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Peltier AC. Autonomic Dysfunction from Diagnosis to Treatment. Prim Care 2024; 51:359-373. [PMID: 38692780 DOI: 10.1016/j.pop.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Autonomic disorders can present with hypotension, gastrointestinal, genitourinary symptoms, and heat intolerance. Diabetes is the most common causes of autonomic failure, and management should focus on glucose control to prevent developing autonomic symptoms. The most prevalent cause of dysautonomia, or autonomic dysfunction, is Postural Orthostatic Tachycardia Syndrome (POTS). Autonomic testing characterizes causes for nonspecific symptoms but is not necessary in patients with classic presentations. Treatment for autonomic dysfunction and failure focus on discontinuing offending medications, behavioral modification, and pharmacologic therapy to decrease symptom severity. Autonomic failure has no cure; therefore, the focus remains on improving quality of life.
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Affiliation(s)
- Amanda C Peltier
- Department of Neurology, Vanderbilt University Medical Center, 1611 21st Avenue South, Nashville, TN 37232, USA; Department of Medicine, Vanderbilt University Medical Center, 1611 21st Avenue South, Nashville, TN 37232, USA.
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2
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Kempler P, Körei A. [Diabetic cardiovascular autonomic neuropathy: clinical significance, diagnosis and therapy]. Orv Hetil 2024; 165:602-612. [PMID: 38643475 DOI: 10.1556/650.2024.33027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/29/2024] [Indexed: 04/23/2024]
Abstract
Az autonóm neuropathia a cukorbetegség igen gyakori szövődménye, mely a diabetes
kórfejlődése során már korán kialakul, sőt már a csökkent glükóztolerancia
stádiumában is jelen lehet. A betegek életminőségére, a cardiovascularis
morbiditásra és mortalitásra gyakorolt prognosztikus jelentősége, a többi
szövődménnyel mutatott összefüggései miatt a cardiovascularis autonóm funkció
károsodása a cukorbetegség szövődményei között kiemelt jelentőségű. A
cardiovascularis autonóm neuropathia klinikai manifesztációi mint a nyugalmi
tachycardia, az orthostaticus hypotonia, a néma myocardialis ischaemia és
infarktus vagy éppen a QT-távolság megnyúlása miatt kialakuló ritmuszavarok mind
hozzájárulnak a cardiovascularis autonóm neuropathia rossz prognózisához. Ezek a
betegek gyakrabban szenvednek el hirtelen szívhalált, és a perioperatív
légzés-keringésleállás kockázata is nagyobb. A szövődmény irányában végzett
szűrővizsgálatok így alapvető jelentőségűek. A diagnosztikában a mai napig a
hagyományos cardiovascularis reflextesztek tekinthetők arany standardnak, melyek
egyszerű, noninvazív, jól reprodukálható, megfelelő szenzitivitással és
specificitással rendelkező eszközös vizsgálatok. Az egyéb vizsgálati lehetőségek
közül a szívfrekvencia-variabilitás és baroreflex-szenzitivitás a prognózis
pontosabb megítélésére, illetve elsősorban klinikai tanulmányokban végpontokként
használatosak. Az összefoglaló kitér emellett a betegek előszűrését szolgáló
kérdőíves módszerekre és a diagnosztika egyszerűsítését célzó újabb
lehetőségekkel kapcsolatos legfrissebb eredményekre. A cardiovascularis autonóm
neuropathia kezelésének sarokkövét a megfelelő glykaemiás kontroll és a
cardiovascularis kockázati tényezők kontrollja jelenti. További oki terápiás
lehetőség az alfa-liponsav alkalmazása, melynek az autonóm funkcióra gyakorolt
kedvező hatásait klinikai vizsgálat igazolta. A hagyományos értelemben vett
glykaemiás kontrollon túl újabban a glykaemiás variabilitás és egyes
antidiabetikumok idegi funkciókra gyakorolt pleiotrop hatásai kerültek előtérbe.
A testsúlycsökkentés nemcsak a diabetes, de az autonóm neuropathia tekintetében
is jótékony hatású, ugyanakkor az életmód-terápia további összetevőivel
kapcsolatban nem egyértelműek az adatok. Orv Hetil. 2024; 165(16): 602–612.
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Affiliation(s)
- Péter Kempler
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Onkológiai Klinika Budapest, Korányi Sándor u. 2/A, 1083 Magyarország
| | - Anna Körei
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Belgyógyászati és Onkológiai Klinika Budapest, Korányi Sándor u. 2/A, 1083 Magyarország
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3
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Kang K, Shi K, Liu J, Li N, Wu J, Zhao X. Autonomic dysfunction and treatment strategies in intracerebral hemorrhage. CNS Neurosci Ther 2024; 30:e14544. [PMID: 38372446 PMCID: PMC10875714 DOI: 10.1111/cns.14544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/15/2023] [Accepted: 11/17/2023] [Indexed: 02/20/2024] Open
Abstract
AIMS Autonomic dysfunction with central autonomic network (CAN) damage occurs frequently after intracerebral hemorrhage (ICH) and contributes to a series of adverse outcomes. This review aims to provide insight and convenience for future clinical practice and research on autonomic dysfunction in ICH patients. DISCUSSION We summarize the autonomic dysfunction in ICH from the aspects of potential mechanisms, clinical significance, assessment, and treatment strategies. The CAN structures mainly include insular cortex, anterior cingulate cortex, amygdala, hypothalamus, nucleus of the solitary tract, ventrolateral medulla, dorsal motor nucleus of the vagus, nucleus ambiguus, parabrachial nucleus, and periaqueductal gray. Autonomic dysfunction after ICH is closely associated with neurological functional outcomes, cardiac complications, blood pressure fluctuation, immunosuppression and infection, thermoregulatory dysfunction, hyperglycemia, digestive dysfunction, and urogenital disturbances. Heart rate variability, baroreflex sensitivity, skin sympathetic nerve activity, sympathetic skin response, and plasma catecholamine concentration can be used to assess the autonomic functional activities after ICH. Risk stratification of patients according to autonomic functional activities, and development of intervention approaches based on the restoration of sympathetic-parasympathetic balance, would potentially improve clinical outcomes in ICH patients. CONCLUSION The review systematically summarizes the evidence of autonomic dysfunction and its association with clinical outcomes in ICH patients, proposing that targeting autonomic dysfunction could be potentially investigated to improve the clinical outcomes.
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Affiliation(s)
- Kaijiang Kang
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Kaibin Shi
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Jiexin Liu
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Na Li
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Jianwei Wu
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Xingquan Zhao
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
- Research Unit of Artificial Intelligence in Cerebrovascular DiseaseChinese Academy of Medical SciencesBeijingChina
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Clement G, Cavillon G, Vuillier F, Bouhaddi M, Béreau M. Unveiling autonomic failure in synucleinopathies: Significance in diagnosis and treatment. Rev Neurol (Paris) 2024; 180:79-93. [PMID: 38216420 DOI: 10.1016/j.neurol.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Abstract
Autonomic failure is frequently encountered in synucleinopathies such as multiple system atrophy (MSA), Parkinson's disease (PD), Lewy body disease, and pure autonomic failure (PAF). Cardiovascular autonomic failure affects quality of life and can be life threatening due to the risk of falls and the increased incidence of myocardial infarction, stroke, and heart failure. In PD and PAF, pathogenic involvement is mainly post-ganglionic, while in MSA, the involvement is mainly pre-ganglionic. Cardiovascular tests exploring the autonomic nervous system (ANS) are based on the analysis of continuous, non-invasive recordings of heart rate and digital blood pressure (BP). They assess facets of sympathetic and parasympathetic activities and provide indications on the integrity of the baroreflex arc. The tilt test is widely used in clinical practice. It can be combined with catecholamine level measurement and analysis of baroreflex activity and cardiac variability for a detailed analysis of cardiovascular damage. MIBG myocardial scintigraphy is the most sensitive test for early detection of autonomic dysfunction. It provides a useful measure of post-ganglionic sympathetic fiber integrity and function and is therefore an effective tool for distinguishing PD from other parkinsonian syndromes such as MSA. Autonomic cardiovascular investigations differentiate between certain parkinsonian syndromes that would otherwise be difficult to segregate, particularly in the early stages of the disease. Exploring autonomic failure by gathering information about residual sympathetic tone, low plasma norepinephrine levels, and supine hypertension can guide therapeutic management of orthostatic hypotension (OH).
