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Liu Q, Zhang Y, Lu H, Yan P, Bai X, Cao L, Zuo X, Liu C, Shu Q. Cholinergic dysautonomia in a patient with systemic lupus erythematosus. Rheumatology (Oxford) 2022; 62:e9-e11. [PMID: 35789378 DOI: 10.1093/rheumatology/keac373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/18/2022] [Accepted: 05/22/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Qi Liu
- Department of Rheumatology, Qilu Hospital, Cheeloo College of Medicine, Shandong University.,Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Department of Rheumatology, Qilu Hospital, Shandong University, Jinan
| | - Yuxian Zhang
- Department of Rheumatology, Qilu Hospital, Cheeloo College of Medicine, Shandong University.,Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Department of Rheumatology, Qilu Hospital, Shandong University, Jinan
| | - Hongqin Lu
- Department of Rheumatology, Qilu Hospital, Cheeloo College of Medicine, Shandong University
| | - Peng Yan
- Department of Rheumatology, Linyi People's Hospital, Linyi
| | | | | | - Xiuli Zuo
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Chao Liu
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qiang Shu
- Department of Rheumatology, Qilu Hospital, Cheeloo College of Medicine, Shandong University.,Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Department of Rheumatology, Qilu Hospital, Shandong University, Jinan
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Postural tachycardia syndrome (POTS) and antiphospholipid syndrome (APS): What do we know so far? Rev Neurol (Paris) 2021; 178:306-314. [PMID: 34895744 DOI: 10.1016/j.neurol.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/21/2022]
Abstract
As part of the non-criteria clinical manifestations, postural orthostatic tachycardia syndrome (POTS), a multisystem autonomic dysfunction, can co-exist with antiphospholipid syndrome (APS). Several pieces of evidence hint on the autoimmune basis of POTS, and its possible association with several autoimmune diseases, including APS. Indeed, the evidence exists in the etiologies, symptomatology, and treatment options. Although infections, viral ones in particular, stress, and pregnancy are etiologies to both POTS and APS, the exact pathophysiological connection is still to be studied taking into consideration the activity of cytokines in both diseases. Nevertheless, certain immunomodulatory treatments used for the catastrophic or obstetrical forms of APS, such as intravenous immunoglobulins (IVIG) and steroids, have been also used for the treatment of POTS resistant to classical treatments. Therefore, our review aims to highlight the association between POTS and APS, shedding light on the common etiologies explaining the pathophysiology of the two disorders, the diagnostic approach to POTS as a possible clinical criterion of APS, and the treatment of APS in the context of treating POTS.
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Murakami K, Koh J, Takahashi M, Ito H. [Acute-onset autoimmune autonomic ganglionopathy remarkably effective in intravenous high-dose immunoglobulin therapy]. Rinsho Shinkeigaku 2021; 61:687-691. [PMID: 34565756 DOI: 10.5692/clinicalneurol.cn-001631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 77-year-old woman developed acute onset of orthostatic hypotension, urinary retention, and constipation. Neurological examination on admission showed severe orthostatic hypotension accompanied by syncope, mydriatic pupils, and attenuation of light reflexes with no abnormalities in other neurological systems. Autonomic testing revealed denervation hypersensitivity in norepinephrine (NE) intravenous infusion test and 0.125% pilocarpine instillation test, low NE in the serum, and decreased amount of sweating in quantitative sudomotor axon reflex test. These findings indicated dysfunction of postganglionic autonomic nerves. Autoimmune autonomic ganglionopathy (AAG) was diagnosed due to the presence of anti-ganglionic acetylcholine receptors. The patient was given intravenous high-dose immunoglobulin therapy (IVIg), improving orthostatic hypotension, urinary retention, and constipation. Previous reports indicated that the response to IVIg varied from case to case. Thus, this case suggests that IVIg is effective in acute-onset AAG cases.
