Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 9 de 9
Filtrar
Más filtros











Base de datos
Intervalo de año de publicación
1.
J Neurol Sci ; 427: 117502, 2021 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-34044239

RESUMEN

OBJECTIVE: The prevalence of autonomic involvement in early stage of Parkinson 's disease (PD) is still debated. Aim of this study is to assess the autonomic functions in de novo PD patients (dnPD) in comparison with PD patients on therapy (PDot) and healthy controls (HC). METHODS: Twenty-eight dnPD and 24 PDot, to whom Unified Parkinson's Rating Scale (UPDRS) was administered, and 23 HC underwent electrochemical skin conductance (ESC) measured with sudoscan, cardiovascular reflexes (head-up tilt test HUTT, Valsalva maneuver, deep breathing, hand grip, and cold face),and Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction (SCOPA-AUT) questionnaire. RESULTS: The mean SCOPA-AUT total score was significantly higher in dnPD group compared with HC group (p < 0.001) and significantly lower than PDot (p = 0.004). No significant difference of ESC mean values were found between dnPD and HC group. DnPD had a significantly lower diastolic blood pressure (BP) response at handgrip test (p = 0.005) compared with HC. Hands and feet ESC significantly negatively correlated with disease duration (p = 0.014; p = 0.025) and feet ESC significantly negatively correlated with UPDRS III (p = 0.039). Systolic and diastolic BP responses at 3rd minute of HUTT correlated significantly negatively with disease duration (p < 0.001; p = 0.003) and with UPDRSIII (p = 0.001; p < 0.001). BP response to Valsalva maneuver negatively correlated with UPDRSIII (p = 0.006). CONCLUSION: Although dnPD patients complain of thermoregulatory symptoms, we found no alteration in the sudomotor function investigated with sudoscan. Furthermore, a deficit of the sympathetic vasoconstrictive response to the isometric exercise was detected, suggesting an early involvement of the autonomic cardiovascular components in dnPD.


Asunto(s)
Enfermedades del Sistema Nervioso Autónomo , Enfermedad de Parkinson , Sistema Nervioso Autónomo , Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Enfermedades del Sistema Nervioso Autónomo/etiología , Mano , Fuerza de la Mano , Humanos , Enfermedad de Parkinson/complicaciones
2.
J Neurol Sci ; 418: 117095, 2020 11 15.
Artículo en Inglés | MEDLINE | ID: mdl-32841918

RESUMEN

OBJECTIVE: Some antiepileptic drugs (AEDs), like sodium channel blockers are significantly associated with autonomic dysfunction in patients with epilepsy. Unlike other sodium-blockers AEDs, lacosamide (LCM) is a third generation AEDs which enhances the slow inactivation of voltage-gated sodium channels. So far, data about LCM on autonomic nervous system are still unknown. This study was designed to investigate cardiovascular autonomic and sudomotor function in patients affected by focal epilepsy on LCM monotherapy, compared to patients treated with carbamazepine (CBZ) monotherapy and healthy subjects. METHODS: Patients on LCM underwent autonomic function tests including head up tilt test (HUTT), Valsalva maneuver, deep breathing, hand grip, and cold face. Heart rate variability (HRV) analysis was performed in rest condition and during HUTT. Sudomotor function was assessed through Sudoscan. All results were compared with patients on carbamazepine (CBZ) monotherapy and with healthy subjects. RESULTS: Fourteen patients on LCM monotherapy, 12 patients on CBZ monotherapy and 16 healthy controls were studied. At cardiovascular function tests, delta systolic blood pressure (∆SBP) at 3 min of HUTT and ∆SBP early phase II-late phase II at Valsalva maneuver were significantly lower in CBZ group compared to LCM patients. Spectral analysis of HRV showed no significant differences among LCM, CBZ and control groups. No difference in sudomotor function was found in all three groups. CONCLUSIONS: In conclusion, our findings suggest that LCM and CBZ on monotherapy do not affect autonomic cardiovascular and sudomotor functions compared to controls. Nevertheless, patients on CBZ showed a lower sympathetic reactivity with respect to LCM.


