{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:53:10Z","timestamp":1790419990718,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T00:00:00Z","timestamp":1663632000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2022,12]]},"abstract":"Abstract<\/jats:title>Background and purpose<\/jats:title>Disorders of the autonomic nervous system (ANS) are common conditions, but it is unclear whether access to ANS healthcare provision is homogeneous across European countries. The aim of this study was to identify neurology\u2010driven or interdisciplinary clinical ANS laboratories in Europe, describe their characteristics and explore regional differences.<\/jats:p><\/jats:sec>Methods<\/jats:title>We contacted the European national ANS and neurological societies, as well as members of our professional network, to identify clinical ANS laboratories in each country and invite them to answer a web\u2010based survey.<\/jats:p><\/jats:sec>Results<\/jats:title>We identified 84 laboratories in 22 countries and 46 (55%) answered the survey. All laboratories perform cardiovascular autonomic function tests, and 83% also perform sweat tests. Testing for catecholamines and autoantibodies are performed in 63% and 56% of laboratories, and epidermal nerve fiber density analysis in 63%. Each laboratory is staffed by a median of two consultants, one resident, one technician and one nurse. The median (interquartile range [IQR]) number of head\u2010up tilt tests\/laboratory\/year is 105 (49\u2013251). Reflex syncope and neurogenic orthostatic hypotension are the most frequently diagnosed cardiovascular ANS disorders. Thirty\u2010five centers (76%) have an ANS outpatient clinic, with a median (IQR) of 200 (100\u2013360) outpatient visits\/year; 42 centers (91%) also offer inpatient care (median 20 [IQR 4\u2013110] inpatient stays\/year). Forty\u2010one laboratories (89%) are involved in research activities. We observed a significant difference in the geographical distribution of ANS services among European regions: 11 out of 12 countries from North\/West Europe have at least one ANS laboratory versus 11 out of 21 from South\/East\/Greater Europe (p<\/jats:italic>\u00a0=\u20090.021).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>This survey highlights disparities in the availability of healthcare services for people with ANS disorders across European countries, stressing the need for improved access to specialized care in South, East and Greater Europe.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.15538","type":"journal-article","created":{"date-parts":[[2022,9,3]],"date-time":"2022-09-03T06:28:16Z","timestamp":1662186496000},"page":"3633-3646","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Clinical autonomic nervous system laboratories in Europe"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3360-1748","authenticated-orcid":false,"given":"Mario","family":"Habek","sequence":"first","affiliation":[{"name":"Department of Neurology University Hospital Centre Zagreb Zagreb Croatia"},{"name":"Department of Neurology University of Zagreb, School of Medicine Zagreb Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1714-5305","authenticated-orcid":false,"given":"Fabian","family":"Leys","sequence":"additional","affiliation":[{"name":"Department of Neurology Medical University of Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Krbot Skori\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital Centre Zagreb Zagreb Croatia"},{"name":"Faculty of Electrical Engineering and Computing University of Zagreb Zagreb Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diogo","family":"Reis Carneiro","sequence":"additional","affiliation":[{"name":"Neurology Department Centro Hospitalar e Universit\u00e1rio de Coimbra Coimbra Portugal"},{"name":"Faculty of Medicine University of Coimbra Coimbra Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Calandra\u2010Buonaura","sequence":"additional","affiliation":[{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy"},{"name":"Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5742-2840","authenticated-orcid":false,"given":"Jennifer","family":"Camaradou","sequence":"additional","affiliation":[{"name":"Patient Partner of the EAN Scientific Panel for Autonomic Nervous System Disorders London UK"},{"name":"UCL Social Research Institute University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Chiaro","sequence":"additional","affiliation":[{"name":"Autonomic Unit National Hospital for Neurology and Neurosurgery, Queen Square London UK"},{"name":"UCL Queen Square Institute of Neurology, Faculty of Brain Sciences University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3633-8818","authenticated-orcid":false,"given":"Pietro","family":"Cortelli","sequence":"additional","affiliation":[{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy"},{"name":"Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Falup\u2010Pecurariu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine Transilvania University Brasov 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York New York USA"},{"name":"Department of Neurology University Erlangen\u2010Nuremberg Erlangen\u2010Nuremberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Iodice","sequence":"additional","affiliation":[{"name":"Autonomic Unit National Hospital for Neurology and Neurosurgery, Queen Square London UK"},{"name":"UCL Queen Square Institute of Neurology, Faculty of Brain Sciences University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Jordan","sequence":"additional","affiliation":[{"name":"Institute of Aerospace Medicine German Aerospace Center (DLR) and Medical Faculty University of Cologne Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evert C. A.","family":"Kaal","sequence":"additional","affiliation":[{"name":"Department of Neurology, Maasstad Ziekenhuis Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Kamondi","sequence":"additional","affiliation":[{"name":"Department of Neurology National Institute of Mental Health, Neurology and Neurosurgery Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9375-1553","authenticated-orcid":false,"given":"Anne","family":"Pavy Le Traon","sequence":"additional","affiliation":[{"name":"Department of Neurology Centre Hospitalier Universitaire de Toulouse and INSERM U 1297 Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Rocha","sequence":"additional","affiliation":[{"name":"Institute of Physiology, Faculty of Medicine University of Lisbon Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann","family":"Sellner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Landesklinikum Mistelbach\u2010G\u00e4nserndorf Mistelbach Austria"},{"name":"Department of Neurology, Klinikum rechts der Isar Technische Universit\u00e4t M\u00fcnchen Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Michel","family":"Senard","sequence":"additional","affiliation":[{"name":"Department of Cardiolog, Toulouse University Hospital Institute des Maladies M\u00e9taboliques et Cardiovasculaires, INSERM U 1297 Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Terkelsen","sequence":"additional","affiliation":[{"name":"Department of Neurology Aarhus University Hospital and Danish Pain Research Center Aarhus University Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor K.","family":"Wenning","sequence":"additional","affiliation":[{"name":"Department of Neurology Medical University of Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Neurology Medical University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1435-8970","authenticated-orcid":false,"given":"Roland D.","family":"Thijs","sequence":"additional","affiliation":[{"name":"Department of Neurology Leiden University Medical Centre Leiden The Netherlands"},{"name":"Stichting Epilepsie Instellingen Nederland (SEIN) Heemstede The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7360-7784","authenticated-orcid":false,"given":"Walter","family":"Struhal","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital Tulln Karl Landsteiner University of Health Sciences Tulln Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2854-4179","authenticated-orcid":false,"given":"Alessandra","family":"Fanciulli","sequence":"additional","affiliation":[{"name":"Department of Neurology Medical University of Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Collaborators of the European Network of Clinical ANS laboratories","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,20]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1509723"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa012407"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2020.11.024"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2004.01114.x"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-011-0119-5"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-018-0529-8"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-020-00738-6"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)60631-4"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.328.7451.1312"},{"key":"e_1_2_10_11_1","unstructured":"https:\/\/unstats.un.org\/unsd\/methodology\/m49\/. 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