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Affiliation(s)
| | - Jinsoo Koh
- Department of Neurology, Wakayama Medical University
| | | | - Hidefumi Ito
- Department of Neurology, Wakayama Medical University
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Rodriguez B, Hoepner R, Salmen A, Kamber N, Z'Graggen WJ. Immunomodulatory treatment in postural tachycardia syndrome: A case series. Eur J Neurol 2021; 28:1692-1697. [PMID: 33382525 DOI: 10.1111/ene.14711] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Postural tachycardia syndrome (POTS) is a form of autonomic dysfunction characterized by symptoms of orthostatic intolerance, often accompanied by sudomotor dysfunction and gastrointestinal dysmotility. Recently, evidence has accumulated that in a subset of patients, the pathogenesis of dysautonomia may be immune-mediated. The aim of the current report was to evaluate the use of intravenous immunoglobulin (IVIG) treatment in patients with progressive and/or refractory immune-mediated POTS. METHODS We retroactively assessed the effect and tolerance of monthly administered IVIG in six patients using autonomic function testing, standardized symptom questionnaires, and patients' symptom diaries both before and 6 months into IVIG treatment. Objective outcome measures included heart rate increase after 10 min of head-up tilt as well as duration and anhidrotic area in a thermoregulatory sweat test. Subjective outcome measures were patient reports and symptom ratings from the symptom questionnaire. RESULTS All patients responded to immunomodulatory treatment, regardless of disease duration. After 6 months of IVIG, symptom severity was reduced by nearly 40%. Autonomic function testing showed improved cardiovascular functioning by 50% and a reduction of anhidrotic areas by one third. Overall, tolerance of IVIG treatment was poor, but could be improved by a reduction in infusion rate, premedication with steroids, and additional intravenous hydration. CONCLUSIONS Using subjective but also standardized objective measures, the case series describes promising effects of IVIG treatment in POTS patients with immune-mediated dysautonomia. By reducing the infusion rate, pretreatment with steroids, and intravenous hydration, tolerance could be improved, and no patient had to discontinue the treatment.
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Affiliation(s)
- Belén Rodriguez
- Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nicole Kamber
- Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Werner J Z'Graggen
- Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
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Golden EP, Vernino S. Autoimmune autonomic neuropathies and ganglionopathies: epidemiology, pathophysiology, and therapeutic advances. Clin Auton Res 2019; 29:277-288. [DOI: 10.1007/s10286-019-00611-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/03/2019] [Indexed: 12/12/2022]
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Bouxin M, Schvartz B, Mestrallet S, Debrumetz A, Hentzien M, Tabary T, Cohen R, Nicolas G, Bani-Sadr F. Rituximab treatment in seronegative autoimmune autonomic neuropathy and autoimmune autonomic ganglionopathy: Case-report and literature review. J Neuroimmunol 2018; 326:28-32. [PMID: 30468952 DOI: 10.1016/j.jneuroim.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Autoimmune autonomic ganglionopathy (AAG) is a rare disease with no well-established treatment. Until recently, AAG could be seropositive (50 to 60% of patients) or seronegative for ganglionic (α3-type) nicotinic acetylcholine receptor (Gα3NAChR) antibodies. In early 2018, the two forms of the disease were distinguished, separating seropositive from seronegative ones, designating this latter form "seronegative autoimmune autonomic neuropathy" (SAAN). Most described treatments are plasma exchange (PE) and intravenous immunoglobulin (IVIG). However in some cases with no or small benefit, other immunomodulatory therapies, such as rituximab have been reported. We report the case of a 24-year-old female patient successfully treated for SAAN with rituximab and steroids after IVIG and PE failure. We also provide a review of case-reports reporting rituximab treatment for both SAAN and AAG. METHODS To identify articles reporting SAAN and AAG treatment with rituximab, we searched the PubMed database using the terms "autoimmune autonomic ganglionopathy", "autoimmune autonomic neuropathy" or "seronegative autoimmune autonomic neuropathy" and "rituximab". RESULTS Including our patient, nine cases have been described in the literature (4 SAAN and 5 AAG). Rituximab had a significant positive effect in 2 out of 4 SAAN and all 5 AAG cases, used alone or in association with other etiologic treatments. CONCLUSION Our study suggests rituximab (alone or in association with other treatments) could provide efficacy in both SAAN and AAG when PE and/or IVIG are not effective enough.
