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Journal of Diabetes Science and... Sep 2012Diabetic autonomic neural imbalance is a severe complication of long-term diabetes patients and may progress to diabetic autonomic neuropathy (DAN). The prevalence of... (Review)
Review
Diabetic autonomic neural imbalance is a severe complication of long-term diabetes patients and may progress to diabetic autonomic neuropathy (DAN). The prevalence of DAN is reported to be between 20 and 70%, depending on the studies. The pathogenesis of DAN remains unresolved. However, emerging evidence suggests that glycemic variability (GV) may be associated with autonomic imbalance in patients with both type 1 and type 2 diabetes. As symptoms are initially weak and uncharacteristic, the condition often remains undiagnosed until late manifestations present themselves. Predominant symptoms may include nausea, vomiting, gastroparesis, involuntary diarrhea, postural hypotension, voiding difficulties, and sexual dysfunction. Analyzing the patterns of heart rate variability carries the potential for detection of autonomic imbalance in the subclinical and asymptomatic stages. In this context, GV may affect the sympathovagal balance by increasing oxidative stress and proinflammatory cytokines. Establishing a GV risk profile could therefore be important in determining risk factors in diabetes patients. This review addresses the issues above and in particular the possible association between diabetic autonomic imbalance and GV.
Topics: Autonomic Nervous System Diseases; Blood Glucose; Diabetes Mellitus; Diabetic Neuropathies; Heart Rate; Humans; Observer Variation; Prevalence
PubMed: 23063048
DOI: 10.1177/193229681200600526 -
Anatolian Journal of Cardiology Jun 2015
Topics: Arthritis, Rheumatoid; Autonomic Nervous System Diseases; Cardiovascular Diseases; Humans; Signal Processing, Computer-Assisted
PubMed: 26258188
DOI: No ID Found -
Revista Portuguesa de Cardiologia :... Oct 2017Knowledge of the physiology underlying the autonomic nervous system is pivotal for understanding autonomic dysfunction in clinical practice. Autonomic dysfunction may... (Review)
Review
Knowledge of the physiology underlying the autonomic nervous system is pivotal for understanding autonomic dysfunction in clinical practice. Autonomic dysfunction may result from primary modifications of the autonomic nervous system or be secondary to a wide range of diseases that cause severe morbidity and mortality. Together with a detailed history and physical examination, laboratory assessment of autonomic function is essential for the analysis of various clinical conditions and the establishment of effective, personalized and precise therapeutic schemes. This review summarizes the main aspects of autonomic medicine that constitute the background of cardiovascular autonomic dysfunction.
Topics: Autonomic Nervous System Diseases; Cardiovascular Diseases; Efferent Pathways; Humans; Reflex
PubMed: 29037833
DOI: 10.1016/j.repc.2017.01.007 -
Clinical Autonomic Research : Official... Apr 2019This perspective piece on head-up tilt table testing is part of a series on autonomic function testing. The tilt table can be a useful diagnostic test, but methodologies... (Review)
Review
This perspective piece on head-up tilt table testing is part of a series on autonomic function testing. The tilt table can be a useful diagnostic test, but methodologies vary, and the results are sometimes misinterpreted. The intent here is not to review comprehensively the utility of various tilt table testing protocols but to convey a number of general points that may give perspective and have practical clinical value, based on an understanding of autonomic physiology and our long clinical and research experience in the evaluation of autonomic disorders. The goals of tilt table testing are to assess orthostatic hypotension (OH), chronic orthostatic intolerance (COI), and unexplained syncope. The testing is useful for distinguishing neurogenic from non-neurogenic OH, identifying failure of the sympathetic noradrenergic system in autonomic neuropathies and ganglionopathies, and assessing baroreflex-sympathoneural function in α-synucleinopathies. For COI, the testing can provide objective data related to the patient's symptoms, diagnose postural tachycardia syndrome (POTS), and distinguish POTS from other causes of tachycardia. Provocative tilt table testing can help understand bases for recurrent transient loss of consciousness in patients with syncope, distinguish neurally mediated syncope from psychogenic pseudosyncope, and separate syncope-related convulsion from epileptic seizures. For each of these purposes, the goals, formats, endpoints, and clinical utility are different. As for any autonomic test, tilt table findings must be interpreted in the context of the patient's clinical presentation.
Topics: Autonomic Nervous System Diseases; Humans; Tilt-Table Test
PubMed: 30838497
DOI: 10.1007/s10286-019-00598-9 -
Parkinsonism & Related Disorders Feb 2011Both pathologic and clinical studies of autonomic pathways have expanded the concept of Parkinson disease (PD) from a movement disorder to a multi-level widespread... (Review)
Review
Both pathologic and clinical studies of autonomic pathways have expanded the concept of Parkinson disease (PD) from a movement disorder to a multi-level widespread neurodegenerative process with non-motor features spanning several organ systems. This review integrates neuropathologic findings and autonomic physiology in PD as it relates to end organ autonomic function. Symptoms, pathology and physiology of the cardiovascular, skin/sweat gland, urinary, gastrointestinal, pupillary and neuroendocrine systems can be probed by autopsy, biopsy and non-invasive electrophysiological techniques in vivo which assess autonomic anatomy and function. There is mounting evidence that PD affects a chain of neurons in autonomic pathways. Consequently, autonomic physiology may serve as a window into non-motor PD progression and allow the development of mechanistically based treatment strategies for several non-motor features of PD. End-organ physiologic markers may be used to inform a model of PD pathophysiology and non-motor progression.
