The remarkable value of the dysautonomia field study in Mexico

• Conditions associated with autonomic dysfunction (another term for dysautonomia) are common and are observed daily in medical consultations in every medical office across our country.
• “Dysautonomia is a term that physicians often use as a diagnostic conclusion to describe a set of diffuse and vague symptoms (primarily due to orthostatic intolerance). However, the term is not specific to any particular condition, as multiple disorders can present with the same symptoms [1].”
• “The clinical evaluation of dysautonomia has evolved significantly over the past four decades. It is based on increasingly sophisticated methods for quantifying and observing common physiological variables (blood pressure and heart rate). These advances allow for greater diagnostic precision, a deeper understanding of autonomic physiology, and truly individualized treatment adjustments for each patient [2].”
• “While a thorough clinical history is the most important tool for suspecting dysautonomia” (in the words of Dr. Goldstein, a pioneer in the autonomic field), it requires patience, time, and a precise focus on the symptoms reported by the patient. These symptoms can be vague and confusing and are frequently exacerbated by anxiety, depression, difficulty falling asleep, dehydration, cognitive and emotional stress, environmental factors, medications, and others. The physician must therefore dedicate at least 60 minutes to the patient interview and formulate targeted questions to detect symptoms of dysautonomia [3].”
• In Mexico, the in-depth study of these conditions is particularly remarkable in certain cases, such as hereditary transthyretin (TTR) amyloidosis, which causes abnormal deposition of the protein encoded by the mutated gene in peripheral nerves and other organ systems. Research conducted by pioneers in the field helps us understand how this condition is distributed in the Mexican population and allows us to offer targeted treatments to these patients, who previously lacked effective therapeutic options. Today, available treatments can achieve remission of the disease [4].
• “However, there are multiple conditions that affect the function of the baroreceptors involved in the delicate systems controlling blood pressure and heart rate. These conditions must be properly classified and characterized to provide each patient with the correct diagnosis and individualized therapeutic options.”
• “To understand man, it is necessary to understand culture” is an adaptation of a famous phrase by Napoleon Bonaparte. Therefore, to understand dysautonomia, it is essential to comprehend the specific characteristics of a population as complex as that of our country.”
• “Our project provides patients and their referring physicians with highly precise diagnoses by combining international-standard evaluations performed in prestigious centers in the United States and around the world, with a distinctive ‘Mexican-style’ adaptation. This dynamic evaluation of each patient’s physiological parameters makes every assessment truly unique — because each person is unique in their blood pressure, heart rate, and response to cognitive, environmental, and emotional stress.”
• “We are excited to share this project with you, which opens a new door to the field of dysautonomia in Mexico and to its unique demographic characteristics worldwide.”

References

1. Benarroch EE. “Dysautonomia”: a plea for precision. Clin Auton Res. 2021;31(1):27-29. doi:10.1007/s10286-020-00749-3
2. O’Dell JA, Walker A, Latham AJ, Parisian DJ, Branch LE, Vanderburg DD, Cox AA, Chavis S, Smith SE. The Diagnostic Journey of Dysautonomia Patients: Insights from a Patient-Reported Outcome Study. J Patient Exp. 2025 Jan 21;12:23743735251314651. doi: 10.1177/23743735251314651.
3. Novak, P., Systrom, D., Marciano, S.P. et al. Mismatch between subjective and objective dysautonomia. Sci Rep 14, 2513 (2024). https://doi.org/10.1038/s41598-024-52368-x
4. González-Duarte A, Cárdenas-Soto K, Bañuelos CE, Fueyo O, Dominguez C, Torres B, Cantú-Brito C. Amyloidosis due to TTR mutations in Mexico with 4 distinct genotypes in the index cases. Orphanet J Rare Dis. 2018 Jul 3;13(1):107. doi: 10.1186/s13023-018-0801-y.

Our facilities in Mexico

Timeline of Autonomic Evaluation in Mexico

Initial simplified Autonomic Evaluation

• First Autonomic Laboratory Foundation, Santa Fe Contadero, Mexico City.

• Initial evaluation of the blood pressure and pulse behaviors.
  • Passive tilt table
    • Assessment protocol
      • Sitting
      • First supine
      • Phase 1 – Passive tilt
      • Phase 2 – blood pressure challenges to evaluate pressor response to stressors.
      • Second supine (recovery phase)

Example of a Healthy 70-Year-Old Man with Normal Baroreceptors in Response to Postural Changes (Initial Supine Position, Passive Tilt, and Supine Recovery Phase)

Autonomic assessment – 2 times

October, 2025

• Time 1.
  • Sitting
  • First supine
  • Phase 1 – Passive tilt
  • Phase 2 – blood pressure challenges to evaluate pressor response to stressors.
  • Second supine (recovery phase)
• Time 2. Oral glucose challenge.
  • Sitting
  • First supine
  • Phase 1 – Passive tilt
  • Phase 2 – blood pressure challenges to evaluate pressor response to stressors.
  • Second supine (recovery phase)

Ejemplos de evaluaciones autonómicas en pacientes con protocolo de 2 tiempos.

Evaluación autonómica – 3 tiempos

Noviembre 2025

• Evaluación inicial del comportamiento de la presión y el pulso durante la prueba de mesa inclinada
  • Tiempo 1.
    • Mesa inclinada pasiva
    • Retos para evaluar la reacción de la presión arterial y el pulso (estándar)
  • Tiempo 2. – Reto con glucosa oral
    • Mesa inclinada pasiva
    • Retos para evaluar la reacción de la presión arterial y el pulso (casos especiales)
  • Tiempo 3. – Reto farmacológico individualizado
    • Mesa inclinada pasiva
    • Retos para evaluar la respuesta de la presión arterial y el pulso – (opcional)
      • Maniobra de Valsalva utilizando el sistema Colin Press Mate.

Ejemplos de evaluaciones autonómicas en pacientes con protocolo de tiempos.

Evaluación inicial del comportamiento de la presión y el pulso durante la prueba de mesa inclinada
Tiempo 1.
-Mesa inclinada pasiva
-Retos para evaluar la reacción de la presión arterial y el pulso (estándar)

Tiempo 2. – Reto con glucosa oral
-Mesa inclinada pasiva
-Retos para evaluar la reacción de la presión arterial y el pulso (individualizado)
Tiempo 3. – Reto farmacológico individualizado
-Mesa inclinada pasiva
-Retos para evaluar la respuesta de la presión arterial y el pulso (individualizado)
-Maniobra de Valsalva utilizando el sistema Colin Press Mate^R y el Kubios HRV System^R

Ejemplo de evaluaciones autonómicas en pacientes con protocolo de tres tiempos