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Affiliation(s)
- M Bouxin
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France
| | - B Schvartz
- Department of Nephrology and Transplantation, Reims Teaching Hospitals, Reims, France
| | - S Mestrallet
- Department of Internal Medicine and Infectious Diseases, CH de Charleville-Mézières, Charleville-Mézières, France
| | - A Debrumetz
- Department of Nephrology and Transplantation, Reims Teaching Hospitals, Reims, France
| | - M Hentzien
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France
| | - T Tabary
- Immunology Laboratory, Reims Teaching Hospitals, Reims, France
| | - R Cohen
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France
| | - G Nicolas
- Department of Neurology, Assistance Publique des Hôpitaux de Paris, Raymond-Poincaré Hospital, Garches, France
| | - F Bani-Sadr
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France; University of Reims Champagne-Ardenne, EA-4684 / SFR CAP-SANTE, Reims F-51095, France.
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Watanabe E, Fujita T, Shimono M, Koike H, Yasumoto S, Hirose S. Recurrent autonomic and sensory neuropathy in a patient with anti-ganglionic acetylcholine receptor antibodies. eNeurologicalSci 2018; 12:36-38. [PMID: 30211328 PMCID: PMC6134429 DOI: 10.1016/j.ensci.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/05/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022] Open
Abstract
We report a case of recurrent neuropathy with predominant autonomic and sensory involvement whose serum was positive for anti-ganglionic acetylcholine receptor (anti-gAChR) antibodies, a diagnostic marker of autoimmune autonomic ganglionopathy. An 11-year-old girl complained of numbness and limb pain after gastroenteritis. Although hyperalgesia and autonomic dysfunctions, such as orthostatic intolerance and gastrointestinal dysmotility subsequently developed, these symptoms faded after a few days. Similar sensory and autonomic impairments recurred three times within 12 months after the first episode. The sensory and autonomic symptoms were rapidly ameliorated by the administration of intravenous immunoglobulin (IVIg) at the second and third relapse; however, the symptoms persisted even after the administration of IVIg at the fourth relapse. The residual symptoms disappeared after methylprednisolone pulse therapy. The patient's serum was found to be positive for anti-gAChR antibodies at the second relapse, and was negative after methylprednisolone pulse therapy. Further studies are needed to clarify the efficacy of treatment and the nosological position in the spectrum of neuropathies that are associated with autonomic and sensory impairments.
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Affiliation(s)
- Eri Watanabe
- Department of Pediatrics, School of Medicine, Fukuoka University, Japan.,Nakatsu Municipal Hospital, Japan
| | - Takako Fujita
- Department of Pediatrics, School of Medicine, Fukuoka University, Japan.,Nakatsu Municipal Hospital, Japan
| | - Masayuki Shimono
- Department of Pediatrics, University of Occupational and Environmental Health, Japan
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Sawa Yasumoto
- Center of Medical Education, School of Medicine, Fukuoka University, Japan
| | - Shinichi Hirose
- Department of Pediatrics, School of Medicine, Fukuoka University, Japan
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Joseph A, Wanono R, Flamant M, Vidal-Petiot E. Orthostatic hypotension: A review. Nephrol Ther 2018; 13 Suppl 1:S55-S67. [PMID: 28577744 DOI: 10.1016/j.nephro.2017.01.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/08/2017] [Indexed: 11/27/2022]
Abstract
Orthostatic hypotension, defined by a drop in blood pressure of at least 20mmHg for systolic blood pressure and at least 10mmHg for diastolic blood pressure within 3minutes of standing up, is a frequent finding, particularly in elderly patients. It is associated with a significant increase in morbidity and mortality. Although it is often multifactorial, the first favoring factor is medications. Other etiologies are divided in neurogenic orthostatic hypotension, characterized by autonomic failure due to central or peripheral nervous system disorders, and non-neurogenic orthostatic hypotension, mainly favoured by hypovolemia. Treatment always requires education of the patient regarding triggering situations and physiological countermanoeuvers. Pharmacological treatment may sometimes be necessary and mainly relies on volume expansion by fludrocortisone and/or a vasopressor agents such as midodrine. There is no predefined blood pressure target, the goal of therapy being the relief of symptoms and fall prevention.