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Affiliation(s)
- G Clement
- Service de neurologie électrophysiologie clinique, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Centre expert Parkinson, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France.
| | - G Cavillon
- Service de neurologie électrophysiologie clinique, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Centre expert Parkinson, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - F Vuillier
- Laboratoire d'anatomie, UFR santé, université de Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - M Bouhaddi
- Laboratoire de physiologie-explorations fonctionnelles, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - M Béreau
- Service de neurologie électrophysiologie clinique, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Centre expert Parkinson, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
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5
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V SK, Patangi SO, Warkari TA, Kothari RJ. "Partial" Harlequin Syndrome in Central Veno-Arterial Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2023; 37:2310-2313. [PMID: 37573215 DOI: 10.1053/j.jvca.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Sunil Kumar V
- Department of Cardiac Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India.
| | - Sanjay Orathi Patangi
- Department of Cardiac Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India
| | - Tejas Arun Warkari
- Department of Cardiac Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India
| | - Richa Jayesh Kothari
- Department of Radiology, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India
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Chen B, Yang W, Luo Y, Tan EK, Wang Q. Non-pharmacological and drug treatment of autonomic dysfunction in multiple system atrophy: current status and future directions. J Neurol 2023; 270:5251-5273. [PMID: 37477834 DOI: 10.1007/s00415-023-11876-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
Multiple system atrophy (MSA) is a sporadic, fatal, and rapidly progressive neurodegenerative disease of unknown etiology that is clinically characterized by autonomic failure, parkinsonism, cerebellar ataxia, and pyramidal signs in any combination. Early onset and extensive autonomic dysfunction, including cardiovascular dysfunction characterized by orthostatic hypotension (OH) and supine hypertension, urinary dysfunction characterized by overactive bladder and incomplete bladder emptying, sexual dysfunction characterized by sexual desire deficiency and erectile dysfunction, and gastrointestinal dysfunction characterized by delayed gastric emptying and constipation, are the main features of MSA. Autonomic dysfunction greatly reduces quality of life and increases mortality. Therefore, early diagnosis and intervention are urgently needed to benefit MSA patients. In this review, we aim to discuss the systematic treatment of autonomic dysfunction in MSA, and focus on the current methods, starting from non-pharmacological methods, such as patient education, psychotherapy, diet change, surgery, and neuromodulation, to various drug treatments targeting autonomic nerve and its projection fibers. In addition, we also draw attention to the interactions among various treatments, and introduce novel methods proposed in recent years, such as gene therapy, stem cell therapy, and neural prosthesis implantation. Furthermore, we elaborate on the specific targets and mechanisms of action of various drugs. We would like to call for large-scale research to determine the efficacy of these methods in the future. Finally, we point out that studies on the pathogenesis of MSA and pathophysiological mechanisms of various autonomic dysfunction would also contribute to the development of new promising treatments and concepts.
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Affiliation(s)
- BaoLing Chen
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Gongye Road 253, Guangzhou, 510282, Guangdong, People's Republic of China
| | - Wanlin Yang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Gongye Road 253, Guangzhou, 510282, Guangdong, People's Republic of China
| | - Yuqi Luo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Gongye Road 253, Guangzhou, 510282, Guangdong, People's Republic of China
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Gongye Road 253, Guangzhou, 510282, Guangdong, People's Republic of China.
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7
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Khaytin I, Victor AK, Barclay SF, Benson LA, Slattery SM, Rand CM, Kurek KC, Weese-Mayer DE. Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD): a collaborative review of the current understanding. Clin Auton Res 2023; 33:251-268. [PMID: 37162653 DOI: 10.1007/s10286-023-00936-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/01/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To provide an overview of the discovery, presentation, and management of Rapid-onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD). To discuss a search for causative etiology spanning multiple disciplines and continents. METHODS The literature (1965-2022) on the diagnosis, management, pathophysiology, and potential etiology of ROHHAD was methodically reviewed. The experience of several academic centers with expertise in ROHHAD is presented, along with a detailed discussion of scientific discovery in the search for a cause. RESULTS ROHHAD is an ultra-rare syndrome with fewer than 200 known cases. Although variations occur, the acronym ROHHAD is intended to alert physicians to the usual sequence or unfolding of the phenotypic presentation, including the full phenotype. Nearly 60 years after its first description, more is known about the pathophysiology of ROHHAD, but the etiology remains enigmatic. The search for a genetic mutation common to patients with ROHHAD has not, to date, demonstrated a disease-defining gene. Similarly, a search for the autoimmune basis of ROHHAD has not resulted in a definitive answer. This review summarizes current knowledge and potential future directions. CONCLUSION ROHHAD is a poorly understood, complex, and potentially devastating disorder. The search for its cause intertwines with the search for causes of obesity and autonomic dysregulation. The care for the patient with ROHHAD necessitates collaborative international efforts to advance our knowledge and, thereby, treatment, to decrease the disease burden and eventually to stop, and/or reverse the unfolding of the phenotype.
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Affiliation(s)
- Ilya Khaytin
- Center for Autonomic Medicine in Pediatrics (CAMP), Division of Autonomic Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Stanley Manne Children's Research Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - A Kaitlyn Victor
- College of Graduate Health Sciences, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sarah F Barclay
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Leslie A Benson
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Susan M Slattery
- Center for Autonomic Medicine in Pediatrics (CAMP), Division of Autonomic Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Stanley Manne Children's Research Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Casey M Rand
- Center for Autonomic Medicine in Pediatrics (CAMP), Division of Autonomic Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Stanley Manne Children's Research Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kyle C Kurek
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Debra E Weese-Mayer
- Center for Autonomic Medicine in Pediatrics (CAMP), Division of Autonomic Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Stanley Manne Children's Research Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Kurono H, Torikai Y, Hara H, Okamura M, Kunimoto M. [Over 5 years follow-up of three cases of autoimmune autonomic ganglionopathy]. Rinsho Shinkeigaku 2022; 62:860-864. [PMID: 36288969 DOI: 10.5692/clinicalneurol.cn-001793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We report the clinical course of three cases of anti-ganglionic acetylcholine receptor (gAChR) antibody positive auto-immune autonomic ganglionopathy (AAG) that have been followed for over 5 years. In all three cases, the symptoms improved by acute treatment, but ultimately relapsed. The first case was a female in her 20s who had a chronic history of photophobia, constipation and amenorrhea. The symptoms almost disappeared by plasma exchange, and menstruation resumed. During the course, it relapsed once after a cold. There was no recurrence of AAG during the two pregnancies. The second case was a male in his 60s who visited a hospital for the acute onset of orthostatic hypotension (OH) and psychological symptoms (infantilization and psychogenic pseudosyncope). Although IVIg was effective, it recurred frequently and was difficult to treat. However, all the symptoms disappeared eight years after the onset without any particular reasons. The third case was a female in her 80s who had a chronic history of OH. Acute treatment was effective, but AAG recurred repeatedly. Additionally, it was difficult to judge relapse because of the residual sequelae. During the course, cerebral hemorrhage due to supine hypertension or short-time blood pressure variability and femoral neck fracture caused by OH occurred. She eventually became a wheelchair. This report is clinically important because there are few reports of long-term follow-up of AAG.
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Affiliation(s)
- Hiroko Kurono
- Department of Neurology, Saiseikai Kanagawaken Hospital
| | - Yuko Torikai
- Department of Neurology, Saiseikai Kanagawaken Hospital
| | - Hajime Hara
- Department of Neurology, Saiseikai Kanagawaken Hospital
- Wellcare Hara Neurology Clinic
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9
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Abraham M, Bhattacharjee S, Ram A, Maramattom BV, Padmanabhan S, Soman A. Understanding and Managing Autonomic Disorders in the Neurocritical Care Unit: A Comprehensive review. Neurol India 2022; 70:485-490. [PMID: 35532608 DOI: 10.4103/0028-3886.344657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND For a favorable outcome, patients admitted to critical care units require continuous monitoring and swift decision-making ability regarding management. One of the biggest challenges in neurocritical care units is the identification and management of autonomic dysfunction and in the worst-case scenario, autonomic storms. OBJECTIVE Most of the literature available focuses mainly on autonomic storms following traumatic brain injury. However, due to the myriad neurological presentations in a critical care setting, it is particularly important for physicians and intensivists to suspect and manage autonomic dysfunction in various neurological scenarios. METHODS Understanding the mechanism of paroxysmal sympathetic hyperactivity (PSH) is essential for early recognition and treatment. PSH-AM is an assessment measurement scale to diagnose and assess the severity of PSH in traumatic brain injury. However, this is not yet standardized across all neurological settings. CONCLUSION We present a comprehensive report on understanding the mechanism of autonomic storms across various neurological disorders and outline the management.
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Affiliation(s)
- Mathew Abraham
- Department of Neurology, Aster Medcity, Kothad, Kochi, Kerala, India
| | | | - Ananth Ram
- Department of Neurology, Aster Medcity, Kothad, Kochi, Kerala, India
| | | | | | - Adithya Soman
- Department of Neurology, Aster Medcity, Kothad, Kochi, Kerala, India
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10
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Meling S, Bertoli D, Sangnes DA, Brock C, Drewes A, Ejskjaer N, Dimcevski G, Søfteland E. Diabetic Gastroenteropathy: Soothe the Symptoms or Unravel a Cure? Curr Diabetes Rev 2022; 18:e220321192412. [PMID: 34225633 DOI: 10.2174/1573399817666210322154618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/19/2021] [Accepted: 02/13/2021] [Indexed: 11/22/2022]
Abstract
Autonomic neuropathy in patients with diabetes mellitus, and especially complications related to gastrointestinal neuropathy, are often overlooked in the clinic. Diabetic gastroenteropathy affects every segment of the gastrointestinal tract and generates symptoms that may include nausea, early satiety, vomiting, abdominal pain, constipation, and diarrhea. Severe cases can be complicated by weight loss, dehydration, and electrolyte disturbances. The pathophysiology is complex, the diagnostics and treatment options are multidisciplinary, and there is generally a lack of evidence for the treatment options. The aims for this review are first to summarize the pathophysiology and describe possible and expected symptoms and complications.Further, we will try to supply the clinician with a straightforward tool for diagnostics, and then, we shall summarize established treatment options, including diet recommendations, pharmacological and non-pharmacological options. Finally, we will explore the multiple possibilities of novel treatment, looking at medications related to the pathophysiology of neuropathy, other manifestations of autonomic neuropathies, and symptomatic treatment for other gastrointestinal disorders, also including new knowledge of endosurgical and neuromodulatory treatment. The overall goal is to increase awareness and knowledge on this frequent diabetic complication and to provide better tools for diagnosis and treatment. Ultimately, we hope to encourage further research in this field, as there are clear shortcomings in terms of biomarkers, pathophysiology, as well as treatment possibilities. In conclusion, diagnosis and management of diabetic gastroenteropathy are challenging and often require multidisciplinary teams and multimodal therapies. Treatment options are sparse, but new pharmacological, endoscopic, and neuromodulatory techniques have shown promising results in initial studies.
