UAB Now Offers Autonomic Testing with a Comprehensive Lab

Mohamed Kazamel, MD in the autonomic testing lab.

The Only Facility in the Southeast

In May, UAB has opened a new autonomic testing lab that will assist physicians to more definitively diagnose disorders of the autonomic system and determine an effective treatment plan.

The autonomic nervous system controls involuntary functions of the human body, including heart rate, breathing, and sweating. Sweating - or more accurately, not sweating - is one of the keys to diagnosing conditions affected by the autonomic nervous system.

The comprehensive testing lab, which includes a tilt table and an autonomic chamber for performing a thermoregulatory sweat test, is the only such facility in the southeast, and one of only seven in the U.S.

"This is very important in the era of precision medicine," said Mohamed Kazamel, MD, assistant professor in the Department of Neurology at UAB. "We try to make more accurate and more specific diagnoses for each patient and make individualized treatment plans according to these diagnoses.

"Before our lab opened in May, we had to diagnose clinically or send patients all the way to Nashville or Jacksonville for testing."

But those labs don't include the sweat lab, or autonomic chamber, the feature that places the UAB lab in an elite group.

One reason there are so few autonomic chambers is that they must be customized and therefore are not commercially available. When UAB decided to build one as part of their autonomic lab, they contacted Case Western Reserve University in Cleveland, Ohio, and arranged to work with the engineer who built three of the other six chambers.

A patient is tilted on the table for testing.

"Many people have a vague diagnosis of dysautonomia that says you have a disorder of your autonomic nervous system, but it doesn't really tell you what the disorder is or what it entails," Kazamel said. "This lab is going to be able to help patients get an accurate diagnosis and hence a plan of treatment."

The patient must refrain from caffeine and alcohol for a short time prior to being tested in the sweat lab. On the day of the test, the patient lies on a hospital bed in the chamber and is coated with alizarin powder, which is yellow to begin with and changes to purple when exposed to sweat. The temperature and humidity are raised slowly as the technicians collect body temperature information. The areas where the patient doesn't sweat are key to a specific diagnosis.

"If the patient's toes and feet don't sweat, that indicates peripheral nerve issues," Kazamel said. "If one leg doesn't sweat, they have a lesion in the spinal cord. And if the whole body doesn't sweat, this is more of a central nervous system issue like multiple system atrophy."

While the sweat lab measures the distribution of sweat, another test will measure the amount a patient sweats.

The response of the heart rate to one minute of deep breathing, and heart rate and blood pressure responses to the Valsalva maneuver also provide important information for autonomic diagnosis as well.

In addition, the facility contains a tilt table that measures various cardiac functions. The patient is tilted at a 70-degree angle, head above feet, for 10 minutes. "This provides a challenge to the heart to see how the heart rate and blood pressure respond to the decreased blood volume, because the blood accumulates in the feet," Kazamel said. "This is very important in cases of syncope and transient loss of consciousness. We can see how patients react to that position and challenge."

The new lab will be available to referring physicians across Alabama and the region. Kazamel anticipates that most referrals will come from neurologists, cardiologists, gastroenterologists, primary care and internal medicine physicians.

Physicians can access referral forms at the UAB Autonomic Testing Laboratory website.

'We are excited to offer such a new service to Birmingham and the whole Southeast," Kazamel said.

Conditions diagnosed at UAB Autonomic Testing Laboratory

  • Amyloidosis
  • Autonomic peripheral neuropathies
  • Diabetic autonomic neuropathy
  • Hereditary sensory and autonomic neuropathy (HSAN)
  • Lambert-Eaton myasthenic syndrome (LEMS)
  • Lewy body disease
  • Multiple system atrophy (MSA)
  • Neurogenic syncope
  • Orthostatic intolerance
  • Orthostatic hypotension
  • Postural orthostatic tachycardia syndrome (POTS)
  • Pure autonomic failure (PAF)
  • Reflex sympathetic dystrophy (RDS), or complex regional pain syndrome (CRPS)
  • Small fiber neuropathy
  • Sweat disorders (anhidrosis/hyperhidrosis)
  • Vasovagal syncope


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autonomic testing lab; UAB; Mohamed Kazamel, MD; Department of Neurology at UAB; comprehensive testing lab


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