Response to Dr. Palma’s letter to the editor

All of the patients included in our study were diagnosed with primary dysautonomia. In other words, no patient was found to have a known primary cause of autonomic dysfunction (i.e. diabetes or neuropathy), autoimmune etiology, or alpha synucleinopathy. We made specific mention of excluding patients with Parkinson’s disease or multiple sclerosis as voiding dysfunction with these diseases is established, well described and not necessarily the result of a secondary dysautonomia.