrome (POTS) and Orthostatic Intolerance (OI)
   2. Neurocardiogenic Syncope (also known as Vasovagal Syncope)
   3. Multiple System Atrophy (MSA)
   4. Pure Autonomic Failure (PAF)

• Parkinsons include lewy body dementia type. 

1. 1. Familial Dysautonomia (Riley-Day Syndrome)
   2. Orthostatic Hypotension
   3. Baroreflex Failure
   4. Diabetic Autonomic Neuropathy
   5. Autoimmune Autonomic Ganglionopathy

• Autoimmune related complications of GAD-65, Sjogrens, Lupus, Rheumatoid Arthritis, Scleroderma to name several. 

• Post Viral Syndromes including LC-POTS, Neuropathic POTS, ME/CFS, resulting often in loss of cerebral blood flow.  

• Small Fiber Neuropathy

• Amyloidosis 

1. 1. Paraneoplastic Autonomic Neuropathy
   2. Hereditary Sensory and Autonomic Neuropathies (HSAN)
   3. Ehlers-Danlos Syndrome (EDS)-related Dysautonomia, “POTS Plus”

• Chronic migraines

These specialists may also manage autonomic dysfunction related to other conditions not listed.  Treatment and management strategies are tailored to each individual patient, depending on the specific disorder and its severity.

Autonomic Medicine – Specialized field of medicine focused on the study, diagnosis, and treatment of disorders related to the autonomic nervous system (ANS).  See Autonomic Disorders.

Autonomic Nervous System (ANS) – The ANS is responsible for regulating involuntary bodily functions, such as heart rate, blood pressure, digestion, and temperature control.  The Autonomic Nervous System (ANS) is the border between the brain and the body.  

Dysautonomia – Refers to a group of disorders in which the autonomic nervous system (ANS) does not function properly. It is not a diagnosis, but an umbrella term for a wide range of Autonomic Disorders (AD) that often result in symptoms of dizziness, fainting, unstable blood pressure, abnormal heart rates, digestive issues, and intolerance to exercise. The severity and specific symptoms can vary greatly depending on the underlying cause and the particular type of dysautonomia. Some common forms include Postural Orthostatic Tachycardia Syndrome (POTS), ME/CFS, and Multiple System Atrophy – representing some of the most chronic complex illnesses encountered by physicians.