Autonomic manifestations are common in many fields of medicine. Autonomic disorders are specific conditions affecting the central or peripheral nervous system (or both) in which the clinical picture is dominated by autonomic signs and symptoms. These disorders are becoming increasingly recognized thanks to greater testing availability and increased awareness.

Autonomic consultations are in high demand, and autonomic specialists interact with other medical specialties and neurological subspecialties to provide a multidisciplinary, comprehensive management to such patients.

Mayo Clinic's campus in Rochester, Minnesota, offers a one-year Autonomic Disorders Fellowship to provide you with advanced training in the clinical and research aspects of autonomic disorders.

During your fellowship, you:

• Participate in the clinical assessment and management of patients with a wide variety of autonomic disorders
• Participate in interpreting the studies performed in the Autonomic Reflex Laboratory and Thermoregulatory Sweat Laboratory
• Have the opportunity to participate in clinical research and work with the related areas of movement disorders and peripheral neuropathy
• Have elective time available

Accreditation

The Autonomic Disorders Fellowship is accredited by the United Council for Neurologic Subspecialties (UCNS).

Certification

When you complete the fellowship, you will be eligible to sit for the UCNS autonomic disorders subspecialty certification examination.

Program history

Mayo Clinic has a long history of clinical and research activity related to autonomic disorders. The Mayo Autonomic Reflex Laboratory was founded in 1983 by Phillip Low, M.D., with Peter Dyck, M.D., and Jack P. Whisnant, M.D., who were instrumental in the early days. Until then, no quantitative tests of sudomotor or adrenergic function were available.

The quantitative sudomotor axon reflex test (QSART), which evaluates the integrity and function of the distal portion of the postganglionic sudomotor axon, was invented by Dr. Low. Patrick Caskey in Mayo's Section of Engineering helped with the design and construction of the unique sweat capsule. Tests of cardiovagal and adrenergic function were added later.

With the availability of beat-to-beat blood pressure recordings using a Finapres device, Mayo investigators coupled this technology with an evaluation of the phases of the Valsalva maneuver to provide a more detailed dissection of adrenergic baroreflex function in addition to a head-up tilt study.

Eduardo Benarroch, M.D., and Paola Sandroni, M.D., Ph.D. contributed significantly in the pharmacological and physiological dissection of the Valsalva maneuver. Robert Fealey, M.D., established thermoregulatory sweat testing, including designing and building the equipment with the help of the facility engineering department and the strong support of Juergen Thomas, M.D.

Mayo Clinic's autonomic laboratory has become the nation's standard and the Mayo paradigm for the evaluation of sudomotor, adrenergic, and cardiovagal functions. 

The Autonomic Disorders Fellowship began in 2015. Learn more about our department and faculty.