Diogo Reis Carneiro

Purpose: The growing recognition of autonomic nervous system (ANS) dysfunction across a broad spectrum of neurological and systemic diseases calls for structured, multidisciplinary care. This position statement by the European Federation of Autonomic Societies aims to provide guidance on establishing an autonomic unit within a neurology department. Methods: A Task Force appointed by the European Federation of Autonomic Societies board in October 2022 proposed staffing and equipment requirements for autonomic units, based on a literature review, survey data from ANS laboratories, and existing diagnostic guidelines. These propositions were integrated into the initial 25 questions and refined using a modified Delphi method to achieve expert consensus. Consensus was predefined as ≥ 80% agreement. Statements that did not reach consensus were revised and reassessed in subsequent rounds. Results: After three rounds of Delphi surveys, expert consensus was achieved on the minimal and optimal requirements for autonomic unit personnel, technical equipment, and the availability of multidisciplinary care. Conclusion: This European Federation of Autonomic Societies position statement presents practical, expert-based recommendations to promote the development of autonomic units across various healthcare systems. By establishing minimum and optimal standards for staffing, equipment, and interdisciplinary collaboration, the document offers a clear framework for standardizing clinical care and supporting collaborative research. This statement serves as a foundational resource for clinicians, administrators, and policymakers committed to strengthening the ANS care infrastructure.

Freezing of gait (FoG) is a common motor symptom in advanced Parkinson’s disease, leading to falls, disability, and reduced quality of life. Although cueing systems using visual or auditory stimuli can help patients resume walking, existing solutions are often expensive, uncomfortable, and conspicuous. ParCuR (Parkinson Cueing and Rehabilitation) is a compact, ankle-worn wearable integrating an inertial sensor, haptic stimulator, and AI-based software. It was developed to detect FoG episodes in real time and provides automatic sensory cues to assist patients with Parkinson’s Disease (PwP). A classifier was trained for FoG detection using the DAPHNet dataset, comparing patient-specific and patient-independent models. While a small-scale trial with PwP assessed usability and reliability. ParCuR is watch-sized (35 × 41 mm), discreet, and comfortable for daily use. The online detection algorithm triggers stimulation within 0.7 s of episode onset and achieves 94.9% sensitivity and 91.3% specificity using only 14 frequency-based features. Preliminary trials confirmed device feasibility and guided design refinements. This low-cost, wearable solution supports personalized, real-time FoG detection and responsive cueing, improving patient mobility while minimizing discomfort and continuous stimulation habituation.

Background and purpose: Centers for training in autonomic nervous system (ANS) disorders are not widely available and the recent coronavirus 2019 pandemic temporarily reduced training opportunities in autonomic medicine across European countries. Here we evaluated the current state of education, clinical skills and postgraduate educational preferences on ANS disorders of European neurology residents and consultants.Methods: A 23‐item questionnaire was developed and distributed online amongst European neurology residents and consultants via mailing lists of the European Academy of Neurology. The questions assessed demographics, current training opportunities and learning preferences in ANS disorders. Six multiple‐choice questions were used to self‐evaluate knowledge of ANS disorders.Results: In all, 285 individuals answered the survey (60% female, mostly 25–34 years of age). All respondents considered clinical autonomic skills necessary for good clinical neurological practice, and 92% would like to increase their ANS knowledge. Female respondents and those who trained in Southern/Eastern/Greater Europe more frequently judged ANS skills important for clinical practice than male respondents (p = 0.012) and respondents from Northern/Western Europe (p = 0.011). Female and younger respondents felt less confident in managing ANS disorders (p = 0.001 and p < 0.001, respectively). Respondents below 45 years of age (p < 0.001) and those with lower confidence in managing ANS disorders (p = 0.004) were more likely to recommend that ANS education is embedded in the residency curriculum.Conclusions: Most European neurology residents and consultants reported a need for more autonomic education, with additional gender, age and regional differences. These findings underscore the importance of increasing the educational content on autonomic medicine in European medical and postgraduate curricula.

Background and purpose: The art of diagnosis in clinical neurology requires attentive listening and careful observation. In certain situations, a fragment of the history or a physical sign may be so distinctive that it allows clinicians to evoke a specific diagnosis. This quick mental process was previously referred to as ‘Augenblickdiagnose’ (‘diagnosis in the blink of an eye’) in a seminal paper by Dr. William Campbell in 1998. We aimed to revisit this concept by providing additional clinical vignettes.Methods: The authors wrote clinical vignettes using examples from their own clinical practice and performed a non‐systematic review of influential neurology textbooks using the words ‘pathognomonic’ and ‘highly suggestive’.Results: Twenty examples from various fields of neurology are presented in a table, stratified by major fields of neurology. A short educational reflection is provided for each diagnosis considered.Conclusion: ‘Augenblickdiagnose’ is an engaging teaching resource that also contributes to ‘neurophilia’, that is, a fascination for neurology, perhaps increasingly in today's modern neurology practice. However, multiple cognitive biases underlying mental shortcuts may lead to an incorrect diagnosis. It is important to stress that good clinical practice in neurology requires taking a thorough history and performing a careful neurological examination.

Background: Cardiovascular autonomic dysfunction may reportedly occur after a coronavirus‐disease‐2019 (COVID‐19) infection, but the available evidence is scattered. Here we sought to understand the acute and mid‐term effects of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection on cardiovascular autonomic function.Methods: We performed a systematic PubMed, Embase, Web of Science, medRxiv, and bioRxiv search for cases of cardiovascular autonomic dysfunction during an acute SARS‐CoV‐2 infection or post‐COVID‐19 condition. The clinical‐demographic characteristics of individuals in the acute versus post‐COVID‐19 phase were compared.Results: We screened 6470 titles and abstracts. Fifty‐four full‐length articles were included in the data synthesis. One‐hundred and thirty‐four cases were identified: 81 during the acute SARS‐CoV‐2 infection (24 thereof diagnosed by history) and 53 in the post‐COVID‐19 phase. Post‐COVID‐19 cases were younger than those with cardiovascular autonomic disturbances in the acute SARS‐CoV‐2 phase (42 vs. 51 years old, p = 0.002) and were more frequently women (68% vs. 49%, p = 0.034). Reflex syncope was the most common cardiovascular autonomic disorder in the acute phase (p = 0.008) and postural orthostatic tachycardia syndrome (POTS) the most frequent diagnosis in individuals with post‐COVID‐19 orthostatic complaints (p < 0.001). Full recovery was more frequent in individuals with acute versus post‐COVID‐19 onset of cardiovascular autonomic disturbances (43% vs. 15%, p = 0.002).Conclusions: There is evidence from the scientific literature about different types of cardiovascular autonomic dysfunction developing during and after COVID‐19. More data about the prevalence of autonomic disorders associated with a SARS‐CoV‐2 infection are needed to quantify its impact on human health.