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Seminars in Neurology Oct 2020Acute-onset and severe sensory and autonomic deficits with no motor dysfunction, typically preceded by a febrile illness, with poor recovery, and often fatal outcome are...
Acute-onset and severe sensory and autonomic deficits with no motor dysfunction, typically preceded by a febrile illness, with poor recovery, and often fatal outcome are the hallmark features of acute sensory and autonomic neuronopathy (ASANN). Pathologically and electrophysiologically, ASANN is characterized by an extensive ganglionopathy affecting sensory and autonomic ganglia with preservation of motor neurons. Consequently, patients, usually children or young adult, develop acute-onset profound widespread loss of all sensory modalities resulting in automutilations, as well as autonomic failure causing neurogenic orthostatic hypotension, neurogenic underactive bladder, and gastroparesis and constipation. The diagnosis is clinical with support of nerve conduction studies and autonomic testing, as well as spinal cord magnetic resonance imaging showing characteristic posterior cord hyperintensities. Although the presumed etiology is immune-mediated, further studies are required to clarify the physiopathology of the disease. We here performed a systematic review of the epidemiology, pathophysiology, diagnosis, and management of ASANN, with three representative cases that recently presented at our clinic. All three patients had the typical clinical manifestations of ASANN but in different combinations, illustrating the variable phenotype of the disorder. Immunosuppression is seldom effective. Management options are limited to supportive and symptomatic care with the goal of minimizing complications and preventing death.
Topics: Autonomic Nervous System Diseases; Ganglia, Autonomic; Ganglia, Sensory; Humans
PubMed: 32906171
DOI: 10.1055/s-0040-1713843 -
Clinical Autonomic Research : Official... Feb 2018We recently defined genetic traits that distinguish sympathetic from parasympathetic neurons, both preganglionic and ganglionic (Espinosa-Medina et al., Science... (Review)
Review
We recently defined genetic traits that distinguish sympathetic from parasympathetic neurons, both preganglionic and ganglionic (Espinosa-Medina et al., Science 354:893-897, 2016). By this set of criteria, we found that the sacral autonomic outflow is sympathetic, not parasympathetic as has been thought for more than a century. Proposing such a belated shift in perspective begs the question why the new criterion (cell types defined by their genetic make-up and dependencies) should be favored over the anatomical, physiological and pharmacological considerations of long ago that inspired the "parasympathetic" classification. After a brief reminder of the former, we expound the weaknesses of the latter and argue that the novel genetic definition helps integrating neglected anatomical and physiological observations and clearing the path for future research.
Topics: Ganglia, Parasympathetic; Ganglia, Sympathetic; Humans; Sacrococcygeal Region; Spinal Cord
PubMed: 29103139
DOI: 10.1007/s10286-017-0478-7 -
Journal of Visualized Experiments : JoVE Mar 2020The bilateral major pelvic ganglia (MPG; synonym, pelvic ganglia) are the primary source of postganglionic sympathetic and parasympathetic neurons innervating pelvic...
The bilateral major pelvic ganglia (MPG; synonym, pelvic ganglia) are the primary source of postganglionic sympathetic and parasympathetic neurons innervating pelvic organs of rodents; the functionally equivalent structure in humans is the inferior hypogastric plexus. The major pelvic ganglia also provide the route by which lumbar and sacral sensory axons reach the pelvic organs. These complex, mixed ganglia can prove challenging to identify and dissect for further experimental study of normal autonomic mechanisms or to establish preclinical models of disease, injury or visceral pain. Here we describe a protocol to access and visualize these ganglia and their associated nerve tracts. We provide this protocol with schematics for both male and female rats, as the ganglion size and landmarks for identification differ between sexes. The protocol describes removal of the ganglion for in vitro studies, but this method can be integrated into a surgical recovery protocol for experimental interventions (e.g., nerve crush, nerve resection) or for mapping neuronal circuits (e.g., by microinjection of neural tracers). We also demonstrate the primary structures of the ganglion and its associated nerves immediately following dissection and following immunohistochemical staining.
Topics: Anatomic Landmarks; Animals; Axons; Dissection; Female; Ganglia, Autonomic; Ganglia, Sympathetic; Male; Nerve Tissue; Pelvis; Rats, Sprague-Dawley
PubMed: 32202526
DOI: 10.3791/60904 -
Autonomic Neuroscience : Basic &... Sep 2020Cardiac sympathetic blockade is a therapeutic approach for arrhythmias and heart failure and may be a beneficial effect of high thoracic epidural anesthesia. These... (Review)
Review
BACKGROUND
Cardiac sympathetic blockade is a therapeutic approach for arrhythmias and heart failure and may be a beneficial effect of high thoracic epidural anesthesia. These treatments require detailed knowledge of the spatial location and distribution of cardiac autonomic nerves, however, there are controversies on this subject in humans.
OBJECTIVE
To provide a systematic overview of current knowledge on human anatomy of the cardiac autonomic nervous system.