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Affiliation(s)
- Sondre Meling
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Davide Bertoli
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Dag A Sangnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Christina Brock
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Asbjørn Drewes
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Niels Ejskjaer
- Steno Diabetes Center North Jutland, Aalborg, Denmark
- Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Georg Dimcevski
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Eirik Søfteland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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11
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Özkaya PY, Turanlı EE, Arı HF, Kurt S, Karapınar B. Cardiac failure in a child with tuberculous meningitis as a complication of Paroxysmal sympathetic hyperactivity. Turk J Pediatr 2022; 64:381-384. [PMID: 35611428 DOI: 10.24953/turkjped.2020.3609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Paroxysmal sympathetic hyperactivity (PSH) is a disorder due to the loss of regulation of autonomic activity. The most common condition predisposing to the development of PSH is traumatic brain injury (TBI), followed by anoxic brain injury, stroke, tumors, and infections. Awareness about the condition and early recognition is important to avoid life threatening complications. CASE We report a 4-year-old child with tuberculous meningitis with symptoms of PSH who developed cardiac failure. PSH episodes were treated with beta blocker, benzodiazepine, morphine, dexmedetomidine, baclofen, and tizanidine. Three weeks after readmission PSH episodes decreased and the patient was transferred to the general ward. CONCLUSIONS PSH assessment tool has benefits such as monitoring the patient, evaluating response to treatment and early diagnosing PSH patients.
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Affiliation(s)
- Pınar Yazıcı Özkaya
- Division of Intensive Care Unit, Ege University Faculty of Medicine, İzmir, Turkey
| | - Eşe Eda Turanlı
- Division of Intensive Care Unit, Ege University Faculty of Medicine, İzmir, Turkey
| | - Hatice Feray Arı
- Division of Intensive Care Unit, Ege University Faculty of Medicine, İzmir, Turkey
| | - Serap Kurt
- Department of Pediatrics, Ege University Faculty of Medicine, İzmir, Turkey
| | - Bülent Karapınar
- Division of Intensive Care Unit, Ege University Faculty of Medicine, İzmir, Turkey
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Abstract
PURPOSE OF REVIEW Autonomic neuropathies are a complex group of disorders and result in diverse clinical manifestations that affect the cardiovascular, gastrointestinal, urogenital, and sudomotor systems. We focus this review on the diagnosis and treatment of peripheral autonomic neuropathies. We summarize the diagnostic tools and current treatment options that will help the clinician care for individuals with peripheral autonomic neuropathies. RECENT FINDINGS Autonomic neuropathies occur often in conjunction with somatic neuropathies but they can also occur in isolation. The autonomic reflex screen is a validated tool to assess sympathetic postganglionic sudomotor, cardiovascular sympathetic noradrenergic, and cardiac parasympathetic (i.e., cardiovagal) function. Initial laboratory evaluation for autonomic neuropathies includes fasting glucose or oral glucose tolerance test, thyroid function tests, kidney function tests, vitamin-B12, serum, and urine protein electrophoresis with immunofixation. Other laboratory tests should be guided by the clinical context. Reduced intraepidermal nerve density on skin biopsy is a finding, not a diagnosis. Skin biopsy can be helpful in selected individuals for the diagnosis of disorders affecting small nerve fibers; however, we strongly discourage the use of skin biopsy without clinical-physiological correlation. Ambulatory blood pressure monitoring may lead to early identification of patients with cardiovascular autonomic neuropathy in the primary care setting. Disease-modifying therapies should be used when available in combination with nonpharmacological management and symptomatic pharmacologic therapies. Autonomic function testing can guide the therapeutic decisions and document improvement with treatment. A systematic approach guided by the autonomic history and standardized autonomic function testing may help clinicians when identifying and/or counseling patients with autonomic neuropathies. Treatment should be individualized and disease-modifying therapies should be used when available.
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Affiliation(s)
- Guillaume Lamotte
- Department of Neurology, University of Utah, Salt Lake City, UT, USA.
| | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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13
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Corell A, Ljungqvist J. [Paroxysmal sympathetic hyperactivity]. Lakartidningen 2021; 118:21070. [PMID: 34914088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Paroxysmal sympathetic hyperactivity (PSH) is a condition mainly described in patients after traumatic brain injury and it is also known under the terms "autonomic storm" and "dysautonomia". It affects between 8-10% of patients after traumatic brain injury and can also affect patients after other neurological diseases, such as anoxic brain injury, stroke, tumors or infections. PSH manifests with six main symptoms: tachycardia, tachypnea, hypertension, hyperthermia, hyperhidrosis and increased muscle tonus. It is of outmost importance to exclude other causes for the symptoms and there are diagnostic criteria established to identify and diagnose PSH. The treatment is pharmacological and non-pharmacological and often multimodal. PSH is probably underdiagnosed and increased awareness is needed.
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Affiliation(s)
- Alba Corell
- med dr, ST-läkare, sektionen för klinisk neurovetenskap, institutionen för neurovetenskap och fysiologi, Göteborgs universitet, Sahlgrens-ka akademin; sektionen för neurokir-urgi, Neurosjukvården, Sahlgrenska universitetssjukhuset, Göteborg
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14
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Roura S, Álvarez G, Solà I, Cerritelli F. Do manual therapies have a specific autonomic effect? An overview of systematic reviews. PLoS One 2021; 16:e0260642. [PMID: 34855830 PMCID: PMC8638932 DOI: 10.1371/journal.pone.0260642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022] Open
Abstract
Background The impact of manual therapy interventions on the autonomic nervous system have been largely assessed, but with heterogeneous findings regarding the direction of these effects. We conducted an overview of systematic reviews to describe if there is a specific autonomic effect elicited by manual therapy interventions, its relation with the type of technique used and the body region where the intervention was applied. Methods We conducted an overview according to a publicly registered protocol. We searched the Cochrane Database of Systematic Reviews, MEDLINE, EPISTEMONIKOS and SCOPUS, from their inception to march 2021. We included systematic reviews for which the primary aim of the intervention was to assess the autonomic effect elicited by a manual therapy intervention in either healthy or symptomatic individuals. Two authors independently applied the selection criteria, assessed risk of bias from the included reviews and extracted data. An established model of generalisation guided the data analysis and interpretation. Results We included 12 reviews (5 rated as low risk of bias according the ROBIS tool). The findings showed that manual therapies may have an effect on both sympathetic and parasympathetic systems. However, the results from included reviews were inconsistent due to differences in their methodological rigour and how the effects were measured. The reviews with a lower risk of bias could not discriminate the effects depending on the body region to which the technique was applied. Conclusion The magnitude of the specific autonomic effect elicited by manual therapies and its clinical relevance is uncertain. We point out some specific recommendations in order to improve the quality and relevance of future research in this field.
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Affiliation(s)
- Sonia Roura
- Spain National Center, Foundation COME Collaboration, Barcelona, Spain
- * E-mail:
| | - Gerard Álvarez
- Spain National Center, Foundation COME Collaboration, Barcelona, Spain
- Iberoamerican Cochrane Centre–Biomedical Research Institute Sant Pau, IIB Sant Pau, Barcelona, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre–Biomedical Research Institute Sant Pau, IIB Sant Pau, Barcelona, Spain
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15
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Abstract
Hirayama disease is a disease of young males causing atrophy of small muscles of the affected hand and forearm. Localized autonomic dysfunction of the affected upper limb such as cold skin and excessive sweating has been described in some patients. In this study, we looked for local as well as systemic involvement of autonomic nervous system in patients with Hirayama disease. Forty-four patients with a median duration of illness of 3 years were included in the study. Assessment of symptom profile and evaluation of autonomic nervous system were done at the time of enrolment. The mean age at presentation was 21.9 (10-32) years, with a delay in seeking medical attention of around 3 (1-11) years. Localized clinical autonomic dysfunction was present in 39 (88.6%) patients, while objective generalized autonomic dysfunction was present in 33 (75%) patients. Cold skin and excessive sweating showed good correlation with the presence of objective autonomic dysfunction (P < 0.05). In three patients, sympathetic skin response (SSR) could not be recorded in one of the four limbs. Compared to controls, the SSR results in patients with Hirayama disease showed increased latency (1.64 ± 0.21 vs. 1.57 ± 0.14, P 0.04) and decreased amplitude in upper limbs (0.65 ± 0.19 vs. 0.86 ± 0.40, P 0.01). Hirayama disease has both localized and systemic dysautonomia. Careful longitudinal evaluation during the progressive phase of the disease may help in diagnosing subtle systemic autonomic dysfunction.
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Affiliation(s)
- Animesh Das
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India.
| | - Sunil Pradhan
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
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16
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Abstract
Recognition of the importance of nonmotor dysfunction as a component of Parkinson's disease has exploded over the past three decades. Autonomic dysfunction is a frequent and particularly important nonmotor feature because of the broad clinical spectrum it covers. Cardiovascular, gastrointestinal, urinary, sexual, and thermoregulatory abnormalities all can appear in the setting of Parkinson's disease. Cardiovascular dysfunction is characterized most prominently by orthostatic hypotension. Gastrointestinal dysfunction can involve virtually all levels of the gastrointestinal tract. Urinary dysfunction can entail either too frequent voiding or difficulty voiding. Sexual dysfunction is frequent and frustrating for both patient and partner. Alterations in sweating and body temperature are not widely recognized but often are present. Autonomic dysfunction can significantly and deleteriously impact quality of life for individuals with Parkinson's disease. Because effective treatment for many aspects of autonomic dysfunction is available, it is vitally important that assessment of autonomic dysfunction be a regular component of the neurologic history and exam and that appropriate treatment be initiated and maintained.