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Affiliation(s)
- Adrien Joseph
- Service de physiologie, DHU Fire, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - Ruben Wanono
- Service de physiologie, DHU Fire, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France
| | - Martin Flamant
- Service de physiologie, DHU Fire, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France; Inserm U1149, 46, rue Henri-Huchard, 75018 Paris, France
| | - Emmanuelle Vidal-Petiot
- Service de physiologie, DHU Fire, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France; Inserm U1149, 46, rue Henri-Huchard, 75018 Paris, France.
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Bradl M, Lassmann H. Neurologic autoimmunity: mechanisms revealed by animal models. HANDBOOK OF CLINICAL NEUROLOGY 2016; 133:121-43. [PMID: 27112675 DOI: 10.1016/b978-0-444-63432-0.00008-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Over the last decade, neurologic autoimmunity has become a major consideration in the diagnosis and management of patients with many neurologic presentations. The nature of the associated antibodies and their targets has led to appreciation of the importance of the accessibility of the target antigen to antibodies, and a partial understanding of the different mechanisms that can follow antibody binding. This chapter will first describe the basic principles of autoimmune inflammation and tissue damage in the central and peripheral nervous system, and will then demonstrate what has been learnt about neurologic autoimmunity from circumstantial clinical evidence and from passive, active, and occasionally spontaneous or genetic animal models. It will cover neurologic autoimmune diseases ranging from disorders of neuromuscular transmission, peripheral and ganglionic neuropathy, to diseases of the central nervous system, where autoantibodies are either pathogenic and cause destruction or changes in function of their targets, where they are harmless bystanders of T-cell-mediated tissue damage, or are not involved at all. Finally, this chapter will summarize the relevance of current animal models for studying the different neurologic autoimmune diseases, and it will identify aspects where future animal models need to be improved to better reflect the disease reality experienced by affected patients, e.g., the chronicity or the relapsing/remitting nature of their disease.
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Affiliation(s)
- Monika Bradl
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Vienna, Austria.
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Vienna, Austria
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Abstract
PURPOSE OF REVIEW This article focuses on the most prevalent forms of autonomic neuropathies, but also discusses conditions such as focal and dysfunctional syndromes (altered autonomic function in the absence of structural lesions). The goal of this review is to allow the reader to promptly recognize these disorders, identify potentially reversible or treatable causes, and implement the appropriate treatment as well as supportive care. RECENT FINDINGS Secondary forms of autonomic neuropathies (eg, diabetes mellitus, amyloidosis) are much more common than primary forms, of which autoimmune ganglioneuropathies represent a major component. However, the spectrum of the latter is continuously evolving and has diagnostic and therapeutic implications. Testing modalities such as autonomic testing, serum autoimmune antibody testing, and skin biopsies are becoming more widely available. SUMMARY Autonomic neuropathies are relatively common conditions, and, because of the prognostic implications as well as impact on patient quality of life, they should be promptly recognized and treated aggressively. Testing is critical as other conditions may mimic autonomic neuropathies. Treatment is symptomatic in many cases, but specific therapies are also available in selected autonomic neuropathies.
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Wakerley BR, Uncini A, Yuki N. Guillain-Barré and Miller Fisher syndromes--new diagnostic classification. Nat Rev Neurol 2014; 10:537-44. [PMID: 25072194 DOI: 10.1038/nrneurol.2014.138] [Citation(s) in RCA: 365] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Guillain-Barré syndrome (GBS) and its variant, Miller Fisher syndrome (MFS), exist as several clinical subtypes with different neurological features and presentations. Although the typical clinical features of GBS and MFS are well recognized, current classification systems do not comprehensively describe the full spectrum of either syndrome. In this Perspectives article, GBS and MFS are classified on the basis of current understanding of the common pathophysiological profiles of each disease phenotype. GBS is subclassified into classic and localized forms (for example, pharyngeal-cervical-brachial weakness and bifacial weakness with paraesthesias), and MFS is divided into incomplete (for example, acute ophthalmoparesis, acute ataxic neuropathy) and CNS subtypes (Bickerstaff brainstem encephalitis). Diagnostic criteria based on clinical characteristics are suggested for each condition. We believe this approach to be more inclusive than existing systems, and argue that it could facilitate early clinical diagnosis and initiation of appropriate immunotherapy.
