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Sentara Neuromuscular and Autonomic Center

Our Approach to Care

The Autonomic Program aims at diagnosing and treating conditions caused by a dysfunction of the Autonomic Nervous System (ANS). It is one of a few centers in the United States and the world that specialize in this part of the nervous system. It is led by an Autonomic Neurologist surrounded by a multidisciplinary team of physicians and healthcare professionals. The diagnosis of disorders of the ANS relies strongly on testing of autonomic function. This is achieved through autonomic testing. Our Center boasts a fully- equipped autonomic laboratory, featuring state-of- the-art technology including Thermoregulatory Sweat Testing (TST) and is one of 7 known locations that provide a similar service in the United States and the only one in the mid-Atlantic region.

Autonomic Testing

Autonomic testing is designed to determine how well the body regulates blood pressure, heart rate and other functions of multiple organ systems, mediated by the ANS. Tests include:

• Heart Rate Variability to Deep Breathing Tests the integrity of the cardiac parasympathetic system.
• Valsalva Maneuver - Tests the integrity of the cardiovascular sympathetic and parasympathetic systems.
• Tilt Table Test - Tests cardiovascular responses in the supine and upright positions.
• Quantitative Sudomotor Axon Reflex Test (QSART) - Tests the small fiber system of the ANS which controls sweat glands.
• Thermoregulatory Sweat Testing (TST) - Tests the total sudomotor (sweat-producing) system diagnosed by different sweat patterns in a monitored heated environment.
• Infrared Dynamic Pupillometry (IDP) - Tests the integrity of the sympathetic and parasympathetic branches of the ANS at the pupil of the eye.
• Laser Doppler Flowmetry (LDF) - Tests the subcutaneous blood flow through small-sized arteries and the capillary system, under the influence of the ANS.

Neuromuscular Program

Sentara offers an integrated system of care focusing specifically on neuromuscular and peripheral nerve disorders. Our neuromuscular physicians are board-certified, fellowship-trained neurologists who diagnose and treat a number of disorders of the peripheral nerves, neuromuscular junction and muscles.
Tests include:

• Electrodiagnostic Testing (formerly known as Electromyography-Nerve Conduction Tests EMG/NCS) - Tests the muscles and nerves to determine where and to what extent damage has occurred. This test aids in the clinic diagnosis of neuromuscular diseases such as: Carpal Tunnel Syndrome, Muscular Dystrophies, and ALS (Lou Gehrig’s Disease) among many others.
• Skin Biopsy - Tests for the amount and morphology of small fibers in the skin and around sweat glands. This state-of-the- art technique helps diagnosing disorders of the small fiber system such small fiberneuropathies and autonomic neuropathies.

Clinical Team

Kamal Chémali, MD

Medical Director