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Katherine Elizabeth Clarke, Stephanie Sorrell, Craig Breheny, Rosanne Jepson, Sophie Adamantos, Elspeth M Milne, Danielle Gunn-moore
Background
Dysautonomia is a degenerative condition of autonomic neurons affecting multiple species. In cats and dogs, it is characterized by gastrointestinal dysmotility, urinary retention, ocular signs (e.g., mydriasis, third eyelid protrusion), and bradycardia. The study aimed to review clinical presentations, diagnostics, treatments, and outcomes in 53 cases of feline and canine dysautonomia in the UK over a nine-year period.
Methods
This retrospective, multicenter study evaluated medical records from 2007 to 2016. Clinical data were collected, including presenting signs, diagnostic findings, treatments, and survival outcomes. Diagnosis was based on clinical presentation and exclusion of other conditions. Pharmacological tests, imaging, and postmortem examinations were included where available.
Results
Population: The study included 34 cats (median age: 3.9 years) and 19 dogs (median age: 3.3 years). Commonly represented breeds included domestic shorthair cats and Labrador retrievers.
Clinical Findings: Cats and dogs shared common signs like vomiting or regurgitation (85% cats; 94% dogs) and anorexia or hyporexia (92% cats; 100% dogs). Constipation was more frequent in cats (55%), whereas diarrhea and urinary retention were more common in dogs (67% and 82%, respectively).
Diagnostics:
Imaging revealed megaesophagus in 65% of cats and 23% of dogs.
Abnormal Schirmer tear tests were seen in 90% of cats and 86% of dogs.
Pharmacologic pilocarpine testing suggested autonomic dysfunction in 86% of cats and 73% of dogs tested.
Treatment: Management was supportive, using medications such as gastrointestinal prokinetics (e.g., cisapride) and treatments for urinary retention (e.g., bethanechol). Feeding tubes were placed in 21 animals, with variable outcomes.
Survival: Survival to discharge was 29% for cats and 47% for dogs. Long-term survival (>2 years) was achieved in six cats and three dogs, with most resolving their clinical signs fully.
Limitations
As a retrospective study, the findings were limited by incomplete records, lack of standardized diagnostic criteria, and selection bias toward severe cases. Postmortem confirmation was unavailable for most animals. Diagnostic and treatment approaches varied across cases.
Conclusions
Dysautonomia remains a rare but challenging condition with high mortality. Some animals achieve long-term survival with supportive care, suggesting prognosis may not be as uniformly poor as historically reported. The presence of ocular signs alongside gastrointestinal or urinary dysfunction strongly supports the diagnosis. Increased awareness and further prospective studies are needed to improve diagnosis and management strategies.
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