Clinical Autonomic Nervous System Laboratories in Europe: A joint survey of the European Academy of Neurology and the European Federation of Autonomic Societies

OBJECTIVES: To identify neurology-driven or interdisciplinary clinical autonomic nervous system (ANS) laboratories in Europe, describe their characteristics and explore regional differences.

METHODS: We contacted the European national ANS and neurological societies, as well as members of our professional network to identify clinical ANS laboratories in each country and invite them to answer a web-based survey.

RESULTS: we identified 84 laboratories in 22 countries and 46 (55%) answered the survey. All laboratories perform cardiovascular autonomic function tests, 83% also sweat tests. Testing for catecholamines and autoantibodies are performed in 63% and 56% of laboratories, epidermal nerve fiber density analysis in 63%. Each laboratory is staffed by a median of two consultants, one resident, one technician and one nurse. The median number of head-up tilt tests/laboratory/year is 105 (IQR 49-251). Reflex syncope and neurogenic orthostatic hypotension are the most frequently diagnosed cardiovascular ANS disorders. Thirty-five centers (76%) have an ANS outpatient clinic with 200 (IQR 100-360) outpatient visits/year; 42 (91%) centers also offer inpatients care [20 (IQR 4 -110) inpatient stays/year]. Forty-one laboratories (89%) are involved in research activities. We observed a significant difference in the geographical distribution of ANS services among European regions: 11 out of 12 countries from north/west Europe have at least one ANS laboratory versus 11 out of 21 from south/east/greater Europe (p=0.021).

CONCLUSIONS: This survey highlights disparities in the availability of health-care services for people with ANS disorders across European countries, stressing the need for improved access to specialized care in south, east and greater Europe.