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