-
Continuum (Minneapolis, Minn.) Apr 2024This article describes the clinical features and treatment of the indomethacin-responsive headache disorders paroxysmal hemicrania and hemicrania continua.
OBJECTIVE
This article describes the clinical features and treatment of the indomethacin-responsive headache disorders paroxysmal hemicrania and hemicrania continua.
LATEST DEVELOPMENTS
Both paroxysmal hemicrania and hemicrania continua are treated with indomethacin at the lowest clinically useful dose. It has recently become clear that some patients with either condition may respond to treatment with noninvasive vagus nerve stimulation, which can be both indomethacin sparing and, in some cases, headache controlling. Given the lifelong nature of both paroxysmal hemicrania and hemicrania continua, brain imaging with MRI is recommended when the conditions are identified, specifically including pituitary views.
ESSENTIAL POINTS
Paroxysmal hemicrania and hemicrania continua are indomethacin-responsive headache disorders that offer a rewarding and unique opportunity to provide marked clinical improvement when recognized and treated appropriately. These disorders share the final common pathway of the trigeminal-autonomic reflex, with head pain and cranial autonomic features, and are differentiated pathophysiologically by the pattern of brain involvement, which can be seen using functional imaging. They have distinct differential diagnoses to which the clinician needs to remain alert.
Topics: Humans; Paroxysmal Hemicrania; Headache Disorders; Headache; Autonomic Nervous System; Indomethacin
PubMed: 38568495
DOI: 10.1212/CON.0000000000001409 -
Trends in Cardiovascular Medicine Nov 2023Resting heart rate is a determinant of cardiac output and physiological homeostasis. Although a simple, but critical, parameter, this vital sign predicts adverse... (Review)
Review
Resting heart rate is a determinant of cardiac output and physiological homeostasis. Although a simple, but critical, parameter, this vital sign predicts adverse outcomes, including mortality, and development of diseases in otherwise normal and healthy individuals. Temporal changes in heart rate can have valuable predictive capabilities. Heart rate can reflect disease severity in patients with various medical conditions. While heart rate represents a compilation of physiological inputs, including sympathetic and parasympathetic tone, aside from the underlying intrinsic sinus rate, how resting heart rate affects outcomes is uncertain. Mechanisms relating resting heart rate to outcomes may be disease-dependent but why resting heart rate in otherwise healthy, normal individuals affects outcomes remains obscure. For specific conditions, physiologically appropriate heart rate reductions may improve outcomes. However, to date, in the normal population, evidence that interventions aimed at reducing heart rate improves outcomes remains undefined. Emerging data suggest that reduction in heart rate via vagal activation and/or sympathetic inhibition is propitious.
Topics: Humans; Heart; Heart Rate; Vagus Nerve
PubMed: 35623552
DOI: 10.1016/j.tcm.2022.05.006 -
Revue Neurologique 2024In autoimmune neurological diseases, the autonomic nervous system can be the primary target of autoimmunity (e.g. autoimmune autonomic ganglionopathy), or, more... (Review)
Review
In autoimmune neurological diseases, the autonomic nervous system can be the primary target of autoimmunity (e.g. autoimmune autonomic ganglionopathy), or, more frequently, be damaged together with other areas of the nervous system (e.g. Guillain-Barré syndrome). Patients with autoimmune encephalitis and paraneoplastic neurological syndromes (PNS) often develop dysautonomia; however, the frequency and spectrum of autonomic signs and symptoms remain ill defined except for those scenarios in which dysautonomia is a core feature of the disease. Such is the case of Lambert-Eaton myasthenic syndrome, Morvan syndrome or anti-NMDAR encephalitis; in the latter, patients with dysautonomia have been reported to carry a more severe disease and to retain higher disability than those without autonomic dysfunction. Likewise, the presence of autonomic involvement indicates a higher risk of death due to neurological cause in patients with anti-Hu PNS. However, in anti-Hu and other PNS, as well as in the context of immune checkpoint inhibitors' toxicities, the characterization of autonomic involvement is frequently overshadowed by the severity of other neurological symptoms and signs. When evaluated with tests specific for autonomic function, patients with autoimmune encephalitis or PNS usually show a more widespread autonomic involvement than clinically suggested, which may reflect a potential gap of care when it comes to diagnosing dysautonomia. This review aims to revise the autonomic involvement in patients with autoimmune encephalitis and PNS, using for that purpose an antibody-based approach. We also discuss and provide general recommendations for the evaluation and management of dysautonomia in these patients.
