The Autonomic Unit draws together the expertise of a large team of specialist clinical neurologists, clinical autonomic scientists, and clinical nurse specialists to provide a comprehensive, national, tertiary diagnostic and clinical service for people living with a wide variety of autonomic disorders.
The Autonomic Unit is equipped with six state of the art laboratories offering the latest advances in non-invasive autonomic investigations including cardiovascular assessment, sudomotor assessment, pupillometry and a catecholamine laboratory for the measurement of autonomic neurotransmitters.
There are approximately 5,000 patient encounters in the clinics every year and over 6,500 autonomic function tests performed annually. All patients are assessed clinically (either in person or via telephone/video) prior to having autonomic testing. Results of autonomic testing are discussed in weekly multidisciplinary team meetings.
Patients with autonomic failure remain under regular clinical follow up with repeat autonomic testing at appropriate time intervals. Patients with confirmed postural tachycardia syndrome and vasovagal syncope are usually streamlined into a nurse-led pathway for management and treatment advice before being discharged back to primary or secondary care.
There is also a dedicated clinic for patients with autoimmune autonomic ganglionopathy for diagnosis, investigation of underlying causes and therapeutic management including immunosuppression.
As the leading centre for autonomic disorders in the UK, we have a broad and active clinical research programme in affiliation with the NIHR University College London Hospitals Biomedical Research Centre and the Department of Translational Neuroscience and Stroke at UCL Queen Square Institute of Neurology.
Patient contact
General enquiries
Service management
David O'Keefe
Other contact information
Clinical lead: Dr Valeria Iodice
Testing/diagnostic queries: 020 3448 3739
Address
Autonomic unit
National Hospital for Neurology and Neurosurgery
2nd Floor
Queen Mary Wing
Queen Square
London, WC1N 3BG
Other referral information
GP referrals
GP referrals must be submitted electronically via NHS e-referrals.
Tertiary Referrals
Referrals from consultants in all specialities within the UK can be submitted by post or email.
Referral criteria for patients with possible postural tachycardia syndrome and vasovagal syncope:
As the only tertiary referral Autonomic Unit in the UK, we are unable to accommodate patients with benign intermittent reflex disorders unless they have undergone a thorough assessment in primary care or secondary care cardiology.
The following steps must be completed prior to referral:
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Initial assessment: evaluation and exclusion of other possible causes.
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Active standing test: baseline measurement of blood pressure and heart rate while sitting at rest, followed by serial measurements of blood pressure and heart rate while standing at 1, 3 and 5 minutes.
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Appropriate cardiology workup (e.g. ECG, Holter monitoring) to rule out structural or primary cardiac conditions.
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A reasonable trial of first-line management:
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The management of any form of orthostatic intolerance (initial orthostatic hypotension, postural tachycardia, autonomically mediated syncope) involves a gradual, stepwise approach. The core of treatment consists of a combination of non-pharmacological measures to help boost circulation. These include:
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Developing an awareness of situations likely to cause symptoms e.g. standing in hot weather or exercising after a large meal and taking action at the onset of symptoms by sitting, crouching or laying down, drinking water and returning to normal activity slowly
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Maintaining a good fluid intake by drinking up to 500 ml immediately when getting out of bed and then sipping enough fluid to keep urine a pale yellow colour (2-3L/day) and add salt liberally (~6g/day)
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Making use of calf pump exercises (simple heel lifts) before getting out of bed, prior to standing or if standing still
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Eating small meals, avoiding sugary foods and being cautious with alcohol
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Maintaining good cardiovascular conditioning. Exercises that are beneficial include aerobic activity with a focus on core and lower limb muscle toning (e.g.cycling, swimming, Pilates, rowing).
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For confirmed postural tachycardia syndrome: Introduction and trial of first-line pharmacological treatments (e.g., fludrocortisone, midodrine, beta-blockers, ivabradine) and assessment of their impact.
Referral address
Autonomic Unit
Box 87
National Hospital for Neurology and Neurosurgery
Queen Square
London
WC1N 3BG
The National Autonomic MDT was established in 2025 at the National Hospital for Neurology and Neurosurgery to offer high quality care for adults with suspected/confirmed autonomic disorders. It currently runs on a weekly basis. The meeting was established to facilitate the discussion and management of adult patients with suspected or confirmed autonomic disorders. Patients from UCLH and from any other UK NHS Trust can be discussed after referral from their lead clinician.
Contact email:
uclh.
Referral information for healthcare providers:
The National Autonomic MDT meeting occurs every Wednesday at 11am. Proformas should be submitted by Tuesday at 10am. Attendance is by invitation only. Clinicians can request an invitation by contacting uclh.
Clinicians from all specialities and from any NHS hospital are welcome to join. A proforma will need to be completed and all patients will be registered at UCLH for accurate documentation.
Referral forms:
- Pure autonomic failure
- Autonomic disorders in neurodegenerative conditions (Parkinson’s disease, multiple system atrophy, dementia with Lewy bodies)
- Autoimmune autonomic disorders
- Autonomic neuropathies (diabetes, amyloidosis, connective tissue disorders and inherited neuropathies)
- Autonomic dysfunction in spinal cord injury including autonomic dysreflexia
- Sweating disorders (hyperhidrosis, hypohidrosis, Harlequin syndrome)
- Genetic autonomic disorders including familial dysautonomia, dopamine beta hydroxylase deficiency, spinocerebellar ataxias and leukodystrophies
- Holmes-Adie syndrome and Adie-plus syndromes
- Intermittent reflex disorders such as vasovagal syncope, carotid sinus hypersensitivity and postural tachycardia syndrome.
The autonomic unit shares care with GPs and local consultants.