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Affiliation(s)
- Benjamin R Wakerley
- Department of Neurology, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK
| | - Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio, Via dei Vestini 31, Chieti 66013, Italy
| | - Nobuhiro Yuki
- Departments of Medicine and Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Unit 09-01, Centre for Translational Medicine, 14 Medical Drive, Singapore 117599, Singapore
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Nishihara H, Koga M, Higuchi O, Tasaki A, Ogasawara JI, Kawai M, Nakane S, Kanda T. Combined immunomodulatory therapies resulted in stepwise recovery in autoimmune autonomic ganglionopathy. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/cen3.12137] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hideaki Nishihara
- Department of Neurology and Clinical Neuroscience; Graduate School of Medicine; Yamaguchi University; Yamaguchi Japan
| | - Michiaki Koga
- Department of Neurology and Clinical Neuroscience; Graduate School of Medicine; Yamaguchi University; Yamaguchi Japan
| | - Osamu Higuchi
- Department of Clinical Research; Nagasaki Kawatana Medical Center; Nagasaki Japan
| | - Ayako Tasaki
- Department of Neurology and Clinical Neuroscience; Graduate School of Medicine; Yamaguchi University; Yamaguchi Japan
| | - Jun-ichi Ogasawara
- Department of Neurology and Clinical Neuroscience; Graduate School of Medicine; Yamaguchi University; Yamaguchi Japan
| | - Motoharu Kawai
- Department of Neurology and Clinical Neuroscience; Graduate School of Medicine; Yamaguchi University; Yamaguchi Japan
| | - Shunya Nakane
- Department of Clinical Research; Nagasaki Kawatana Medical Center; Nagasaki Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience; Graduate School of Medicine; Yamaguchi University; Yamaguchi Japan
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Spoo JW, Shelton GD. Recurrent gastric dilatation and intestinal dysmotility possibly resulting from autonomic neuropathy in a Great Dane. J Am Anim Hosp Assoc 2014; 50:221-6. [PMID: 24659724 DOI: 10.5326/jaaha-ms-6176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 5 yr old female spayed Great Dane was presented for recurrent episodes of gastric dilatation, intestinal dysmotility, and one episode of gastric rupture. Numerous hematologic, radiographic, and endocrine diagnostic tests were performed with no identifiable underlying cause. Many risk factors have been identified for gastric dilatation and most were present in this Great Dane. A number of symptomatic treatments, aimed primarily at altering the gastrointestinal tract flora and motility were tried, but failed to influence the clinical course of the disease. The dog continued to worsen, experienced more frequent episodes of gastric dilatation, and developed generalized muscle atrophy. Biopsies were collected from the biceps femoris and triceps brachii muscles. A pattern of denervation atrophy was evident in both muscles, consistent with polyneuropathy. The owners elected humane euthanasia and a necropsy was performed. A striking finding at necropsy was severe loss of myelinated fibers with extensive endoneurial fibrosis in the vagus nerve, consistent with an autonomic neuropathy. Autonomic neuropathy is a previously unexplored cause of gastric dilatation and intestinal dysmotility in dogs. These findings should open new directions for exploring pathogenic mechanisms for gastric dilatation in this species.
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Autonomic involvement in subacute and chronic immune-mediated neuropathies. Autoimmune Dis 2013; 2013:549465. [PMID: 23853716 PMCID: PMC3703364 DOI: 10.1155/2013/549465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/28/2013] [Indexed: 12/03/2022] Open
Abstract
Autonomic function can be impaired in many disorders in which sympathetic, parasympathetic, and enteric arms of the autonomic nervous system are affected. Signs and symptoms of autonomic involvement are related to impairment of cardiovascular, gastrointestinal, urogenital, thermoregulatory, sudomotor, and pupillomotor autonomic functions. Availability of noninvasive, sensitive, and reproducible tests can help to recognize these disorders and to better understand specific mechanisms of some, potentially treatable, immune-mediated autonomic neuropathies. This paper describes autonomic involvement in immune-mediated neuropathies with a subacute or chronic course.
