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Ugeskrift For Laeger Apr 2018Neurogenic autonomic dysfunction (NAD) is underdiagnosed, and it is likely in patients, who have orthostatic hypotension and symptoms from multiple organ systems as well... (Review)
Review
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.
Topics: Adult; Algorithms; Autonomic Nervous System Diseases; Humans; Hypotension, Orthostatic; Parasympathetic Nervous System; Sympathetic Nervous System
PubMed: 29720343
DOI: No ID Found -
International Journal of Molecular... Feb 2024Autoimmune autonomic ganglionopathy (AAG) is a disease of autonomic failure caused by ganglionic acetylcholine receptor (gAChR) autoantibodies. Although the detection of... (Review)
Review
Autoimmune autonomic ganglionopathy (AAG) is a disease of autonomic failure caused by ganglionic acetylcholine receptor (gAChR) autoantibodies. Although the detection of autoantibodies is important for distinguishing the disease from other neuropathies that present with autonomic dysfunction, other factors are important for accurate diagnosis. Here, we provide a comprehensive review of the clinical features of AAG, highlighting differences in clinical course, clinical presentation, and laboratory findings from other neuropathies presenting with autonomic symptoms. The first step in diagnosing AAG is careful history taking, which should reveal whether the mode of onset is acute or chronic, followed by an examination of the time course of disease progression, including the presentation of autonomic and extra-autonomic symptoms. AAG is a neuropathy that should be differentiated from other neuropathies when the patient presents with autonomic dysfunction. Immune-mediated neuropathies, such as acute autonomic sensory neuropathy, are sometimes difficult to differentiate, and therefore, differences in clinical and laboratory findings should be well understood. Other non-neuropathic conditions, such as postural orthostatic tachycardia syndrome, chronic fatigue syndrome, and long COVID, also present with symptoms similar to those of AAG. Although often challenging, efforts should be made to differentiate among the disease candidates.
Topics: Humans; Ganglia, Autonomic; Post-Acute COVID-19 Syndrome; Autoimmune Diseases of the Nervous System; Autonomic Nervous System; Autonomic Nervous System Diseases; Autoimmune Diseases; Peripheral Nervous System Diseases; Autoantibodies
PubMed: 38396973
DOI: 10.3390/ijms25042296 -
Clinical Autonomic Research : Official... Aug 2019Parkinson disease has traditionally been classified as a movement disorder, despite patients' accounts of diverse symptoms stemming from impairments in numerous body... (Review)
Review
Parkinson disease has traditionally been classified as a movement disorder, despite patients' accounts of diverse symptoms stemming from impairments in numerous body systems. Today, Parkinson disease is increasingly recognized by clinicians and scientists as a complex neurodegenerative disorder featuring both motor and nonmotor manifestations concomitant with pathology throughout all major branches of the nervous system. Dysfunction of the autonomic nervous system, or dysautonomia, is a common feature of Parkinson disease. It produces signs and symptoms that severely affect patients' quality of life, such as blood pressure dysregulation, hyperhidrosis, and constipation. Treatment options for dysautonomia are limited to symptom alleviation because the cause of these symptoms and Parkinson disease overall are still unknown. Animal models provide a platform to interrogate mechanisms of Parkinson disease-related autonomic nervous system dysfunction and test novel treatment strategies. Several animal models of Parkinson disease are available, each with different effects on the autonomic nervous system. This review critically analyses key dysautonomia signs and symptoms and associated pathology in Parkinson disease patients and relevant findings in animal models. We focus on the cardiovascular system, adrenal medulla, skin/thermoregulation, bladder, pupils, and gastrointestinal tract, to assess the contribution of animal models to the understanding of Parkinson disease autonomic dysfunction.
Topics: Animals; Autonomic Nervous System; Autonomic Nervous System Diseases; Blood Pressure; Brain; Disease Models, Animal; Gastrointestinal Tract; Humans; Parkinson Disease
PubMed: 30604165
DOI: 10.1007/s10286-018-00584-7 -
Cardiac Electrophysiology Clinics Mar 2021Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia and eludes an efficacious cure despite an increasing prevalence and a significant association with... (Review)
Review
Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia and eludes an efficacious cure despite an increasing prevalence and a significant association with morbidity and mortality. In addition to an array of clinical sequelae, the origins and propagation of AF are multifactorial. In recent years, the contribution from the autonomic nervous system has been an area of particular interest. This review highlights the relevant physiology of autonomic and neurohormonal contributions to AF origin and maintenance, the current state of the literature on targeted therapies, and the path forward for clinical interventions.