Topics: Humans; Paraneoplastic Syndromes; Autonomic Nervous System Diseases; Peripheral Nervous System Diseases; Autoimmune Diseases of the Nervous System; Autonomic Nervous System; Paraneoplastic Syndromes, Nervous System; Autoantibodies; Encephalitis; Hashimoto Disease
PubMed: 38142198
DOI: 10.1016/j.neurol.2023.12.001 -
Neurological Sciences : Official... Sep 2023Although dysautonomia is a well-recognized complication of acute demyelinating polyradiculoneuropathy, it is rarely reported and evaluated in chronic demyelinating... (Review)
Review
BACKGROUND AND AIMS
Although dysautonomia is a well-recognized complication of acute demyelinating polyradiculoneuropathy, it is rarely reported and evaluated in chronic demyelinating neuropathies. The purpose of this review is to search and synthesize the current literature on the prevalence and type of autonomic dysfunction (AD) in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).
METHODS
PubMed and Web of Science were searched for studies reporting AD in CIDP.
RESULTS
Twelve studies, including 346 patients with CIDP, were found eligible for the review. Seven studies used autonomic tests only as an additional component of the comprehensive clinical evaluation, and found that dysautonomia in CIDP may indicate the presence of a comorbid disease (e.g., diabetes) and facilitate the differentiation of CIDP from other neuropathies (e.g., amyloid neuropathy). Five studies performed quantitative assessment of autonomic function in CIDP as a primary goal. Two studies have used the Composite Autonomic Severity Score (CASS) to assess severity and distribution of dysautonomia. The reported prevalence of dysautonomia in CIDP during quantitative assessment of autonomic function ranged from 25 to 89%, depending on the battery of tests used, with CASS not exceeding 4 points. The abnormalities in autonomic tests indicated both sympathetic and parasympathetic dysfunction and did not correlate with the duration, severity and variant of CIDP.
CONCLUSIONS
Clinical or subclinical involvement of the ANS has been shown to be common and relatively mild in CIDP. The impact of autonomic impairment on disability and of its possible response to therapy in CIDP needs to be further investigated.
Topics: Humans; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating; Autonomic Nervous System; Diabetes Mellitus; Primary Dysautonomias
PubMed: 37083958
DOI: 10.1007/s10072-023-06802-z -
Scientific Reports Sep 2023Self-induced cognitive trance (SICT) is a voluntary non-ordinary state of consciousness characterized by a lucid yet narrowed awareness of the external surroundings. It...
Self-induced cognitive trance (SICT) is a voluntary non-ordinary state of consciousness characterized by a lucid yet narrowed awareness of the external surroundings. It involves a hyper-focused immersive experience of flow, expanded inner imagery, modified somatosensory processing, and an altered perception of self and time. SICT is gaining attention due to its potential clinical applications. Similar states of non-ordinary state of consciousness, such as meditation, hypnosis, and psychedelic experiences, have been reported to induce changes in the autonomic nervous system. However, the functioning of the autonomic nervous system during SICT remains poorly understood. In this study, we aimed to investigate the impact of SICT on the cardiac and respiratory signals of 25 participants proficient in SICT. To accomplish this, we measured various metrics of heart rate variability (HRV) and respiration rate variability (RRV) in three conditions: resting state, SICT, and a mental imagery task. Subsequently, we employed a machine learning framework utilizing a linear discriminant analysis classifier and a cross-validation scheme to identify the features that exhibited the best discrimination between these three conditions. The results revealed that during SICT, participants experienced an increased heart rate and a decreased level of high-frequency (HF) HRV compared to the control conditions. Additionally, specific increases in respiratory amplitude, phase ratio, and RRV were observed during SICT in comparison to the other conditions. These findings suggest that SICT is associated with a reduction in parasympathetic activity, indicative of a hyperarousal state of the autonomic nervous system during SICT.