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Affiliation(s)
- Ronald F Pfeiffer
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA.
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17
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Lombardi C, Pengo MF, Parati G. Obstructive sleep apnea syndrome and autonomic dysfunction. Auton Neurosci 2019; 221:102563. [PMID: 31445406 DOI: 10.1016/j.autneu.2019.102563] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/23/2019] [Accepted: 07/09/2019] [Indexed: 01/29/2023]
Abstract
Autonomic nervous system (ANS) has been extensively explored in obstructive sleep apnea (OSA). Autonomic alterations in these patients have been described by means of several methods, evaluating ANS function both directly with microneurography and indirectly through baroreflex sensitivity (BRS, by the sequence method or the cross-spectral approach), heart rate variability analysis (HRV, both in the time and frequency domain) during sleep and wake, or conventional laboratory tests, including cold pressor test, hand grip test or measurement of urinary cathecolamine excretion. Several studies in OSA patients have shown ANS alterations, in particular sympathetic overactivity, both acutely during apnea events and chronically during the daytime, being both also involved in cardiovascular consequences of sleep disordered breathing. The association between OSA and sympathetic dysregulation suggests a dose response relationship between OSA severity and the degree of sympathetic overactivity and this association seems to be reversible as the treatment of OSA is implemented. Additionally ANS is involved in regulating visceral and humoral functions to maintain the body homeostasis and in reaction and adaptation to external and internal stressor stimuli. However, the vast majority of studies have focussed on cardiovascular alterations, which are easier to measure, somewhat neglecting the other functions regulated by ANS. More evidence is therefore needed to better characterize the impact that sleep disorder breathing may have on ANS both in the short and long term.
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Affiliation(s)
- C Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - M F Pengo
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - G Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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18
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Spallone V. Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet. Diabetes Metab J 2019; 43:3-30. [PMID: 30793549 PMCID: PMC6387879 DOI: 10.4093/dmj.2018.0259] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/01/2019] [Indexed: 12/15/2022] Open
Abstract
The burden of diabetic cardiovascular autonomic neuropathy (CAN) is expected to increase due to the diabetes epidemic and its early and widespread appearance. CAN has a definite prognostic role for mortality and cardiovascular morbidity. Putative mechanisms for this are tachycardia, QT interval prolongation, orthostatic hypotension, reverse dipping, and impaired heart rate variability, while emerging mechanisms like inflammation support the pervasiveness of autonomic dysfunction. Efforts to overcome CAN under-diagnosis are on the table: by promoting screening for symptoms and signs; by simplifying cardiovascular reflex tests; and by selecting the candidates for screening. CAN assessment allows for treatment of its manifestations, cardiovascular risk stratification, and tailoring therapeutic targets. Risk factors for CAN are mainly glycaemic control in type 1 diabetes mellitus (T1DM) and, in addition, hypertension, dyslipidaemia, and obesity in type 2 diabetes mellitus (T2DM), while preliminary data regard glycaemic variability, vitamin B12 and D changes, oxidative stress, inflammation, and genetic biomarkers. Glycaemic control prevents CAN in T1DM, whereas multifactorial intervention might be effective in T2DM. Lifestyle intervention improves autonomic function mostly in pre-diabetes. While there is no conclusive evidence for a disease-modifying therapy, treatment of CAN manifestations is available. The modulation of autonomic function by SGLT2i represents a promising research field with possible clinical relevance.
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Affiliation(s)
- Vincenza Spallone
- Division of Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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19
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Abstract
The autonomic nervous system is designed to maintain physiologic homeostasis. Its widespread connections make it vulnerable to disruption by many disease processes including primary etiologies such as Parkinson's disease, multiple system atrophy, dementia with Lewy bodies, and pure autonomic failure and secondary etiologies such as diabetes mellitus, amyloidosis, and immune-mediated illnesses. The result is numerous symptoms involving the cardiovascular, gastrointestinal, and urogenital systems. Patients with autonomic dysfunction (AUD) often have peripheral and/or cardiac denervation leading to impairment of the baroreflex, which is known to play a major role in determining hemodynamic outcome during orthostatic stress and low cardiac output states. Heart rate and plasma norepinephrine responses to orthostatic stress are helpful in diagnosing impairment of the baroreflex in patients with orthostatic hypotension (OH) and suspected AUD. Similarly, cardiac sympathetic denervation diagnosed with MIBG scintigraphy or 18F-DA PET scanning has also been shown to be helpful in distinguishing preganglionic from postganglionic involvement and in diagnosing early stages of neurodegenerative diseases. In this chapter, we review the causes of AUD, the pathophysiology and resulting cardiovascular manifestations with emphasis on the diagnosis and treatment of OH.
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Affiliation(s)
- Martina Rafanelli
- Division of Geriatric Cardiology and Medicine, University of Florence, Florence, Italy
| | - Kathleen Walsh
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Mohamed H Hamdan
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Laura Buyan-Dent
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
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20
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Lisukha LM, Stepanova YI, Kolpakov IY, Podrushnyak AY. ELECTROLYTE CONTENT IN SALIVA OF CHILDREN WITH DEVIATION IN VEGETATIVE STATUS RESIDING AT RADIOACTIVELY CONTAMINATED TERRITORIES OF UKRAINE AFTER APPLICATION OF INTERMITTENT NORMOBARIC HYPOXIA. Probl Radiac Med Radiobiol 2018; 23:359-372. [PMID: 30582857 DOI: 10.33145/2304-8336-2018-23-359-372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Indexed: 06/09/2023]
Abstract
Objective was to determine the content of sodium (Na+), potassium (K+), calcium (Ca2+), and magnesium (Mg2+) elec-trolytes in non-stimulated mixed saliva of children, with disorders of autonomous nervous system (ANS), who wereborn and are permanently residing at radioactive contaminated territories after application of intermittent normo-baric hypoxia (INH) of sanogenic level.Patientes and methods. The children (41 boys and 62 girls) aged 6-17 years were examined. All they were dividedinto three groups: the control group consisted of 30 persons (group I); the comparison group - 30 person (groupII); the main group - 43 patients (group III). The collection of anamnesis, patient complaints, clinical and labora-tory examinations were included into the studied program. The content of electrolytes in oral fluids was determinedby the atomic absorption method. 10 seances of INH with a hypoxic component of 12 % oxygen in nitrogen wereused by us.Results. It was shown that the content of electrolytes in non-stimulated mixed saliva had a multidirectional signi-ficance in different age groups after INH: in examined children of primary school age (6-11 years), the Na+ concen-tration was significantly increased by 0.8 mmol/l, K+ concentration was decreased by 3 mmol/l, Ca2+ concentrationwas decreased by 1.07 mmol/l and in children of senior school age (12-17 years) - Na+, and Ca2+ concentrations weredecreased by 2 mmol/l and 0.17 mmol/l, respectively.Сonclusions. The obtained results allow to recommend the INH seances for addition to basic treatment of childrenwith disorders of autonomous nervous system, who were born and are permanently residing at radioactive contam-inated territories of Ukraine.
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Affiliation(s)
- L M Lisukha
- O. O. Bogomoletz Institute of Physiology, National Academy Sciences of Ukraine, 4 Bogomoletz street, Kyiv, 01024, Ukraine
| | - Ye I Stepanova
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Melnykova street, Kyiv, 04050, Ukraine
| | - I Ye Kolpakov
- State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Melnykova street, Kyiv, 04050, Ukraine
| | - A Ye Podrushnyak
- State Institution «L.I. Medved's Research Center of Preventive Toxicolog Food and Chemical Safety», 6 Heroiv Oborony str., Kyiv, 03680, Ukraine
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21
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Terkelsen AJ, Hansen J, Klostergaard A, Otto M, Mølgaard H, Hvas CL, Krogh K, Kirkeby HJ, Andersen H, Jensen TS. [Neurogenic autonomic dysfunction in adults]. Ugeskr Laeger 2018; 180:V08170612. [PMID: 29720343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Neurogenic autonomic dysfunction (NAD) is underdiagnosed, and it is likely in patients, who have orthostatic hypotension and symptoms from multiple organ systems as well as abnormal results from a neurological examination. A clinical and neurophysiological examination of the autonomic nervous system combined with a standardised paraclinical evaluation should be performed. NAD may be present in neurodegenerative disorders, vitamin deficiency, toxicity, infection, and in paraneoplastic, metabolic, hereditary and immune-mediated conditions.
