At the Mass General Brigham Small Fiber and Autonomic Neurology Program, we offer comprehensive evaluations, second opinion consultations, autonomic testing and ongoing expert management for patients with suspected or confirms autonomic disorders. Among the services we offer are:
- Quantitative autonomic screening tests such as deep breathing, Valsalva maneuver, tilt test and sweat tests.
- Skin biopsies for quantification of small nerve fibers, and to look for possible causes.
- Comprehensive testing to look for common and rare causes of autonomic and small fiber disorders.
- Telehealth services.
Treatment plans are tailored to each patient’s diagnosis.
Autonomic Testing
In addition to evaluation and management services, we offer comprehensive autonomic reflex testing, often referred to at Mass General Brigham as “Autonomic Function Testing” (AFTs). These tests may help your doctor to determine whether the autonomic nerves are functioning like they should.
We currently have three Autonomic Laboratories devoted to testing the autonomic nervous system: Brigham and Women’s Faulkner Hospital (BWFH), Massachusetts General Hospital (MGH), and Wentworth-Douglass Hospital (WDH).
AFTs can be ordered within Epic (type “AFTs”), or your physician can fax an order to 617-983-7195 (BWFH), 603-749-0973 (WDH), or 617-726-2019 (MGH).
A typical autonomic reflex battery may include the following components:
- Screening tests that measure heart rate and blood pressure during tasks such as deep breathing, Valsalva maneuver, and head-up tilt test
- Sweat testing
Additional testing that may be helpful include the following:
- Skin biopsies to allow for quantification of nerve fiber density and for identification of underlying pathology
- Continuous cerebral blood flow and exhaled carbon dioxide recordings during the tilt test, which can help sometimes in establishing a cause of dizziness.
- Ice-water immersion.
Other diagnostic tests may be recommended by your team:
- Genetic testing, neuronal autoimmune profiles, and other specialized tests if certain autonomic disorders are suspected.
- Nerve conduction studies with electromyograophy, nerve ultrasound, or brain, nerve, or spinal imaging, if large nerve fibers or the brain could be involved.
Please note: patients will NOT receive a consultation from a provider during the autonomic testing appointment. Autonomic testing is a procedure performed by trained technicians. Results of the test are interpreted by an autonomic specialist. These results and the interpretation will then be sent to the ordering provider or referring physician.
Please be sure to carefully review all the Instructions for Autonomic Testing, which will also be sent to you by mail or through the Patient Gateway.
You may need to review these instructions with the ordering physician or provider and ask them questions, so give yourself plenty of time. Please be sure to read these instructions as soon as you receive them, after your appointment is made. It may be beneficial to stop certain medications, after discussing this with the referring provider.
***NEVER stop any of your regularly prescribed medications without consulting with your doctor***