Asunto(s)
Epilepsias Parciales , Fuerza de la Mano , Anticonvulsivantes/uso terapéutico , Carbamazepina/uso terapéutico , Epilepsias Parciales/tratamiento farmacológico , Humanos , Lacosamida/uso terapéutico
3.
CNS Drugs ; 33(11): 1133-1139, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31650471

RESUMEN

BACKGROUND: Dimethyl fumarate (DMF) exerts anti-inflammatory effects in multiple sclerosis by activating the Nrf2 antioxidant pathway, which is also stimulated by acetylcholine via alpha-7 nicotinic acetylcholine receptors. In animal models, Nrf2 potentiates cholinergic synaptic plasticity. OBJECTIVE: The aim of this study was to test whether treatment with DMF modulates cholinergic pathways in relapsing-remitting multiple sclerosis (RRMS). METHODS: Patients starting DMF (20) or IFN-ß 1a (20) and healthy subjects (20) were enrolled. Short-latency afferent inhibition (SAI), which is a transcranial stimulation measure of central cholinergic transmission, was recorded in patients and controls at baseline and, in patients only, after 6 months of treatment. Patients treated with DMF also underwent autonomic function testing to further explore peripheral and central cholinergic tone. RESULTS: At baseline, SAI was similar in patients and in controls (p = 0.983). Treatment with DMF significantly increased SAI (p = 0.01), while IFNß had no effect (p = 0.80). In the cold face test, DMF treatment also increased reflex bradycardia (p = 0.013), and reduced diastolic blood pressure variation (p = 0.010), further indicating its ability to stimulate cholinergic transmission. CONCLUSIONS: Treatment of MS patients with DMF results in increased cholinergic stimulation, with possible implications for neuroinflammation and neuroprotection.


Asunto(s)
Acetilcolina/uso terapéutico , Colinérgicos/uso terapéutico , Dimetilfumarato/uso terapéutico , Inmunosupresores/uso terapéutico , Esclerosis Múltiple Recurrente-Remitente/tratamiento farmacológico , Adulto , Femenino , Humanos , Interferón beta/metabolismo , Masculino , Esclerosis Múltiple Recurrente-Remitente/metabolismo , Factor 2 Relacionado con NF-E2/metabolismo , Resultado del Tratamiento
4.
Sleep Med ; 52: 163-167, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30359891

RESUMEN

OJECTIVE: To investigate cardiovascular and sudomotor autonomic functions in patients with idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) during wakefulness compared to patients with Parkinson's disease (PD) and healthy subjects. METHODS: Drug-naïve iRBD patients, PD patients and healthy controls underwent cardiovascular function tests including head-up tilt test (HUTT), Valsalva maneuver, deep breathing, hand grip, and cold face. Heart rate variability (HRV) analysis was performed in the frequency domain using an autoregressive algorithm in the rest supine condition and during HUTT. Sudomotor function was assessed through Sudoscan. RESULTS: Fourteen iRBD patients, 17 PD patients and 12 healthy controls were included in the study. In the supine resting condition, the baseline values of systolic and diastolic blood pressure and heart rate were comparable in all groups. At Valsalva maneuver, iRBD patients and PD patients showed an overshoot which was significantly lower than controls. In addition, iRBD patients showed a significant reduction of sinus arrhythmia at deep breathing compared to controls. Cardiovascular responses to cold face were similar in the three groups while isometric handgrip was significantly reduced in PD patients with respect to healthy subjects. Spectral analysis of HRV showed no significant differences among iRBD, PD patients and controls in the supine resting condition; whereas during HUTT the low-frequency (LF) component of HRV was significantly higher in controls with respect to iRBD and the high-frequency (HF) component was significantly higher in iRBD patients compared to controls. In addition, a significant increase in the LF/HF ratio in healthy subjects was detected compared to iRBD. Finally, four out of 14 iRBD patients (29%) and nine of 17 PD patients (53%) had a sudomotor dysfunction. CONCLUSIONS: Our findings obtained in de novo iRBD and PD patients indicate that some alterations of the autonomic nervous system are shared by both groups of patients, reinforcing the close link between the two pathologies, and show an autonomic fragility during wakefulness in iRBD that mainly arises under stress conditions.


Asunto(s)
Sistema Nervioso Autónomo/fisiopatología , Frecuencia Cardíaca/fisiología , Trastorno de la Conducta del Sueño REM/fisiopatología , Vigilia/fisiología , Anciano , Presión Sanguínea/fisiología , Sistema Cardiovascular/fisiopatología , Femenino , Humanos , Masculino , Enfermedad de Parkinson/fisiopatología , Pruebas de Mesa Inclinada
5.
Sleep Med ; 42: 68-72, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29458748