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Palma JA, Kaufmann H. Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies. Mov Disord 2018; 33:372-390. [PMID: 29508455 PMCID: PMC5844369 DOI: 10.1002/mds.27344] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 12/12/2022] Open
Abstract
Dysfunction of the autonomic nervous system afflicts most patients with Parkinson disease and other synucleinopathies such as dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure, reducing quality of life and increasing mortality. For example, gastrointestinal dysfunction can lead to impaired drug pharmacodynamics causing a worsening in motor symptoms, and neurogenic orthostatic hypotension can cause syncope, falls, and fractures. When recognized, autonomic problems can be treated, sometimes successfully. Discontinuation of potentially causative/aggravating drugs, patient education, and nonpharmacological approaches are useful and should be tried first. Pathophysiology-based pharmacological treatments that have shown efficacy in controlled trials of patients with synucleinopathies have been approved in many countries and are key to an effective management. Here, we review the treatment of autonomic dysfunction in patients with Parkinson disease and other synucleinopathies, summarize the nonpharmacological and current pharmacological therapeutic strategies including recently approved drugs, and provide practical advice and management algorithms for clinicians, with focus on neurogenic orthostatic hypotension, supine hypertension, dysphagia, sialorrhea, gastroparesis, constipation, neurogenic overactive bladder, underactive bladder, and sexual dysfunction. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
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24
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Neto OB, de Sordi CC, da Mota GR, Marocolo M, Chriguer RS, da Silva VJD. Exercise training improves hypertension-induced autonomic dysfunction without influencing properties of peripheral cardiac vagus nerve. Auton Neurosci 2017; 208:66-72. [PMID: 28964689 DOI: 10.1016/j.autneu.2017.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 01/10/2023]
Abstract
We examined the vagal transfer function of autonomic heart rate (HR) control in anesthetized sedentary and exercise-trained Spontaneously Hypertensive Rats (SHR). To this end, male SHR and Wystar-Kyoto (WKY) rats with 48-50weeks of age-old were divided into 4 groups: sedentary (SHRS, n=12) and trained (SHRT, n=14) hypertensive rats, sedentary (WKYS, n=13) and trained (WKYT, n=13) normotensive rats. The trained groups were submitted to swimming protocol for 9weeks. Blood pressure (BP), HR, HR variability (HRV), BP variability (BPV), baroreflex sensitivity and cardiac tonus were recorded in baseline conditions. Following, electric stimulation of peripheral vagus nerve was performed in anesthetized conditions. Resting bradycardia was observed in SHRT and WKYT when compared to their respective sedentary groups (p<0.001). The BP was lower in SHRT than in SHRS (p<0.001). The SHRT and WKYT rats showed higher baroreflex-mediated tachycardia values when compared to their respective sedentary counterparts (p<0.001). Baroreflex bradycardic response in SHRT was higher than in SHRS (p<0.005). The SHRT and WKYT rats showed a decreased sympathetic activity in comparison to their respective sedentary groups (p<0.05). The cardiac vagal tonus was higher in SHRT than in SHRS (p<0.05). Regarding the dynamic transducer properties of peripheral vagus nerve to the heart no difference was observed among the groups. In conclusion, our results demonstrate that exercise training decreased BP in SHR and improved cardiovascular autonomic balance to the heart without changes in transduction properties of peripheral cardiac vagus nerve.
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Affiliation(s)
- Octávio Barbosa Neto
- Human Performance and Sport Research Group, Department of Sport Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil; Department of Physiology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil.
| | - Carla Cristina de Sordi
- Department of Endocrinology and Metabolism, Postgraduate Course on Health Science, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Gustavo Ribeiro da Mota
- Human Performance and Sport Research Group, Department of Sport Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Moacir Marocolo
- Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | - Valdo José Dias da Silva
- Department of Physiology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil
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25
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Thornton K, Mitchell MO. Autonomic dysfunction: A guide for FPs. J Fam Pract 2017; 66:539-543. [PMID: 28863200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Impotence, bladder dysfunction, GI symptoms, and orthostatic hypotension can signal autonomic dysfunction. Here's what you'll see and how to respond.
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Affiliation(s)
- Kristen Thornton
- Highland Hospital Family Medicine Residency, University of Rochester School of Medicine and Dentistry, NY, USA.
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Abstract
Atypical parkinsonism (AP) comprises mainly multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD), which are distinct pathological entities, presenting with a wide phenotypic spectrum. The classic syndromes are now called MSA-parkinsonism (MSA-P), MSA-cerebellar type (MSA-C), Richardson's syndrome, and corticobasal syndrome. Nonmotor features in AP have been recognized almost since the initial description of these disorders; however, research has been limited. Autonomic dysfunction is the most prominent nonmotor feature of MSA, but also gastrointestinal symptoms, sleep dysfunction, and pain, can be a feature. In PSP and CBD, the most prominent nonmotor symptoms comprise those deriving from the cognitive/neuropsychiatric domain. Apart from assisting the clinician in the differential diagnosis with Parkinson's disease, nonmotor features in AP have a big impact on quality of life and prognosis of AP and their treatment poses a major challenge for clinicians.
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Affiliation(s)
| | - Maria Stamelou
- HYGEIA Hospital, Athens, Greece; Neurology Clinic, Philipps University Marburg, Marburg, Germany; University of Athens, Athens, Greece.
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Abstract
PURPOSE OF REVIEW Neurointestinal diseases are increasingly recognized as causes of significant gastrointestinal morbidity in children. This review highlights the most common pediatric enteric neuropathies and their diagnosis and management, emphasizing insights and discoveries from the most recent literature available. RECENT FINDINGS The embryologic and histopathologic causes of enteric neuropathies are varied. They range from congenital aganglionosis in Hirschsprung disease, to autoimmune-mediated loss of neuronal subtypes in esophageal achalasia and Chagas disease, to degenerative neuropathies in some cases of chronic intestinal pseudo-obstruction and gastroparesis. Increased awareness of the clinical presentation and diagnostic evaluation of these conditions is essential as it allows for earlier initiation of treatment and improved outcomes. Most current therapies, which include medical management, neurostimulation, and operative intervention, aim to minimize the symptoms caused by these conditions. The evidence base for many of these treatments in children is poor, and multiinstitutional prospective studies are needed. An innovative therapy on the horizon involves using neuronal stem cell transplantation to treat the underlying disorder by replacing the missing or damaged neurons in these diseases. SUMMARY Although recent advances in basic and clinical neurogastroenterology have significantly improved our awareness and understanding of enteric neuropathies, the efficacy of current treatment approaches is limited. The development of novel therapies, including pharmacologic modulators of neurointestinal function, neurostimulation to enhance gut motility, and neuronal cell-based therapies, is essential to improve the long-term outcomes in children with these disorders.
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Affiliation(s)
- Maggie L. Westfal
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Allan M. Goldstein
- Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
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Abstract
Despite major advances in medical therapies late mortality after myocardial infarction (MI) is still high. A substantial proportion of post-MI patients die from sudden cardiac death. Prophylactic implantable-cardioverter defibrillator (ICD) therapy has been established for post-MI patients with reduced left ventricular ejection fraction (LVEF ≤35%). However, most patients who die after MI have an LVEF >35%. For this large group of patients, no specific prophylactic strategies exist. There is strong evidence that measures of cardiac autonomic dysfunction after MI provide important prognostic information in post-MI patients with preserved LVEF. Combinations of autonomic markers can identify high-risk patients after MI with LVEF >35% whose prognosis is equally worse than that of patients with LVEF ≤35%. The ongoing REFINE-ICD (NCT00673842) and SMART-MI trials (NCT02594488) test different preventive strategies in high-risk post-MI patients with cardiac autonomic dysfunction and LVEF 36-50%. While REFINE-ICD follows the traditional concept of ICD-implantation, SMART-MI uses implantable cardiac monitors with remote monitoring capabilities to sensitively detect asymptomatic, but prognostically relevant arrhythmias that could trigger specific diagnostic and therapeutic interventions.
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Affiliation(s)
- Axel Bauer
- Medizinische Klinik und Poliklinik I, Munich University Clinic, Munich, Germany; German Center for Cardiovascular Research (DZHK), Germany.
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Wang Y, Hensley MK, Tasman A, Sears L, Casanova MF, Sokhadze EM. Heart Rate Variability and Skin Conductance During Repetitive TMS Course in Children with Autism. Appl Psychophysiol Biofeedback 2016; 41:47-60. [PMID: 26341093 DOI: 10.1007/s10484-015-9311-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Autism spectrum disorder (ASD) is a developmental disorder marked by difficulty in social interactions and communication. ASD also often present symptoms of autonomic nervous system (ANS) functioning abnormalities. In individuals with autism the sympathetic branch of the ANS presents an over-activation on a background of the parasympathetic activity deficits, creating an autonomic imbalance, evidenced by a faster heart rate with little variation and increased tonic electrodermal activity. The objective of this study was to explore the effect of 12 sessions of 0.5 Hz repetitive transcranial magnetic stimulation (rTMS) over dorsolateral prefrontal cortex (DLPFC) on autonomic activity in children with ASD. Electrocardiogram and skin conductance level (SCL) were recorded and analyzed during each session of rTMS. The measures of interest were time domain (i.e., R-R intervals, standard deviation of cardiac intervals, NN50-cardio-intervals >50 ms different from preceding interval) and frequency domain heart rate variability (HRV) indices [i.e., power of high frequency (HF) and low frequency (LF) components of HRV spectrum, LF/HF ratio]. Based on our prior pilot studies it was proposed that the course of 12 weekly inhibitory low-frequency rTMS bilaterally applied to the DLPFC will improve autonomic balance probably through improved frontal inhibition of the ANS activity, and will be manifested in an increased length of cardiointervals and their variability, and in higher frequency-domain HRV in a form of increased HF power, decreased LF power, resulting in decreased LF/HF ratio, and in decreased SCL. Our post-12 TMS results showed significant increases in cardiac intervals variability measures and decrease of tonic SCL indicative of increased cardiac vagal control and reduced sympathetic arousal. Behavioral evaluations showed decreased irritability, hyperactivity, stereotype behavior and compulsive behavior ratings that correlated with several autonomic variables.