Topics: Atrial Fibrillation; Autonomic Nervous System; Autonomic Nervous System Diseases; Heart Disease Risk Factors; Humans; Nervous System Diseases; Renin-Angiotensin System; Transcutaneous Electric Nerve Stimulation
PubMed: 33516396
DOI: 10.1016/j.ccep.2020.11.012 -
European Journal of Preventive... Jan 2018Sudden death is a major health problem all over the world. The most common causes of sudden death are cardiac but there are also other causes such as neurological... (Review)
Review
Sudden death is a major health problem all over the world. The most common causes of sudden death are cardiac but there are also other causes such as neurological conditions (stroke, epileptic attacks and brain trauma), drugs, catecholamine toxicity, etc. A common feature of all these diverse pathologies underlying sudden death is the imbalance of the autonomic nervous system control of the cardiovascular system. This paper reviews different pathologies underlying sudden death with emphasis on the autonomic nervous system contribution, possibilities of early diagnosis and prognosis of sudden death using various clinical markers including autonomic markers (heart rate variability and baroreflex sensitivity), present possibilities of management and promising prevention by electrical neuromodulation.
Topics: Animals; Autonomic Nervous System; Autonomic Nervous System Diseases; Baroreflex; Cardiovascular System; Death, Sudden, Cardiac; Early Diagnosis; Genetic Predisposition to Disease; Heart Rate; Humans; Predictive Value of Tests; Primary Prevention; Prognosis; Risk Factors
PubMed: 29053016
DOI: 10.1177/2047487317736827 -
Current Hypertension Reports Sep 2014Obstructive sleep apnea (OSA) and hypertension are closely linked conditions. Disordered breathing events in OSA are characterized by increasing efforts against an... (Review)
Review
Obstructive sleep apnea (OSA) and hypertension are closely linked conditions. Disordered breathing events in OSA are characterized by increasing efforts against an occluded airway while asleep, resulting in a marked sympathetic response. This is predominantly due to hypoxemia activating the chemoreflexes, resulting in reflex increases in sympathetic neural outflow. In addition, apnea - and the consequent lack of inhibition of the sympathetic system that occurs with lung inflation during normal breathing - potentiates central sympathetic outflow. Sympathetic activation persists into the daytime, and is thought to contribute to hypertension and other adverse cardiovascular outcomes. This review discusses chemoreflex physiology and sympathetic modulation during normal sleep, as well as the sympathetic dysregulation seen in OSA, its extension into wakefulness, and changes after treatment. Evidence supporting the role of the peripheral chemoreflex in the sympathetic dysregulation seen in OSA, including in the context of comorbid obesity, metabolic syndrome, and systemic hypertension, is reviewed. Finally, alterations in cardiovascular variability and other potential mechanisms that may play a role in the autonomic imbalance in OSA are also discussed.
Topics: Autonomic Nervous System Diseases; Blood Pressure; Chemoreceptor Cells; Humans; Reflex; Sleep; Sleep Apnea, Obstructive; Sympathetic Nervous System
PubMed: 25097113
DOI: 10.1007/s11906-014-0476-2 -
Neurology India Mar 2024
Topics: Humans; Hypohidrosis; Autonomic Nervous System Diseases; Flushing; Male; Female; Adult
PubMed: 38817189
DOI: 10.4103/neurol-india.Neurol-India-D-24-00157 -
Clinical Autonomic Research : Official... Aug 2017The most important autonomic function test-the autonomic medical history-is the patient's account, interpreted by a clinician skilled in asking the right questions, of... (Review)
Review
The most important autonomic function test-the autonomic medical history-is the patient's account, interpreted by a clinician skilled in asking the right questions, of symptoms during daily activities that relate to the autonomic nervous system. The chronology and pattern of these symptoms combine to create a portrait of autonomic function or dysfunction. We summarize the steps in obtaining a comprehensive autonomic medical history.
Topics: Autonomic Nervous System; Autonomic Nervous System Diseases; Humans; Medical History Taking; Patients
PubMed: 28551871
DOI: 10.1007/s10286-017-0425-7 -
Ugeskrift For Laeger May 2016
Topics: Autonomic Nervous System Diseases; Female; Flushing; Humans; Hypohidrosis; Middle Aged
PubMed: 27188995
DOI: No ID Found -
Current Opinion in Pediatrics Jun 2017Neurointestinal diseases are increasingly recognized as causes of significant gastrointestinal morbidity in children. This review highlights the most common pediatric... (Review)
Review
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.
Topics: Autonomic Nervous System Diseases; Child; Enteric Nervous System; Gastrointestinal Diseases; Humans; Pediatrics
PubMed: 28319561
DOI: 10.1097/MOP.0000000000000486