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Acquired neuropathies. J Neurol 2013; 260:2433-40. [DOI: 10.1007/s00415-013-6994-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/31/2013] [Accepted: 06/03/2013] [Indexed: 11/26/2022]
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16
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Autonomic manifestations in acute sensory ataxic neuropathy: a case report. Auton Neurosci 2013; 179:155-8. [PMID: 23598285 DOI: 10.1016/j.autneu.2013.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/20/2013] [Accepted: 03/25/2013] [Indexed: 11/23/2022]
Abstract
Acute sensory ataxic neuropathy (ASAN) is known to occur with acute and monophasic sensory ataxia. Although autonomic dysfunctions have been reported, no detailed descriptions are currently available. We describe a case of ASAN in which the autonomic manifestations were systematically investigated. Although the patient did not complain of any autonomic symptoms, except for photophobia due to mydriasis, autonomic testing revealed widespread autonomic dysfunctions. Norepinephrine and dobutamine infusion test indicated the presence of sympathetic dysfunction. Additionally, the pupillary response to pilocarpine revealed the presence of parasympathetic dysfunction. In conclusion, widespread, subclinical autonomic dysfunctions may be present in ASAN patients.
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Koike H, Sobue G. [Autoimmune autonomic ganglionopathy and acute autonomic and sensory neuropathy]. Rinsho Shinkeigaku 2013; 53:1326-1329. [PMID: 24291976 DOI: 10.5692/clinicalneurol.53.1326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Autonomic neuropathies may occur primarily or secondarily to various underlying diseases. Primary autonomic neuropathies are divided into pure autonomic neuropathy, autonomic neuropathy with sensory impairment, and autonomic neuropathy with sensory and motor impairment based on the concomitance or absence of sensory or motor dysfunctions. Autoimmune autonomic ganglionopathy refers to a pure autonomic neuropathy, which typically affects both cholinergic and adrenergic functions. About a half of the patients with autoimmune autonomic ganglionopathy are positive for anti-ganglionic acetylcholine receptor antibodies. The mode of progression widely ranges from acute to chronic, including that mimicking pure autonomic failure. The number of unmyelinated fibers in the sural nerve biopsy specimens tends to decrease with the duration of disease become longer. Immunomodulatory treatments are suggested to be effective for autoimmune autonomic ganglionopathy. Acute autonomic and sensory neuropathy is characterized by autonomic and sensory impairment without motor dysfunction that reaches its nadir within a short period of time mimicking the progression of Guillain-Barré syndrome. The monophasic clinical course and frequent presence of a history of antecedent infections suggests a participation of immune mechanisms. The initial symptoms are those related to autonomic disturbance or superficial sensory impairment, while deep sensory impairment accompanied by sensory ataxia subsequently appears in some patients. Sural nerve biopsy specimens reveal small-fiber predominant axonal loss, and autopsy cases show neuronal loss in the thoracic sympathetic and dorsal root ganglia. Hence, small neurons in the autonomic and sensory ganglia may be affected in the initial phase and, subsequently, large neurons in the sensory ganglia are damaged in acute autonomic and sensory neuropathy.
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Affiliation(s)
- Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine
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Ohyama K, Yasui K, Hasegawa Y, Morozumi S, Koike H, Sobue G. Differential recovery in cardiac and vasomotor sympathetic functional markers in a patient with acute autonomic sensory and motor neuropathy. Intern Med 2013; 52:497-502. [PMID: 23411709 DOI: 10.2169/internalmedicine.52.8787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Acute autonomic sensory and motor neuropathy (AASMN) is characterized by prominent dysautonomia with somatic sensory and motor impartment. Prominent dysautonomia is observed during the early phase of AASMN. We herein describe a case of AASMN that involved prolonged autonomic failure and disturbance of sensation despite a rapid recovery from motor weakness. The early and delayed heart-to-mediastinum ratios on (123)I-meta-iodobenzylguanidine myocardial scintigraphy were decreased and improved within seven months. However, orthostatic hypotension was prolonged. These results suggest a differential improvement in the cardiac and vasomotor sympathetic functions.
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Affiliation(s)
- Ken Ohyama
- Department of Neurology, Nagoya Daini Red Cross Hospital, Japan.
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