RESUMEN

OBJECTIVE: This study is aimed at evaluating whether Continuous Positive Airway Pressure treatment (CPAP) may affect autonomic nervous system (ANS) in male patients with severe obstructive sleep apnea (OSAS). METHODS: We compared autonomic symptoms of de novo severe OSAS patients, OSAS patients on chronic CPAP treatment and healthy controls, using the Scales for Outcome in Parkinson disease-Autonomic (SCOPA-AUT) questionnaire. All groups underwent cardiovascular function tests including head-up tilt test (HUTT), Valsalva maneuver, deep breathing, hand grip and cold face tests. Statistical significance was set at p < 0.05. RESULTS: Twelve de novo severe OSAS patients, 17 male OSAS on CPAP and 14 controls were studied. The mean SCOPA-AUT total score was significantly higher in de novo OSAS patients compared with controls. Regarding the distinct domains, both de novo OSAS and CPAP group had abnormalities in respect of controls in urinary sphere. In supine rest condition the baseline values of systolic blood pressure were significantly increased in untreated OSAS patients compared with controls, whereas the basal values of diastolic blood pressure were significantly higher in CPAP patients with respect to controls. After ten min of HUTT, diastolic blood pressure changes were significantly higher in controls compared to both OSAS groups. Untreated OSAS patients showed significant different responses at deep breathing compared to controls. Both OSAS groups had a significant reduction of reflex bradycardia at cold face test. CONCLUSIONS: Our study shows that both treated and untreated OSAS patients complain of subjective autonomic symptoms like other sleep disorders reinforcing the close relationship between sleep and autonomic activity. Furthermore, cardiovascular reflexes indicate a tendency to hypertension and a reduced sensitivity to stimuli during wakefulness even in OSA patients on CPAP treatment, suggesting potentially permanent autonomic function deficits.


Asunto(s)
Sistema Nervioso Autónomo/fisiopatología , Presión de las Vías Aéreas Positiva Contínua/métodos , Apnea Obstructiva del Sueño/fisiopatología , Presión Sanguínea/fisiología , Sistema Cardiovascular/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Maniobra de Valsalva
6.
Mult Scler J Exp Transl Clin ; 3(2): 2055217317701317, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28607756

RESUMEN

BACKGROUND: Sympathovagal imbalance has been associated with poor prognosis in chronic diseases, but there is conflicting evidence in multiple sclerosis. OBJECTIVES: The objective of this study was to investigate the autonomic nervous system dysfunction correlation with inflammation and progression in multiple sclerosis. METHODS: Heart rate variability was analysed in 120 multiple sclerosis patients and 60 healthy controls during supine rest and head-up tilt test; the normalised units of low frequency and high frequency power were considered to assess sympathetic and vagal components, respectively. Correlation analyses with clinical and radiological markers of disease activity and progression were performed. RESULTS: Sympathetic dysfunction was closely related to the progression of disability in multiple sclerosis: progressive patients showed altered heart rate variability with respect to healthy controls and relapsing-remitting patients, with higher rest low frequency power and lacking the expected low frequency power increase during the head-up tilt test. In relapsing-remitting patients, disease activity, even subclinical, was associated with lower rest low frequency power, whereas stable relapsing-remitting patients did not differ from healthy controls. Less sympathetic reactivity and higher low frequency power at rest were associated with incomplete recovery from relapse. CONCLUSIONS: Autonomic balance appears to be intimately linked with both the inflammatory activity of multiple sclerosis, which is featured by an overall hypoactivity of the sympathetic nervous system, and its compensatory plastic processes, which appear inefficient in case of worsening and progressive multiple sclerosis.

7.
Sleep Med ; 16(9): 1071-6, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26298781

RESUMEN

OBJECTIVE: The link between the autonomic nervous system and restless legs syndrome (RLS) has been recently postulated. Since dopaminergic agents are used as first-line treatment for RLS, the purpose of our study is to verify whether chronic pramipexole treatment could influence the autonomic control of cardiovascular reflexes and heart rate variability (HRV) in RLS during wakefulness. METHODS: Consecutive drug naive RLS patients underwent polysomnography (PSG), subjective scales, and cardiovascular function tests including head-up tilt test (HUTT), Valsalva maneuver, deep breathing, handgrip and cold face before and after 3-month pramipexole therapy. HRV analysis was performed in the frequency domain using both autoregressive and fast Fourier transform algorithms in rest supine condition and during HUTT. RESULTS: Twenty RLS patients reported a significant reduction of RLS symptoms after pramipexole treatment, while PSG did not show significant improvements except for periodic limb movement index. Pramipexole induced a trend to a lower systolic blood pressure and a significant higher variation of systolic and diastolic blood pressure at HUTT. Cardiovascular responses to the other tests were unchanged. No significant differences in HRV spectral analysis between drug naive and treated patients were observed. Moreover, the within-group analysis of HRV between orthostatic and supine position did not show any significant change in sympathetic and parasympathetic components both in the drug naive and pramipexole groups. CONCLUSIONS: Chronic pramipexole treatment does not seem to affect autonomic balance during wakefulness. Considering that neither PSG data nor autonomic parameters are significantly modified by pramipexole, we hypothesize a non-dopaminergic autonomic dysfunction in RLS.