Topics: Animals; Autonomic Nervous System; Autonomic Nervous System Diseases; Humans; Multiple System Atrophy; Parkinson Disease
PubMed: 20851033
DOI: 10.1016/j.parkreldis.2010.08.022 -
Journal of Diabetes Investigation Nov 2020Impaired awareness of hypoglycemia (IAH) is a reduction in the ability to recognize low blood glucose levels that would otherwise prompt an appropriate corrective... (Review)
Review
Impaired awareness of hypoglycemia (IAH) is a reduction in the ability to recognize low blood glucose levels that would otherwise prompt an appropriate corrective therapy. Identified in approximately 25% of patients with type 1 diabetes, IAH has complex pathophysiology, and might lead to serious and potentially lethal consequences in patients with diabetes, particularly in those with more advanced disease and comorbidities. Continuous glucose monitoring systems can provide real-time glucose information and generate timely alerts on rapidly falling or low blood glucose levels. Given their improvements in accuracy, affordability and integration with insulin pump technology, continuous glucose monitoring systems are emerging as critical tools to help prevent serious hypoglycemia and mitigate its consequences in patients with diabetes. This review discusses the current knowledge on IAH and effective diagnostic methods, the relationship between hypoglycemia and cardiovascular autonomic neuropathy, a practical approach to evaluating cardiovascular autonomic neuropathy for clinicians, and recent evidence from clinical trials assessing the effects of the use of CGM technologies in patients with type 1 diabetes with IAH.
Topics: Autonomic Nervous System Diseases; Blood Glucose Self-Monitoring; Diabetes Complications; Diabetes Mellitus; Diabetic Neuropathies; Health Knowledge, Attitudes, Practice; Humans; Hypoglycemia; Prognosis; Risk Factors
PubMed: 32403204
DOI: 10.1111/jdi.13290 -
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 -
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 -
Journal of the Royal Society of Medicine Nov 2011Recent gynaecological studies show that childbirth, constipation, trauma and surgery cause injuries to autonomic nerves at different anatomical sites in the female... (Review)
Review
Recent gynaecological studies show that childbirth, constipation, trauma and surgery cause injuries to autonomic nerves at different anatomical sites in the female pelvis resulting in endometriosis, adenomyosis and fibroids. Re-growth of abnormal nerves causes allodynic symptoms ('light touch causing pain or discomfort') some years later including vulvodynia, dyspareunia, dysmenorrhea, irritative bladder and bowel symptoms. Further consequences of autonomic denervation include tissue hypoplasia and hyperplasia, visceral dysfunction, susceptibility to infection, alcohol, tobacco and drugs, as well as pain with sensitization of the central nervous system. The 'autonomic denervation' view extrapolates these observations from the female pelvis to the varied anatomy of branches of the cardiac and coeliac plexi to provide primary mechanisms for many forms of Western disease. This account sets out the autonomic denervation view, identifies features of autonomic denervation in extrapelvic organs, and, contrasts it with prior accounts of chronic Western diseases including those of DP Burkitt, PRJ Burch and DP Barker.
Topics: Autonomic Denervation; Autonomic Nervous System Diseases; Autonomic Pathways; Cardiovascular Diseases; Constipation; Female; Genital Diseases, Female; Humans; Hyperalgesia; Intestinal Diseases; Leiomyoma; Wounds and Injuries
PubMed: 22048676
DOI: 10.1258/jrsm.2011.110014 -
Journal of Neurology Oct 2021Ross syndrome is a rare disorder characterized by tonic pupils, hyporeflexia, and segmental anhidrosis. We sought to characterize the clinical presentation, associated...
BACKGROUND
Ross syndrome is a rare disorder characterized by tonic pupils, hyporeflexia, and segmental anhidrosis. We sought to characterize the clinical presentation, associated autoimmune disorders, and autonomic profile in patients with Ross syndrome to further elucidate its pathophysiology.
METHODS
We performed a retrospective chart review of all patients who underwent a thermoregulatory sweat test (TST) between 1998 and 2020 and had confirmation of the diagnosis of Ross syndrome by an autonomic disorders specialist. Standardized autonomic reflex testing was reviewed when available.
RESULTS
Twenty-six patients with Ross syndrome were identified. The most common initial reported manifestation was an abnormal segmental sweating response in 16 patients (described as hyperhidrosis in 12 patients and anhidrosis in 4 patients) while a tonic pupil was the initial manifestation in 10 patients. Other commonly reported symptoms included fatigue, chronic cough, and increased urinary frequency. An associated autoimmune disorder was identified in one patient. Positive autoantibodies were found in a minority of patients often with unclear clinical significance. Distributions of anhidrosis encountered were segmental (n = 15), widespread (n = 7), and global (n = 4). Well-circumscribed small areas of preserved sweating within areas of anhidrosis were observed in the majority of patients (88.5%). Anhidrosis progressed slowly over time and sudomotor dysfunction was predominantly (post)ganglionic. Cardiovagal and adrenergic functions were preserved in most patients.
CONCLUSIONS
The pattern of autonomic dysfunction in Ross syndrome is suggestive of a limited autonomic ganglioneuropathy. Sudomotor impairment is prominent and should be the focus of symptomatic management; however, clinicians should be aware of symptoms beyond the classic triad.
Topics: Autonomic Nervous System Diseases; Humans; Hypohidrosis; Retrospective Studies; Syndrome; Tonic Pupil
PubMed: 33813643
DOI: 10.1007/s00415-021-10531-8