Topics: Humans; Consciousness; Autonomic Nervous System; Benchmarking; Discriminant Analysis; Hallucinogens
PubMed: 37737222
DOI: 10.1038/s41598-023-42393-7 -
The Korean Journal of Gastroenterology... Feb 2024Achalasia is an esophageal motility disorder characterized by dysphagia and noncardiac chest pain. Impairment of vagal function has been reported in achalasia. This...
BACKGROUND/AIMS
Achalasia is an esophageal motility disorder characterized by dysphagia and noncardiac chest pain. Impairment of vagal function has been reported in achalasia. This study evaluated autonomic nervous system (ANS) dysfunctions in patients with achalasia to establish a correlation between an ANS dysfunction and the clinical symptoms of achalasia.
METHODS
Nineteen patients with achalasia (six males/13 females; mean age, 47.1±16.3 years) and 10 healthy controls (four males/six females; 34.8±10.7 years) were enrolled prospectively at Gangnam Severance Hospital between June 2013 and June 2014. All patients completed a questionnaire on ANS dysfunction symptoms and underwent a heart rate variability (HRV) test.
RESULTS
ANS dysfunction symptoms were present in 13 patients with achalasia (69%) and three controls (30%). The ANS dysfunction score was significantly higher in patients with achalasia than in the controls (p=0.035). There were no significant differences in the standard deviation of all normal R-R intervals, high frequency (HF), low frequency (LF), and LF/HF ratio in the HRV test. In subgroup analysis comparing female achalasia patients with controls, the cardiac activity was significantly higher in the female achalasia patients than in the controls (p=0.036). The cardiac activity (p=0.004) and endurance to stress (p=0.004) were significantly higher in the achalasia patients with ANS dysfunction symptoms than the achalasia patients without ANS dysfunction symptoms.
CONCLUSIONS
ANS dysfunction symptoms are common in patients with achalasia. Female achalasia patients and those with ANS dysfunction symptoms showed increased cardiac activity. Hence, more attention should be paid to cardiac overload in achalasia patients who are female or have ANS dysfunction symptoms.
Topics: Male; Humans; Female; Adult; Middle Aged; Autonomic Nervous System; Esophageal Achalasia; Heart; Heart Rate
PubMed: 38389461
DOI: 10.4166/kjg.2023.144 -
Acta Cardiologica Aug 2023The role of the autonomic nervous system in the onset of supraventricular and ventricular arrhythmias is well established. It can be analysed by the spontaneous... (Review)
Review
The role of the autonomic nervous system in the onset of supraventricular and ventricular arrhythmias is well established. It can be analysed by the spontaneous behaviour of the heart rate with ambulatory ECG recordings, through heart rate variability measurements. Input of heart rate variability parameters into artificial intelligence models to make predictions regarding the detection or forecast of rhythm disorders is becoming routine and neuromodulation techniques are now increasingly used for their treatment. All this warrants a reappraisal of the use of heart rate variability for autonomic nervous system assessment.Measurements performed over long periods such as 24H-variance, total power, deceleration capacity, and turbulence are suitable for estimating the individual basal autonomic status. Spectral measurements performed over short periods provide information on the dynamics of systems that disrupt this basal balance and may be part of the triggers of arrhythmias, as well as premature atrial or ventricular beats. All heart rate variability measurements essentially reflect the modulations of the parasympathetic nervous system which are superimposed on the impulses of the adrenergic system. Although heart rate variability parameters have been shown to be useful for risk stratification in patients with myocardial infarction and patients with heart failure, they are not part of the criteria for prophylactic implantation of an intracardiac defibrillator, because of their high variability and the improved treatment of myocardial infarction. Graphical methods such as Poincaré plots allow quick screening of atrial fibrillation and are set to play an important role in the e-cardiology networks. Although mathematical and computational techniques allow manipulation of the ECG signal to extract information and permit their use in predictive models for individual cardiac risk stratification, their explicability remains difficult and making inferences about the activity of the ANS from these models must remain cautious.