RESULTS
In contrast to the often claimed assumption that human preganglionic sympathetic cardiac neurons originate mainly from thoracic spinal segments T1-T4 or T5, there is ample evidence indicating involvement of cervical spinal segment C8 and thoracic spinal segments below T5. Whether cervical ganglia besides the stellate ganglion play a role in transmission of cardiac sympathetic signals is unclear. Similarly, there is debate on the origin of cardiac nerves from different thoracic ganglia. Most human studies report thoracic cardiac nerves emerging from the first to fourth thoracic paravertebral ganglia; others report contributions from the fifth, sixth and even the seventh thoracic ganglia. There is no agreement on the precise composition of nerve plexuses at the cardiac level. After years of debate, it is generally accepted that the vagal nerve contributes to ventricular innervation. Vagal distribution appears higher in atria, whereas adrenergic fibers exceed the number of vagal fibers in the ventricles.
CONCLUSION
Anatomy of the human cardiac autonomic nervous system is highly variable and likely extends beyond generally assumed boundaries. This information is relevant for thoracic epidural anesthesia and procedures targeting neuronal modulation of cardiac sympathetic innervation.
Topics: Adult; Animals; Autonomic Nervous System; Ganglia, Sympathetic; Heart; Humans
PubMed: 32497872
DOI: 10.1016/j.autneu.2020.102674 -
Methodist DeBakey Cardiovascular Journal 2015Circumferential pulmonary vein isolation is the mainstay of atrial fibrillation (AF) ablation, but alternative approaches and techniques have been developed to improve... (Review)
Review
Circumferential pulmonary vein isolation is the mainstay of atrial fibrillation (AF) ablation, but alternative approaches and techniques have been developed to improve the outcomes. One of these additional ablation targets are ganglionated plexi of the intrinsic cardiac autonomic system that contain a variety of sympathetic and parasympathetic neurons that communicate with the extrinsic cardiac autonomic nervous system. The ganglionated plexi of the heart do not serve as a simple relay station but could modulate the autonomic interaction between the extrinsic and intrinsic cardiac autonomic system. Intrinsic cardiac autonomic nerve activity is an invariable trigger of paroxysmal atrial tachyarrhythmia, including atrial fibrillation. Although multiple studies have shown that ganglionated plexi play an important role in initiating atrial fibrillation, there is no consensus on a standardized protocol for selecting target sites and determining how ganglionated plexi ablation can best be accomplished. Recent clinical trials have demonstrated the feasibility and efficacy of ganglionated plexi ablation in addition to pulmonary vein isolation, but novel technologies and strategies are necessary to improve the current ablation techniques in managing patients with atrial fibrillation. This review focuses on the relationship between atrial ganglionated plexi and atrial fibrillation and the potential benefits and limitations of ganglionated plexi ablation in the management of atrial fibrillation.
Topics: Animals; Atrial Fibrillation; Autonomic Denervation; Catheter Ablation; Ganglia, Autonomic; Heart Atria; Heart Rate; Humans; Treatment Outcome
PubMed: 26306124
DOI: 10.14797/mdcj-11-2-82 -
Anatolian Journal of Cardiology Jul 2021This study aimed to explore the safety and effectiveness of selective cardiac autonomic ganglion plexus (GP) ablation on patients with bradyarrhythmia. The heart is...
OBJECTIVE
This study aimed to explore the safety and effectiveness of selective cardiac autonomic ganglion plexus (GP) ablation on patients with bradyarrhythmia. The heart is controlled by its own intrinsic and central autonomic nerves. Increased cardiac vagal tone leads to sinus node dysfunction and atrioventricular conduction disorders, resulting in bradyarrhythmia. Pacemaker implantation can relieve the symptoms of arrhythmia caused by bradycardia, but it is not easy for patients to accept a pacemaker implantation as a form of treatment. Therefore, more and more attention has been paid to cardiac vagus nerve ablation.
METHODS
In this study, 20 patients who met the inclusion criteria of GP ablation in the First Affiliated Hospital of Xinjiang Medical University from November 2019 to June 2020 were enrolled. Biochemical and other related examinations along with electrophysiological examinations were conducted before ablation, and then cardiac GP ablation was performed. The patients were followed up 3 times at 3, 6, and 12 months after the operation.
RESULTS
The minimum HR and mean HR were significantly increased after treatment with cardiac autonomic GP ablation (p<0.01). Moreover, the SDNN (Standard deviation of Normal-to-Normal Intervals) and RMSSD (Root mean square successive differences between successive R-R intervals) was significantly decreased after treatment with cardiac autonomic ganglion plexus ablation for 6 months and 12 months (p<0.01).
CONCLUSION
Cardiac GP ablation is relatively simple and easy to implement in units that have performed radiofrequency ablation for bradyarrhythmias. This procedure can be performed without any new equipment. Some patients with bradycardia may not have a permanent pacemaker implantation and may go in for additional treatment options.
Topics: Autonomic Pathways; Bradycardia; Catheter Ablation; Ganglia, Autonomic; Heart Rate; Humans; Sick Sinus Syndrome
PubMed: 34236324
DOI: 10.5152/AnatolJCardiol.2021.94797 -
Journal of Anatomy Jan 2019Only a few papers exist dealing with the development and aging of the autonomic nervous system - and even rarer are studies that investigated the otic ganglion. Using a...