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Affiliation(s)
- Yao Wang
- University of Louisville, Louisville, KY, USA
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, No. 19 Xinjiekouwai St., Hai Dian District, Beijing, 100875, People's Republic of China
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Quadri F, Boni E, Pini L, Bottone D, Venturoli N, Corda L, Tantucci C. Exercise tolerance in obstructive sleep apnea-hypopnea (OSAH), before and after CPAP treatment: Effects of autonomic dysfunction improvement. Respir Physiol Neurobiol 2016; 236:51-56. [PMID: 27840271 DOI: 10.1016/j.resp.2016.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obstructive sleep apnea hypopnea (OSAH) is associated with decreased exercise tolerance and autonomic abnormalities and represents a risk for cardiovascular diseases. The aim of the study was to evaluate the effects of CPAP on cardiovascular autonomic abnormalities and exercise performance in patients with OSAH without changes in lifestyle and body weight during treatment. METHODS Twelve overweight subjects with OSAH underwent anthropometric measures, autonomic cardiovascular and incremental symptom-limited cardio-respiratory exercise tests before and after two months of treatment with CPAP. RESULTS Lower frequency component of power spectrum of heart rate variability (59.5±24.2 msec2 vs 43.2±25.9 msec2; p<0.05) and improvements of maximal workload (99.3±13.5 vs 108.3±16.8%pred.; p<0.05) and peak oxygen consumption (95.3±7.6 vs 105.5±7.9%pred.; p<0.05) were observed in these patients after CPAP, being their BMI unchanged. CONCLUSIONS CPAP-induced decrease of sympathetic hyperactivity is associated with better tolerance to the effort in OSAH patients that did not change their BMI and lifestyle, suggesting that OSAH limits per se the exercise capacity.
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Affiliation(s)
- F Quadri
- Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - E Boni
- Division of Internal Medicine, Spedali Civili of Brescia, P.zza Spedali Civili, 1, Brescia, Italy.
| | - L Pini
- Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - D Bottone
- Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - N Venturoli
- Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - L Corda
- Division of Internal Medicine, Spedali Civili of Brescia, P.zza Spedali Civili, 1, Brescia, Italy.
| | - C Tantucci
- Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
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Kiba T, Kanbara K, Ban I, Kato F, Kawashima S, Saka Y, Yamamoto K, Nishiyama J, Mizuno Y, Abe T, Fukunaga M. Saliva amylase as a measure of sympathetic change elicited by autogenic training in patients with functional somatic syndromes. Appl Psychophysiol Biofeedback 2016. [PMID: 26219656 DOI: 10.1007/s10484-015-9303-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of this study was to discuss the effect of autogenic training (AT) on patients with functional somatic syndrome (FSS) using salivary amylase, the skin temperature of the finger, subjective severity of symptoms, and psychological characteristics as measures. We assessed 20 patients with FSS and 23 healthy controls before and after AT. Baseline levels of salivary amylase prior to an AT session were significantly higher in the FSS group than in the control group. However, this difference was not significant after AT. The skin temperature of the finger increased after AT in both the FSS and control groups. AT contributed to the improvement of somatic symptoms in patients with FSS. Our results regarding psychological characteristics suggest that mood disturbances are deeply involved in the pathology of FSS. Individuals with FSS exhibited elevated levels of sympathetic activity compared with healthy controls. Our data indicates that AT eased dysregulation of the autonomic nervous system in patients with FSS. Thus, salivary amylase may be a useful index of change induced by AT in patients with FSS.
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Affiliation(s)
- Tadashi Kiba
- Department of Psychosomatic Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-shi, Osaka, Japan.
| | - Kenji Kanbara
- Department of Psychosomatic Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-shi, Osaka, Japan
| | - Ikumi Ban
- Department of Psychosomatic Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-shi, Osaka, Japan
| | - Fumie Kato
- Department of Psychosomatic Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-shi, Osaka, Japan
| | - Sadanobu Kawashima
- Department of Psychosomatic Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-shi, Osaka, Japan
| | - Yukie Saka
- Department of Psychosomatic Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-shi, Osaka, Japan
| | - Kazumi Yamamoto
- Department of Psychosomatic Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-shi, Osaka, Japan
- Department of Psychosomatic Medicine, Nishi Kyoto Hospital, 24 Goryo Mizoura-cho, Nishikyo-ku, Kyoto, Japan
| | - Junji Nishiyama
- Department of Psychosomatic Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-shi, Osaka, Japan
| | - Yasuyuki Mizuno
- Department of Psychosomatic Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-shi, Osaka, Japan
| | - Tetsuya Abe
- Department of Psychosomatic Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-shi, Osaka, Japan
| | - Mikihiko Fukunaga
- Department of Psychosomatic Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata-shi, Osaka, Japan
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Esposito P, Mereu R, De Barbieri G, Rampino T, Di Toro A, Groop PH, Dal Canton A, Bernardi L. Trained breathing-induced oxygenation acutely reverses cardiovascular autonomic dysfunction in patients with type 2 diabetes and renal disease. Acta Diabetol 2016; 53:217-26. [PMID: 25956276 DOI: 10.1007/s00592-015-0765-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 04/22/2015] [Indexed: 02/07/2023]
Abstract
AIMS Cardiovascular autonomic dysfunction, evaluated as baroreflex sensitivity (BRS), could be acutely corrected by slow breathing or oxygen administration in patients with type 1 diabetes, thus suggesting a functional component of the disorder. We tested this hypothesis in patients with the type 2 diabetes with or without renal impairment. METHODS Twenty-six patients with type 2 diabetes (aged 61.0 ± 0.8 years, mean ± SEM; duration of diabetes 10.5 ± 2 years, BMI 29.9 ± 0.7 kg/m(2), GFR 68.1 ± 5.6 ml/min) and 24 healthy controls (aged 58.5 ± 1.0 years) were studied. BRS was obtained from recordings of RR interval and systolic blood pressure fluctuations during spontaneous and during slow, deep (6 breaths/min) controlled breathing in conditions of normoxia or hyperoxia (5 l/min oxygen). RESULTS During spontaneous breathing, diabetic patients had lower RR interval and lower BRS compared with the control subjects (7.1 ± 1.2 vs. 12.6 ± 2.0 ms/mmHg, p < 0.025). Deep breathing and oxygen administration significantly increased arterial saturation, reduced RR interval and increased BRS in both groups (to 9.6 ± 1.8 and 15.4 ± 2.4 ms/mmHg, respectively, p < 0.05, hyperoxia vs. normoxia). Twelve diabetic patients affected by chronic diabetic kidney disease (DKD) presented a significant improvement in the BRS during slow breathing and hyperoxia (p < 0.025 vs. spontaneous breathing during normoxia). CONCLUSIONS Autonomic dysfunction present in patients with type 2 diabetes can be partially reversed by slow breathing, suggesting a functional role of hypoxia, also in patients with DKD. Interventions known to relieve tissue hypoxia and improve autonomic function, like physical activity, may be useful in the prevention and management of complications in patients with diabetes.
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Affiliation(s)
- Pasquale Esposito
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy.
| | - Roberto Mereu
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Giacomo De Barbieri
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Teresa Rampino
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy
| | - Alessandro Di Toro
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Per-Henrik Groop
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Folkhälsan Research Center Biomedicum Helsinki, Helsinki, Finland
- Baker ID Heart and Diabetes Institute, Melbourne, Australia
| | - Antonio Dal Canton
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Piazzale Golgi 19, 27100, Pavia, Italy
| | - Luciano Bernardi
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
- Folkhälsan Institute of Genetics, Folkhälsan Research Center Biomedicum Helsinki, Helsinki, Finland
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Popugaev KA, Lubnin AY, Zabelin MV, Samoylov AS. [AUTONOMIC NERVOUS SYSTEM AND ITS IMBALANCE IN NEURO INTENSIVE CARE UNIT]. Anesteziol Reanimatol 2016; 61:137-142. [PMID: 27468506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The autonomic nervous system (ANS) provides homeostasis due to the innervation of the secretory glands, smooth muscle and cardiac muscle. Higher centers of the ANS (primarily the hypothalamus, some centers of the brain stem and limbic system) form a integrative network, which plays a key role in coordinating the functioning of the endocrine, immune system and other parts of the central nervous system. Intracranial centers of the ANS are responsible for the consciousness, behavioral, emotional, and other components of the higher nervous activity. Thus, the significance of the ANS can't be overestimated. At the same time today in neurointensive care there are no clear criteria for ANS dysfunction, we don't have universally recognized monitoring facilities for ANS and approaches to targeted therapy of its disorders. This paradox is even more important as in the pathogenesis of some critical conditions such as neurogenic pulmonary edema, stunned myocardium, cardiomyopathy Takotsubo lies precisely ANS imbalance. This review devoted to the ANS and some problems associated with its imbalance.
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Abstract
The symptoms caused by gastrointestinal autonomic neuropathy in diabetes mellitus is important to highlight since it affects a large proportion of people with diabetes, regardless of whether this is type 1 or type 2. Gastroparesis and general signs of bowel dysfunction, such as constipation, diarrhoea and abdominal pain are most often encountered and involve both pharmacological and non-pharmacological treatment options. This mini-review summarises a presentation given at the 'Diagnosis and treatment of autonomic diabetic neuropathy in the gut' symposium at the 2015 annual meeting of the EASD. It is accompanied by another mini-review on a topic from this symposium (by Azpiroz and Malagelada, DOI: 10.1007/s00125-015-3831-1 ) and a commentary by the Session Chair, Péter Kempler (DOI: 10.1007/s00125-015-3826-y ).
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Affiliation(s)
- Hans Törnblom
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-41345, Gothenburg, Sweden.