Topics: Humans; Heart Rate; Artificial Intelligence; Autonomic Nervous System; Heart; Myocardial Infarction; Atrial Fibrillation; Heart Atria
PubMed: 36803313
DOI: 10.1080/00015385.2023.2177371 -
Ageing Research Reviews Sep 2023A recent call was made for autonomic nervous system (ANS) measures as digital health markers for early detection of Alzheimer's disease and related dementia (AD/ADRD).... (Review)
Review
A recent call was made for autonomic nervous system (ANS) measures as digital health markers for early detection of Alzheimer's disease and related dementia (AD/ADRD). Nevertheless, contradictory or inconclusive findings exist. To help advance understanding of ANS' role in dementia, we draw upon aging and dementia-related literature, and propose a framework that centers on the role of ANS flexibility to guide future work on application of ANS function to differentiating the degree and type of dementia-related brain pathologies. We first provide a brief review of literature within the past 10 years on ANS and dementia-related brain pathologies. Next, we present an ANS flexibility model, describing how the model can be applied to understand these brain pathologies, as well as differentiate or even be leveraged to modify typical brain aging and dementia. Lastly, we briefly discuss the implication of the model for understanding resilience and vulnerability to dementia-related outcomes.
Topics: Humans; Brain; Autonomic Nervous System; Alzheimer Disease; Aging
PubMed: 37459967
DOI: 10.1016/j.arr.2023.102016 -
Bone Research Sep 2023Recent studies have determined that the nervous system can sense and respond to signals from skeletal tissue, a process known as skeletal interoception, which is crucial... (Review)
Review
Recent studies have determined that the nervous system can sense and respond to signals from skeletal tissue, a process known as skeletal interoception, which is crucial for maintaining bone homeostasis. The hypothalamus, located in the central nervous system (CNS), plays a key role in processing interoceptive signals and regulating bone homeostasis through the autonomic nervous system, neuropeptide release, and neuroendocrine mechanisms. These mechanisms control the differentiation of mesenchymal stem cells into osteoblasts (OBs), the activation of osteoclasts (OCs), and the functional activities of bone cells. Sensory nerves extensively innervate skeletal tissues, facilitating the transmission of interoceptive signals to the CNS. This review provides a comprehensive overview of current research on the generation and coordination of skeletal interoceptive signals by the CNS to maintain bone homeostasis and their potential role in pathological conditions. The findings expand our understanding of intersystem communication in bone biology and may have implications for developing novel therapeutic strategies for bone diseases.
Topics: Humans; Homeostasis; Central Nervous System; Afferent Pathways; Autonomic Nervous System; Bone Diseases
PubMed: 37669953
DOI: 10.1038/s41413-023-00285-6 -
Physiological Reports Sep 2023The cardiovascular system is primarily controlled by the autonomic nervous system, and any changes in sympathetic or parasympathetic activity also have an impact on... (Review)
Review
The cardiovascular system is primarily controlled by the autonomic nervous system, and any changes in sympathetic or parasympathetic activity also have an impact on myocardial activity. Heart rate variability (HRV) is a readily available metric used to assess heart rate control by the autonomic nervous system. HRV can provide information about neural (parasympathetic, sympathetic, reflex) and humoral (hormones, thermoregulation) control of myocardial activity. Because there are no relevant reference values for HRV parameters in rats in the scientific literature, all experimental results are only interpreted on the basis of changes from currently measured control or baseline HRV values, which are, however, significantly different in individual studies. Considering the significant variability of published HRV data, the present study focused primarily on comparing control or baseline HRV values under different conditions in in vivo experiments involving rats. The aim of the study was therefore to assess whether there are differences in the starting values before the experiment itself.
Topics: Male; Animals; Rats; Heart Rate; Autonomic Nervous System; Body Temperature Regulation; Myocardium; Reference Values
PubMed: 37735345
DOI: 10.14814/phy2.15827