Autonomic nervous system autoimmunity and proposed immunotherapies.

This paper reviews autoimmune causes of autonomic nervous system (ANS) dysfunction, emphasizing that they are relatively common but frequently missed. The author explains that immune-mediated damage can affect central and peripheral autonomic pathways and usually involves both sympathetic and parasympathetic branches, plus the enteric (gut) nervous system. Some disorders are primarily autonomic, such as autoimmune autonomic ganglionopathy linked to ganglionic acetylcholine receptor antibodies; others are part of broader neurologic or systemic autoimmune disease (e.g., paraneoplastic syndromes, Sjögren’s), where autonomic nerves are collateral targets. The article stresses careful clinical history, detailed autonomic testing, and attention to the distribution (generalized vs more restricted) and severity of dysautonomia to clarify diagnosis. Recognizing specific autonomic symptom patterns in different autoimmune autonomic disorders is crucial, because it guides both symptomatic management (e.g., blood pressure, heart rate, GI and sweating problems) and decisions about immunotherapies (such as IVIG, plasma exchange, or immunosuppressants). For clinicians treating POTS or other dysautonomias, the paper reinforces that an autoimmune mechanism should be considered in the right clinical context and that targeted immunotherapy may be appropriate in selected patients after thorough evaluation.