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35
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Kanjwal K, Masudi S, Grubb BP. Syncope in Children and Adolescents. Adolesc Med State Art Rev 2015; 26:692-711. [PMID: 27282019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
MESH Headings
- Adolescent
- Aortic Valve Stenosis/complications
- Aortic Valve Stenosis/diagnosis
- Aortic Valve Stenosis/therapy
- Arrhythmias, Cardiac/complications
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Autonomic Nervous System Diseases/complications
- Autonomic Nervous System Diseases/diagnosis
- Autonomic Nervous System Diseases/therapy
- Breath Holding
- Cardiomyopathies/complications
- Cardiomyopathies/diagnosis
- Cardiomyopathies/therapy
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Child
- Diagnosis, Differential
- Electrocardiography
- Electrocardiography, Ambulatory
- Epilepsy/diagnosis
- Heart Diseases/complications
- Heart Diseases/diagnosis
- Heart Diseases/therapy
- Humans
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/therapy
- Phobic Disorders/diagnosis
- Phobic Disorders/therapy
- Postural Orthostatic Tachycardia Syndrome/complications
- Postural Orthostatic Tachycardia Syndrome/diagnosis
- Postural Orthostatic Tachycardia Syndrome/therapy
- Syncope/diagnosis
- Syncope/etiology
- Syncope/therapy
- Syncope, Vasovagal/diagnosis
- Syncope, Vasovagal/therapy
- Tilt-Table Test
- Video Recording
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Abstract
BACKGROUND Although a diversity of neurotransmitters and hormones participate in controlling blood pressure, norepinephrine released from postganglionic sympathetic nerve terminals is an important mediator of the rapid regulation of cardiovascular function required for homeostasis of cerebral perfusion. Hence, neurogenic orthostatic hypotension (NOH) often represents a deficiency of noradrenergic responsiveness to postural change. RESEARCH DESIGN AND METHODS PubMed searches with 'orthostatic hypotension' and 'norepinephrine' as conjoint search terms and no restriction on language or date, so as to survey the pathophysiologic and clinical relevance of norepinephrine deficiency for current NOH interventions and for future directions in treatment and research. RESULTS Norepinephrine deficiency in NOH can arise peripherally, due to cardiovascular sympathetic denervation (as in pure autonomic failure, Parkinson's disease, and a variety of neuropathies), or centrally, due to a failure of viscerosensory signals to generate adequate sympathetic traffic to intact sympathetic nerve endings (as in multiple system atrophy). Nonpharmacologic countermeasures such as pre-emptive water intake may yield blood-pressure increases exceeding those achieved pharmacologically. For patients with symptomatic NOH unresponsive to such strategies, a variety of pharmacologic interventions have been administered off-label on the basis of drug mechanisms expected to increase blood pressure via blood-volume expansion or vasoconstriction. Two pressor agents have received FDA approval: the sympathomimetic midodrine and more recently the norepinephrine prodrug droxidopa. CONCLUSIONS Pressor agents are important for treating symptomatic NOH in patients unresponsive to lifestyle changes alone. However, the dysautonomia underlying NOH often permits blood-pressure excursions toward both hypotension and hypertension. Future research should aim to shed light on the resulting management issues, and should also explore the possibility of pharmacotherapy selectively targeting orthostatic blood-pressure decreases.
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Affiliation(s)
- Adam Loavenbruck
- a a Department of Neurology , University of Minnesota , Minneapolis , MN , USA
| | - Paola Sandroni
- b b Department of Neurology , Mayo Clinic , Rochester , MN , USA
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Lundberg AS, Andersen MK, Kasch H, Hansen RM. [Patients with spinal cord injuries experience many sequelae]. Ugeskr Laeger 2015; 177:V06150476. [PMID: 26509457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Spinal cord injuries (SCI) affect all organs and may cause multiple sequelae. Complications after SCI can be life-threatening and socially disabling. Furthermore, a spinal cord injury is often a chronic condition and the patient may have contact with both the general practitioner and several departments in a hospital. Thus, it is important for all doctors to recognize risks and morbidities related to SCI, in order to prevent and treat the short- and long-term complications and disabilities. This article systematically describes the most commonly encountered sequelae after SCI.
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Abstract
Diabetes mellitus is associated with a series of macrovascular and microvascular changes that can manifest as a wide range of complications. Foot ulcerations affect ∼2-4% of patients with diabetes mellitus. Risk factors for foot lesions include peripheral and autonomic neuropathy, vascular disease and previous foot ulceration, as well as other microvascular complications, such as retinopathy and end-stage renal disease. Ulceration is the result of a combination of components that together lead to tissue breakdown. The most frequently occurring causal pathways to the development of foot ulcers include peripheral neuropathy and vascular disease, foot deformity or trauma. Peripheral vascular disease is often not diagnosed in patients with diabetes mellitus until tissue loss is evident, usually in the form of a nonhealing ulcer. Identification of patients with diabetes mellitus who are at high risk of ulceration is important and can be achieved via annual foot screening with subsequent multidisciplinary foot-care interventions. Understanding the factors that place patients with diabetes mellitus at high risk of ulceration, together with an appreciation of the links between different aspects of the disease process, is essential to the prevention and management of diabetic foot complications.
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Affiliation(s)
- Frank L Bowling
- Manchester Royal Infirmary, University of Manchester, 193 Hathersage Road, Manchester M13 0JE, UK
| | - S Tawqeer Rashid
- Manchester Royal Infirmary, University of Manchester, 193 Hathersage Road, Manchester M13 0JE, UK
| | - Andrew J M Boulton
- Manchester Royal Infirmary, University of Manchester, 193 Hathersage Road, Manchester M13 0JE, UK
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Pascoe MC, Bauer IE. A systematic review of randomised control trials on the effects of yoga on stress measures and mood. J Psychiatr Res 2015; 68:270-82. [PMID: 26228429 DOI: 10.1016/j.jpsychires.2015.07.013] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/10/2015] [Accepted: 07/10/2015] [Indexed: 12/19/2022]
Abstract
Stress related disorders such as depression and anxiety are leading sources of disability worldwide, and current treatment methods such as conventional antidepressant medications are not beneficial for all individuals. There is evidence that yoga has mood-enhancing properties possibly related to its inhibitory effects on physiological stress and inflammation, which are frequently associated with affective disorders. However the biological mechanisms via which yoga exerts its therapeutic mood-modulating effects are largely unknown. This systematic review investigates the effects of yoga on sympathetic nervous system and hypothalamic pituitary adrenal axis regulation measures. It focuses on studies collecting physiological parameters such as blood pressure, heart rate, cortisol, peripheral cytokine expression and/or structural and functional brain measures in regions involved in stress and mood regulation. Overall the 25 randomised control studies discussed provide preliminary evidence to suggest that yoga practice leads to better regulation of the sympathetic nervous system and hypothalamic-pituitary-adrenal system, as well as a decrease in depressive and anxious symptoms in a range of populations. Further research is warranted to confirm these preliminary findings and facilitate implementation in clinical settings.
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Affiliation(s)
- Michaela C Pascoe
- Institute of Neuroscience and Physiology, Dept. of Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy at University of Gothenburg, Sweden.
| | - Isabelle E Bauer
- University of Texas Health Science Center, Department of Psychiatry and Behavioral Science, Houston, TX, USA
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40
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Koike H, Sobue G. [Acute autonomic and sensory neuropathy]. Nihon Rinsho 2015; 73 Suppl 7:452-457. [PMID: 26480741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Maier A, Mannartz V, Wasmuth H, Trautwein C, Neumann UP, Weis J, Grosse J, Fuest M, Hilz MJ, Schulz JB, Haubrich C. GAD Antibodies as Key Link Between Chronic Intestinal Pseudoobstruction, Autonomic Neuropathy, and Limb Stiffness in a Nondiabetic Patient: A CARE-Compliant Case Report and Review of the Literature. Medicine (Baltimore) 2015; 94:e1265. [PMID: 26252289 PMCID: PMC4616576 DOI: 10.1097/md.0000000000001265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Chronic intestinal pseudoobstruction (CIP) can be a severe burden and even a life-threatening disorder. Typically, several years of uncertainty are passing before diagnosis. We are reporting the case of a young woman with a decade of severe, progressive gastrointestinal dysmotility. Unusually, she had also developed an autonomic neuropathy, and a stiff limb syndrome.In addition to achalasia and CIP the young woman also developed neuropathic symptoms: orthostatic intolerance, urinary retention, a Horner syndrome, and lower limb stiffness. Careful interdisciplinary diagnostics excluded underlying infectious, rheumatoid, metabolic or tumorous diseases.The detection of GAD (glutamic acid decarboxylase) antibodies, however, seemed to link CIP, autonomic neuropathy, and limb stiffness and pointed at an autoimmune origin of our patient's complaints. This was supported by the positive effects of intravenous immunoglobulin. In response to this therapy the body weight had stabilized, orthostatic tolerance had improved, and limb stiffness was reversed.The case suggested that GAD antibodies should be considered in CIP also in nondiabetic patients. This may support earlier diagnosis and immunotherapy.
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Affiliation(s)
- Andrea Maier
- From the Department of Neurology (AM, VM, JBS, CH), University Hospital RWTH Aachen,; Department of Medicine (HW), Luisenhospital Aachen; Department of Gastroenterology (CT), University Hospital RWTH Aachen; Department of Visceral Surgery (U-PN), University Hospital RWTH Aachen; Institute of Neuropathology (JW), University Hospital RWTH Aachen; Department of Urology (JG), University Hospital RWTH Aachen; Department of Ophthalmology (MF), University Hospital RWTH Aachen); and Department of Neurology (M-JH), Erlangen University Hospital, Germany
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Zheng L, Ai Y, Zhu H, Meng P, Wang L, Su X. [Clinical observation of dysantonomia treated with transcutaneous electrical stimulation at Renying (ST 9) combined with stellate ganglion block]. Zhongguo Zhen Jiu 2015; 35:557-560. [PMID: 26480551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare the clinical efficacy difference in dysantonomia between transcutaneous electrical stimulation at Renying(ST 9) combined with stellate ganglion block(SGB) and simple SGB. METHODS Sixty patients in accord with the diagnostic criteria of dysantonomia were randomly divided into two groups,30 cases in each group. In the observation group,transcutaneous electrical stimulation at Renying(ST 9) combined with SGB were adopted; in the control group,simple SGB was applied. In the two groups, treatment was used three times a week,and nine treatments were considered as one course. There was an interval of one week between courses,and two courses were treated. Total seven weeks were required. Scores were evaluated according to subjective symptoms before treatment,one month and three months after treatment in the two groups. RESULTS The scores of subjective symptoms were not statistically different before treatment in the two groups(P>0. 05). The scores of subjective symptoms one month and three months after treatment were all lower than those before treatment(all P< 0. 01), and subjective symptoms scores in the observation group were lower than those in the control group(both P<0. 01). CONCLUSION Transcutaneous electrical stimulation at Renying(ST 9) combined with SGB could obviously enhance the clinical effects for dysantonomia, and the control and improvement for clinical symptoms are apparently superior to simple SGB.