Asunto(s)
Sistema Nervioso Autónomo/fisiopatología , Benzotiazoles/uso terapéutico , Agonistas de Dopamina/uso terapéutico , Síndrome de las Piernas Inquietas/tratamiento farmacológico , Síndrome de las Piernas Inquietas/fisiopatología , Adulto , Anciano , Presión Sanguínea/fisiología , Estudios de Cohortes , Esquema de Medicación , Frecuencia Cardíaca/fisiología , Humanos , Persona de Mediana Edad , Pramipexol , Vigilia/fisiología
8.
CNS Neurosci Ther ; 21(9): 727-32, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26205884

RESUMEN

AIMS: Disorders of the autonomic nervous system (ANS) have a variable degree of clinical relevance in patients with Parkinson's disease (PD). Here, we assessed whether subclinical autonomic dysfunction, as evaluated by a complete battery of autonomic function tests (AFTs), correlates with PD progression. METHODS: A series of 27 consecutive patients with PD underwent extensive ANS investigations including the head-up tilt test (HUTT), Valsalva maneuver, deep-breathing test, and handgrip test (HG); further, they performed 123I-meta-iodobenzylguanidine (MIBG) scintigraphy. RESULTS: Seven of the 27 patients showed orthostatic hypotension (OH) at HUTT and pathological responses to the deep-breathing and HG test and Valsalva maneuver. The majority of the remaining 20 patients with PD showed pathological responses to deep-breathing (n = 13) and/or HG (n = 11). Only 3 of 27 suffered relevant OH. MIBG uptake of myocardium was decreased in 19 patients with PD (H/M ratio 1.3 ± 0.2). Prolonged clinical observation (>3 years), persistent response to levodopa, and MIBG repetition allowed us to exclude negative MIBG as attributable to atypical Parkinsonism. MIBG uptake did not correlate with OH and other AFTs. Both HG test response and MIBG did correlate with the Unified Parkinson's Disease Rating Scale (UPDRS) motor score and disease duration. A positive correlation emerged between diastolic blood pressure (DBP) response to HG test and MIBG and with systolic blood pressure (SBP) response at tilt test. CONCLUSIONS: Our investigation suggests that ANS impairment affects the majority of patients with PD, even those PD patients showing negative MIBG, irrespective of clinical neurovegetative symptoms. The strict correlation that has been revealed with disease progression supports the routine utilization of AFTs as a reliable and inexpensive tool for monitoring peripheral sympathetic dysfunction in PD and optimizing therapy.


Asunto(s)
Sistema Nervioso Autónomo/fisiopatología , Enfermedad de Parkinson/fisiopatología , 3-Yodobencilguanidina , Adulto , Anciano , Antiparkinsonianos/uso terapéutico , Presión Sanguínea/fisiología , Femenino , Fuerza de la Mano , Corazón/diagnóstico por imagen , Humanos , Levodopa/uso terapéutico , Masculino , Persona de Mediana Edad , Imagen de Perfusión Miocárdica , Examen Neurológico , Enfermedad de Parkinson/diagnóstico por imagen , Enfermedad de Parkinson/tratamiento farmacológico , Radiofármacos , Índice de Severidad de la Enfermedad , Factores de Tiempo
9.
Sleep Med ; 15(11): 1392-7, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25266501

RESUMEN

OBJECTIVE: To investigate cardiovascular autonomic function in patients with restless leg syndrome (RLS) by means of cardiovascular reflexes and heart rate variability (HRV) during wakefulness. METHODS: Twelve RLS patients and 14 controls underwent cardiovascular function tests including head-up tilt test (HUTT), Valsalva maneuver, deep breathing, hand grip, and cold face. HRV analysis was performed in the frequency domain using both autoregressive (AR) and fast Fourier transform algorithms in rest supine condition and during HUTT. RESULTS: There was a significant increase in systolic blood pressure values in supine rest condition and a trend toward a lower Valsalva ratio in RLS patients with respect to controls. The significant and physiological changes of HRV at HUTT detected in healthy subjects were not found in RLS patients. CONCLUSION: RLS patients exhibit a tendency toward hypertension, reduced amplitude of both sympathetic and parasympathetic responses at HUTT, as well as blunted parasympathetic drive to blood pressure changes. These findings, if confirmed by more controlled studies, might support the hypothesis of autonomic nervous system involvement during wakefulness and consequently an enhanced cardiovascular risk in RLS.


Asunto(s)
Sistema Nervioso Autónomo/fisiopatología , Síndrome de las Piernas Inquietas/fisiopatología , Vigilia/fisiología , Estudios de Casos y Controles , Femenino , Fuerza de la Mano/fisiología , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Mesa Inclinada , Maniobra de Valsalva
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA