Setting up an autonomic unit within the neurological department: a position statement of the European Federation of Autonomic Societies

Purpose The growing recognition of autonomic nervous system (ANS) dysfunction across a broad spectrum of neurological and systemic diseases calls for structured, multidisciplinary care. This position statement by the European Federation of Autonomic Societies aims to provide guidance on establishing an autonomic unit within a neurology department. Methods A Task Force appointed by the European Federation of Autonomic Societies board in October 2022 proposed staffing and equipment requirements for autonomic units, based on a literature review, survey data from ANS laboratories, and existing diagnostic guidelines. These propositions were integrated into the initial 25 questions and refined using a modified Delphi method to achieve expert consensus. Consensus was predefined as ≥ 80% agreement. Statements that did not reach consensus were revised and reassessed in subsequent rounds. Results After three rounds of Delphi surveys, expert consensus was achieved on the minimal and optimal requirements for autonomic unit personnel, technical equipment, and the availability of multidisciplinary care. Conclusion This European Federation of Autonomic Societies position statement presents practical, expert-based recommendations to promote the development of autonomic units across various healthcare systems. By establishing minimum and optimal standards for staffing, equipment, and interdisciplinary collaboration, the document offers a clear framework for standardizing clinical care and supporting collaborative research. This statement serves as a foundational resource for clinicians, administrators, and policymakers committed to strengthening the ANS care infrastructure.