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Boitsov IV. [The interference-electropuncture for the disordered vegetative maintenance of the vertebral-motor segments in the patients presenting with dorsopathies]. Vopr Kurortol Fizioter Lech Fiz Kult 2015; 92:18-22. [PMID: 26036083 DOI: 10.17116/kurort2015218-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Vegetative neuropathy of the vertebral component of the spinal nerve was identified based on the results of dynamic segmental diagnosis in the course of medical rehabilitation of 390 patients presenting with dorsopathies. 153 patients experienced segmental autonomous imbalance at the level of the vertebral-motor segments (VMS) of the spinal column. This neuropathy was characterized by the increased sympathetic influence on the tissues of VMS in 85 patients and the impaired sympathetic regulation of the VMS tissue in the remaining 68 patients. Interference-electropuncture (IFEP) as the method for the influence on the biologically active points by interference currents was included in the complex of rehabilitative measures in a group of 51 patients. IFEP parameters were selected on an individual basis taking into consideration the segmental mechanisms of vegetative regulation. The results of medical rehabilitation of these patients were substantially better and significantly different from the results of the treatment of other patients managed with the use of standard medicamental therapy and physiotherapy. At the same time, the patients with dorsopathies receiving IFEP reported a more pronounced alleviation of pain, regression of muscle-tonic manifestations, and improvement of the indicators of the quality of life associated with the improvement of vertebroneurological symptoms.
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Affiliation(s)
- I V Boitsov
- GBOU VPO 'Nizhegorodskaja gosudarstvennaja meditsinskaja akademija', pl. Minina i Pozharskogo, 10/1, Nizhnij Novgorod, Rossijskaja Federatsija, 603005
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Abstract
Paragangliomas (PGLs) are rare vascular, neuroendocrine tumors of paraganglia, which are associated with either sympathetic tissue in adrenal (pheochromocytomas (PCCs)) and extraadrenal (sympathetic paraganglioma (sPGLs)) locations or parasympathetic tissue of the head and neck paragangliomas (HNPGLs). As HNPGLs are usually benign and most tumors grow slowly, a wait-and-scan policy is often advised. However, their location in the close proximity to cranial nerves and vasculature may result in considerable morbidity due to compression or infiltration of the adjacent structures, necessitating balanced decisions between a wait-and-see policy and active treatment. The main treatment options for HNPGL are surgery and radiotherapy. In contrast to HNPGLs, the majority of sPGL/PCCs produces catecholamines, in advanced cases resulting in typical symptoms and signs such as palpitations, headache, diaphoresis, and hypertension. The state-of-the-art diagnosis and localization of sPGL/PCCs are based on measurement of plasma and/or 24-h urinary excretion of (fractionated) metanephrines and methoxytyramine (MT). sPGL/PCCs can subsequently be localized by anatomical (computed tomography and/or magnetic resonance imaging) and functional imaging studies (123I-metaiodobenzylguanidine-scintigraphy, 111In-pentetreotide scintigraphy, or positron emission tomography with radiolabeled dopamine or dihydroxyphenylalanine). Although most PGL/PCCs are benign, factors such as genetic background, tumor size, tumor location, and high MT levels are associated with higher rates of metastatic disease. Surgery is the only curative treatment. Treatment options for patients with metastatic disease are limited. PGL/PCCs have a strong genetic background, with at least one-third of all cases linked with germline mutations in 11 susceptibility genes. As genetic testing becomes more widely available, the diagnosis of PGL/PCCs will be made earlier due to routine screening of at-risk patients. Early detection of a familial PGL allows early detection of potentially malignant PGLs and early surgical treatment, reducing the complication rates of this operation.
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Affiliation(s)
- Eleonora P Corssmit
- Department of EndocrinologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment and Division of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes A Romijn
- Department of EndocrinologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment and Division of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Rossetti E, Bianchi R, Paglietti MG, Cutrera R, Picardo S. Severe phenotype of rapid-onset obesity, hypoventilation, hypothalamic dysfunction, and autonomic dysfunction syndrome. Minerva Anestesiol 2014; 80:744-745. [PMID: 24492667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- E Rossetti
- DEA-ARCO Department, Pediatric Intensive Care Unit, IRCCS, Bambino Gesù Children's Hospital, Rome, Italy -
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46
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Abstract
The maintenance of blood pressure in the upright position requires intact autonomic cardiovascular reflexes. Diseases that affect the sympathetic innervation of the cardiovascular system result in a sustained fall in blood pressure upon standing (i.e., neurogenic orthostatic hypotension) that can impair the blood supply to the brain and other organs and cause considerable morbidity and mortality. Here we review treatment options for neurogenic orthostatic hypotension and include an algorithm for its management that emphasizes the importance of non-pharmacologic measures and provides guidance on pharmacologic treatment options.
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Affiliation(s)
- Christoph Schroeder
- Institute of Clinical Pharmacology, OE 5350, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Germany.
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48
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Lambru G, Shanahan P, Watkins L, Matharu MS. Occipital nerve stimulation in the treatment of medically intractable SUNCT and SUNA. Pain Physician 2014; 17:29-41. [PMID: 24452643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or with cranial autonomic symptoms (SUNA) are primary headaches characterized by frequent attacks of severe headaches in association with cranial autonomic features. Patients with chronic SUNCT or SUNA have unremitting symptoms that necessitate prolonged use of medical preventive treatments, many of which are prone to causing side effects. They can be medically intractable, in which case neurally destructive or cranially invasive surgical treatments can be offered, though these have hitherto yielded conflicting results. Occipital nerve stimulation (ONS) offers a nondestructive and relatively low risk surgical alternative. OBJECTIVE To assess the efficacy and safety of ONS in chronic, medically intractable SUNCT and SUNA patients. STUDY DESIGN Prospective open-label study. METHODS Nine medically intractable, chronic SUNCT and SUNA patients were implanted with electrodes for bilateral occipital nerve stimulation. Data were collected prospectively for pre- and postimplantation headache characteristics, including frequency, intensity and duration of attacks. Diaries were used to assess headache improvement. RESULTS At a median follow-up of 38 months (range 24-55 months), all but one patient reported substantial improvement. Four patients became pain-free, 3 were almost pain-free (96 - 98% improvement), and one had a marked reduction in attack frequency and severity (81% improvement). After an initial rapid improvement, the maximum benefit of ONS was attained after a lag of a few months. Device malfunction was followed by recurrence or worsening of the attacks within a few days in most patients. Adverse events included lead migration, exposure of the electrode, and pain due to muscle recruitment over the leads. One patient developed hemicrania continua one month after implantation and was successfully treated with indomethacin. CONCLUSION ONS appears to offer an effective and safe treatment option, without significant morbidity, for medically intractable SUNCT and SUNA. Given the variable results with cranially invasive or neurally destructive surgery, ONS might be considered the surgical treatment of choice for medically intractable SUNCT and SUNA.
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Affiliation(s)
| | | | | | - Manjit Singh Matharu
- Headache Group and Division of Neurosurgery; Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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49
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Agasiev AR. [Sanatorium care in autonomic nervous system disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2014; 114:49-52. [PMID: 25176267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore a role, place and effectiveness of different therapeutic methods in sanatorium care. MATERIAL AND METHODS We compared volume and structure of therapeutic methods of treatment of autonomic nervous system disorders in 571 patients of a neurological sanatorium and 924 patients of a cardiologic sanatorium. RESULTS AND CONCLUSION The actual volume and structure of the therapeutic methods in sanatoriums differed from republican standards. This can be explained by the aspiration of physicians to individualize treatment. Treatment outcome was correlated with the volume and structure of therapeutic methods. Sensitivity, specificity and predictive value of some methods were defined. Barotherapy, oxygen influence and psychotherapy predicted the effectiveness of different therapeutic methods in sanatorium care of patients with autonomic nervous system disorders.
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50
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Punkkinen J, Koskenpato J, Rosengård-Bärlund M. [Autonomic neuropathy--a problem of the circulatory system and digestive tract]. Duodecim 2014; 130:1223-1233. [PMID: 25016668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
An autonomic disorder of the circulatory system becomes manifest as aberrant heart rate variability and baroreflex sensitivity already years before progressing into symptomatic disease, in which case the condition is no longer curable. Diagnosis is based on tests of autonomic nervous system function. The main thing in the treatment is management of risk factors of cardiovascular diseases in addition to enhanced glucose homeostasis. Autonomic neuropathy may also affect the digestive tract and be accompanied by esophageal motility disorder, gastroparesis, diarrhea, constipation or fecal incontinence. It is essential in the diagnosis to exclude other diseases of the digestive tract.
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