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Autonomic Testing Lab

in the Non-Invasive Testing Department

Autonomic Testing

A state-of-the-art autonomic testing lab is available at Brigham and Women’s Faulkner Hospital. The lab offers one of the most comprehensive evaluations available throughout New England and the United States.

Components of Autonomic Nervous System Testing:

Autonomic nervous system testing helps to determine the presence, severity and localization of autonomic dysfunction and related small fiber neuropathy. It also helps to assess the cerebral blood flow. The Autonomic Lab at Brigham and Women’s Faulkner Hospital employs the Brigham Protocol or Syncope Protocol.

The Brigham Protocol has the following components:

  1. Autonomic functional testing: Deep breathing, Valsalva and tilt test with monitoring of heart rate, blood pressure (both continuous from finger and intermittent from arm), end tidal CO2, respiratory frequency, and cerebral blood flow velocity from middle cerebral artery. All autonomic testing is noninvasive.
  2. Skin biopsy for evaluation of epidermal and sweat gland nerve fiber density
  3. Sudomotor function evaluation using Quantitative Sudomotor Axon Reflex Test (QSART) or Electrochemical Skin Conductance (ESC).

Syncope Protocol

  1. Autonomic functional testing (deep breathing, Valsalva and tilt test) with monitoring of heart rate, blood pressure, end tidal CO2, respiratory frequency, and CBFv
  2. Sudomotor function evaluation (QSART or ESC).

Autonomic testing assists physicians with the diagnosis, evaluation and treatment of:

  • Syncope
  • Chronic fatigue
  • Hypotension
  • Dizziness
  • Postural tachycardia
  • Abnormal sweating
  • Poor hemodynamic compensation
  • Movement disorders
  • Small fiber neuropathies
  • Bladder and bowel dysfunction
  • Assessment of dysautonomia in patients with diagnosis of Parkinson’s disease
  • Multiple-system atrophy
  • Diabetes
  • Monitoring disease progression of autonomic disorders and response to treatment
  • Differentiation of psychogenic from organic conditions
  • Evaluation of syncopal seizures


All autonomic studies will be interpreted and available within four weeks of the completed study.


Call 617-983-7580.

Frequently Asked Questions About Autonomic Testing

How long does the autonomic test take?

Autonomic testing lasts between 60-90 minutes. This is a diagnostic appointment only. This is not a provider visit or consultation.

What preparation is there to be done before testing?

Avoid drinking alcohol, caffeinated beverages and smoking one day prior to testing. You can have a normal meal before testing. Do not use lotion or oils on legs or arms day of testing. Wear a loose fitting short-sleeve top and bring a change of shorts.

In general, medication that is used for dysautonomia should be put on hold. This medication includes blood pressure medication, medication for abnormal heart rate, and certain pain medications (amitriptyline, nortriptyline, elavil).

Do not stop any of your medication by yourself! Always ask your physician about what medications you should stop taking before testing.

What does autonomic testing consist of?

Autonomic testing consists of deep breathing exam, valsalva maneuver, cranial Doppler (blood flow), sweat test, tilt test and/or skin biopsy.

Is medication administered during the test?

We do not administer any medication during testing. However, for the skin biopsy we do give a Lidocaine injection to numb the sites we take the sample from. If patients are allergic to Lidocaine we do offer a cold spray to freeze the area before taking the sample.

If I am allergic to certain medications or dressings will I still be able to have testing done?

Lidocaine with epinephrine is the only medication we give topically for the skin biopsy. If a patient is allergic to epinephrine we have a pure lidocaine alternative. For patients allergic to lidocaine we can use the cold spray. For patients with Latex allergies we offer Latex-free dressings (such as paper tape).


Is there a weight limit for the tilt table?

Yes, there is a weight limit. Patients over 350 lbs. are unable to be tested.

How wide and deep is the skin biopsy?

The skin biopsy is 2 to 3mm wide and deep, it does not require stitching (just a regular bandage). You should keep the biopsy site dry for 1 week, so please schedule your testing accordingly. We are recommending avoiding bathing/swimming for 1 week. For showering, you might cover the biopsy site with an elastic bondage to keep it dry. 

Will I be able to drive after testing?

Right after testing you can resume all regular activities including driving but if you have concerns feel free to bring someone with you.

How long does it take to get results?

Test results take approximately 5-6 weeks. No testing results will be provided on the day of your visit.

What is your cancellation policy?

The lab has a strict 15-minute late policy. Patients who arrive more than 15-minutes past their scheduled appointment. Time will need to reschedule to another day. Cancellations should be made 24 hours or more prior to your scheduled test date by calling 617-983-7104.

Do I need to check with my insurance company about coverage?

Yes, we recommend checking with your insurance company prior to testing to ensure the procedure is covered and the facility is in network. For procedure codes and/or NPI numbers please call 617-983-7104.


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