Autonomic Nervous System Disorders:
Specialist Care in Hyderabad at KIMS Neuroscience

What you are describing — dizziness and rapid heart rate on standing that is not due to low blood pressure — is the classic presentation of POTS (Postural Orthostatic Tachycardia Syndrome), the most common form of dysautonomia. In POTS, the heart rate rises by 30 beats per minute or more within 10 minutes of standing, producing palpitations, dizziness, lightheadedness, and sometimes near-fainting — even though the blood pressure may be maintained. This happens because the autonomic nervous system fails to constrict the blood vessels in the legs adequately when standing, allowing blood to pool in the leg veins. The heart speeds up to compensate for the reduced venous return to the heart. POTS is diagnosed with a tilt table test at KIMS — the heart rate is monitored continuously while the table is tilted from horizontal to 70 degrees. Treatment is effective: increased fluid and salt intake, compression stockings, a structured exercise programme, and if needed, medications (fludrocortisone, propranolol, ivabradine). Call 040-44885000.

Yes — this presentation (high fever + extreme muscle rigidity + confusion in a patient on antipsychotics) is the clinical picture of Neuroleptic Malignant Syndrome (NMS), a life-threatening drug reaction. This is a medical emergency. Call 040-46324365 immediately. The antipsychotic medication must be stopped urgently and the patient needs ICU admission. At KIMS, treatment includes: stopping the offending drug immediately · Dantrolene sodium (which relaxes the muscle rigidity) · Bromocriptine or amantadine (which restore dopaminergic signalling) · Aggressive cooling and IV fluids · Monitoring for rhabdomyolysis (muscle breakdown causing kidney failure). NMS has a mortality of 10–20% when untreated. Time is critical — call 040-46324365 now.

If your uncle had a serious reaction during anaesthesia (extreme fever, muscle rigidity, or cardiac arrest in the operating theatre), malignant hyperthermia (MH) is a real possibility. MH is a genetic condition (usually caused by a mutation in the RYR1 gene) in which certain anaesthetic gases (halothane, sevoflurane) and the muscle relaxant succinylcholine trigger uncontrolled calcium release in muscle cells, causing catastrophic fever, rigidity, and metabolic breakdown. MH is inherited in an autosomal dominant pattern — so if your uncle had it, your father has a significant risk of carrying the same mutation. This must be disclosed to the anaesthesia team before any operation. At KIMS, the anaesthesia team will: avoid all triggering anaesthetic agents and use a "trigger-free" anaesthetic (using propofol + non-triggering agents) · Ensure dantrolene is immediately available in the operating theatre. Genetic testing (RYR1 sequencing) and/or the in vitro contracture test (IVCT) on a muscle biopsy can confirm MH susceptibility before surgery. Call 040-44885000 to discuss with the KIMS anaesthesia team before scheduling surgery.

Multiple System Atrophy (MSA) and Parkinson's disease (PD) both cause parkinsonism (slow movement, stiffness, balance problems), but they are distinct diseases with different causes, trajectories, and treatments. The key differences: MSA is more rapidly progressive than PD (median survival from diagnosis is 9–10 years vs 15–20+ in PD) · MSA causes severe autonomic failure early in the disease (significant orthostatic hypotension, urinary incontinence or retention, erectile dysfunction in men — all within the first 2 years) · MSA does not respond well to levodopa (unlike PD, where levodopa produces dramatic benefit) · MSA causes stridor (a harsh breathing noise from vocal cord paralysis) · MSA MRI shows characteristic changes in the brainstem and cerebellum (hot cross bun sign in the pons, putaminal hypointensity). The distinction matters because: the prognosis is different (MSA is more severe) · The treatment is different (autonomic failure management is central, not just dopaminergic therapy) · Family members do not need genetic counselling (MSA is usually sporadic). At KIMS, the movement disorders and autonomic specialist team provides the full MSA evaluation. Call 040-44885000.

A tilt table test is a controlled assessment of how your blood pressure and heart rate respond to changes in posture. You lie flat on a motorised table that is then gradually tilted up to about 70 degrees while heart rate and blood pressure are monitored continuously. It distinguishes orthostatic hypotension (a drop in blood pressure on standing) from POTS (an excessive heart-rate rise without a major drop in blood pressure) and from vasovagal syncope (a sudden combined drop in both with fainting). It is the cornerstone investigation for unexplained fainting, postural dizziness, and palpitations. The test is performed in the KIMS autonomic laboratory.

Yes — direct appointments are accepted for all autonomic assessments. Outpatient: 040-44885000 (Mon–Sat). For an active emergency — suspected NMS, suspected malignant hyperthermia, severe autonomic crisis — call 040-46324365 immediately; the on-call team activates the protocol on the phone.

The initial neurology consultation is typically 30–60 minutes. The tilt table test and full autonomic battery (HRV, Valsalva, QSART, sweat testing) usually takes a single morning. Cases that need 24-hour ambulatory blood pressure monitoring or genetic testing may take 1–3 weeks for the complete diagnostic picture to be in place.