| Autonomic nervous system disorders  

Impact of the COVID-19 pandemic on clinical autonomic practice in Europe

Since 2020, the world has been facing the COVID-19 pandemic caused by the SARS-CoV-2 virus. The range of symptoms associated to a SARS-CoV-2 infection involves virtually all body systems. The cardiovascular autonomic nervous system is involved differently according to whether the infection is acute or when symptoms progress or appear for more than a month after the acute infection (the so-called post-COVID-19)(Reis Carneiro et al 2023). Also, some reports suggest that SARS-CoV-2 vaccination may lead to autonomic side effects.

In a paper published in the European Journal of Neurology, Fanciulli and collaborators (2023) present an overview of the impact of the COVID-19 pandemic on clinical autonomic practice in Europe. In a comprehensive survey, the authors documented the severe impact of the pandemic on European clinical autonomic practice, including outpatient and inpatient visits, in particular during the first year. COVID-19 infection caused new autonomic disorders and the worsening of previously diagnosed ones. Postural orthostatic tachycardia syndrome, orthostatic hypotension and recurrent vasovagal syncope were the most frequent and likely related to a previous infection. Many responders also reported people with new onset of orthostatic intolerance but negative tilt-table test (47%) or a final diagnosis about people with psychogenic pseudosyncope after COVID-19 (16%). Most patients were treated using non-pharmacological measures, and recovery of symptoms at follow-up was frequent (≥45%). The association of cardiovascular autonomic disorders with COVID-19 vaccines remains controversial.
In the end, the importance of a specialized autonomic workup was reinforced in the differential diagnosis of people with post-COVID-19 orthostatic complaints.

Key points:

• Clinical autonomic labs in Europe were severely impacted during the SARS-CoV-2 pandemic
• Cardiovascular autonomic disorders may develop or worsen following a COVID-19 infection
• A specialized diagnostic work-up was critical to identify non-autonomic disorders in people with post-COVID-19 orthostatic complaints


  1. Reis Carneiro D, Rocha I, Habek M, et al. Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID-19 infection - A systematic review. Eur J Neurol. Jan 24 2023;doi:10.1111/ene.15714
  2. Fanciulli A, Leys F, Krbot Skorić M, et al. Impact of the COVID-19 pandemic on clinical autonomic practice in Europe A survey of the European Academy of Neurology (EAN) and the European Federation of Autonomic Societies (EFAS). Eur J Neurol. Mar 15 2023;doi:10.1111/ene.15787

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