Only a few papers exist dealing with the development and aging of the autonomic nervous system - and even rarer are studies that investigated the otic ganglion. Using a special trepan, we removed and investigated 172 samples from 86 corpses, ranging from 20 weeks of gestational age (GA) to 95 years of age. The aim of the study was to measure different morphometric parameters of the ganglionic neurons in order to study age-related changes from early development until old age. Fetuses show the highest numerical density of neurons. Then, in the first years of life, a rapid growth of the cytoplasm takes place, which is the main reason for the neuronal growth and the increase of the general size of the otic ganglion at this age. Also, the number of satellite cells increases till puberty. In adults, the parameters are relatively stable over decades and decrease slowly, in contrast to the steep increase in the first years of life. Moreover, neuronal degeneration, storage of pigments, neuro-axonal dystrophy, and lymphocytic infiltrates increase with age.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Embryonic Development; Female; Ganglia, Parasympathetic; Humans; Infant; Infant, Newborn; Male; Middle Aged; Young Adult
PubMed: 30411352
DOI: 10.1111/joa.12898 -
British Journal of Pharmacology and... Dec 1959The actions of 1,1-dimethyl-4-phenylpiperazinium iodide (DMPP) have been studied to discover under what conditions a blocking action could be seen....
The actions of 1,1-dimethyl-4-phenylpiperazinium iodide (DMPP) have been studied to discover under what conditions a blocking action could be seen. Dimethylphenylpiperazinium has a stimulant action on autonomic ganglia, stimulating the superior cervical ganglion and causing contraction of the nictitating membrane. It caused slowing followed by acceleration of the rate of beat of isolated rabbit atria. The denervated gastrocnemius muscle contracted if dimethylphenylpiperazinium was injected intra-arterially. Under other circumstances a blocking action was seen. It blocked peristalsis in the isolated guinea-pig ileum stimulated by raising intraluminal pressure and inhibited the response of the rat diaphragm and of the cat gastrocnemius stimulated through the motor nerve. It is suggested that dimethylphenylpiperazinium acts by depolarization, causing stimulation of resting muscle but inhibition by prolonging depolarization.
Topics: Animals; Cats; Dimethylphenylpiperazinium Iodide; Ganglia, Autonomic; Guinea Pigs; Ileum; Nictitating Membrane; Piperazines; Rabbits; Rats
PubMed: 14417244
DOI: 10.1111/j.1476-5381.1959.tb00957.x -
Cephalalgia : An International Journal... Mar 2020The presence of calcitonin gene-related peptide and its receptors in multiple brain areas and peripheral tissues previously implicated in migraine initiation and its...
BACKGROUND
The presence of calcitonin gene-related peptide and its receptors in multiple brain areas and peripheral tissues previously implicated in migraine initiation and its many associated symptoms raises the possibility that humanized monoclonal anti-calcitonin gene-related peptide antibodies (CGRP-mAbs) can prevent migraine by modulating neuronal behavior inside and outside the brain. Critical to our ability to conduct a fair discussion over the mechanisms of action of CGRP-mAbs in migraine prevention is data generation that determines which of the many possible peripheral and central sites are accessible to these antibodies - a question raised frequently due to their large size.
MATERIAL AND METHODS
Rats with uncompromised and compromised blood-brain barrier (BBB) were injected with Alexa Fluor 594-conjugated fremanezumab (Frema594), sacrificed 4 h or 7 d later, and relevant tissues were examined for the presence of Frema594.
RESULTS
In rats with uncompromised BBB, Frema594 was similarly observed at 4 h and 7 d in the dura, dural blood vessels, trigeminal ganglion, C2 dorsal root ganglion, the parasympathetic sphenopalatine ganglion and the sympathetic superior cervical ganglion but not in the spinal trigeminal nucleus, thalamus, hypothalamus or cortex. In rats with compromised BBB, Frema594 was detected in the cortex (100 µm surrounding the compromised BBB site) 4 h but not 7 d after injections.
DISCUSSION
Our inability to detect fluorescent (CGRP-mAbs) in the brain supports the conclusion that CGRP-mAbs prevent the headache phase of migraine by acting mostly, if not exclusively, outside the brain as the amount of CGRP-mAbs that enters the brain (if any) is too small to be physiologically meaningful.
Topics: Animals; Antibodies, Monoclonal; Blood-Brain Barrier; Brain; Brain Chemistry; Calcitonin Gene-Related Peptide; Dura Mater; Fluorescent Dyes; Ganglia, Autonomic; Ganglia, Sensory; Male; Rats; Rats, Sprague-Dawley
PubMed: 31856583
DOI: 10.1177/0333102419896760 -
JACC. Clinical Electrophysiology Jul 2022
Topics: Atrial Fibrillation; Ganglia, Autonomic; Heart Rate; Humans
PubMed: 35863817
DOI: 10.1016/j.jacep.2022.05.006