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1.
Sci Rep ; 12(1): 11461, 2022 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-35794147

RESUMO

The risk factors of mild cognitive impairment (MCI) in patients with de novo Parkinson's disease (PD) remain unclear. Therefore, the objective of this study was to compare motor and non-motor symptoms between de novo patients with PD with and without MCI. Moreover, detailed relationships between each cognitive deficit and other clinical characteristics in de novo patients with PD were investigated. Consecutive patients with de novo PD were retrospectively enrolled in this study. Motor symptoms were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) part-III and the Hoehn and Yahr (HY) stage. Non-motor symptoms including depression, anxiety, fatigue, and autonomic dysfunction were measured using representative questionnaires. Motor symptoms, depression, and dysautonomia were associated with MCI in de novo patients with PD. Compared with the non-MCI group with PD, the MCI group with PD had higher scores of UPDRS-III, HY stage, depression, and dysautonomia, but not fatigue or anxiety. Both UPDRS-III and HY stage were significantly linked to all cognitive deficits except attention. Logistic regression analysis showed that depression was associated with memory, visuospatial, and executive impairment, and dysautonomia was related to visuospatial and executive impairment. The results of this study suggest that cognitive impairment in PD might have a different relationship pattern to the motor and some non-motor symptoms.


Assuntos
Transtornos Cognitivos , Disfunção Cognitiva , Doença de Parkinson , Disautonomias Primárias , Transtornos Cognitivos/etiologia , Disfunção Cognitiva/complicações , Disfunção Cognitiva/diagnóstico , Humanos , Doença de Parkinson/diagnóstico , Disautonomias Primárias/complicações , Estudos Retrospectivos
2.
Sci Rep ; 12(1): 12051, 2022 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-35835832

RESUMO

We report the first study assessing human colon manometric features and their correlations with changes in autonomic functioning in patients with refractory chronic constipation prior to consideration of surgical intervention. High-resolution colonic manometry (HRCM) with simultaneous heart rate variability (HRV) was performed in 14 patients, and the resulting features were compared to healthy subjects. Patients were categorized into three groups that had normal, weak, or no high amplitude propagating pressure waves (HAPWs) to any intervention. We found mild vagal pathway impairment presented as lower HAPW amplitude in the proximal colon in response to proximal colon balloon distention. Left colon dysmotility was observed in 71% of patients, with features of (1) less left colon HAPWs, (2) lower left colon HAPW amplitudes (69.8 vs 102.3 mmHg), (3) impaired coloanal coordination, (4) left colon hypertonicity in patients with coccyx injury. Patients showed the following autonomic dysfunction: (1) high sympathetic tone at baseline, (2) high sympathetic reactivity to active standing and meal, (3) correlation of low parasympathetic reactivity to the meal with absence of the coloanal reflex, (4) lower parasympathetic and higher sympathetic activity during occurrence of HAPWs. In conclusion, left colon dysmotility and high sympathetic tone and reactivity, more so than vagal pathway impairment, play important roles in refractory chronic constipation and suggests sacral neuromodulation as a possible treatment.


Assuntos
Colo/fisiopatologia , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Constipação Intestinal/terapia , Motilidade Gastrointestinal/fisiologia , Trânsito Gastrointestinal/fisiologia , Frequência Cardíaca , Humanos , Manometria/métodos , Disautonomias Primárias/complicações , Sistema Nervoso Simpático/fisiopatologia , Nervo Vago/fisiopatologia
3.
Medicina (Kaunas) ; 58(7)2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35888657

RESUMO

Harlequin syndrome (HS) is a rare autonomic disorder. The causes and risk factors of the disease are not fully understood. Some cases of HS are associated with traumatic injuries, tumors, or vascular impairments of the head. Symptoms of HS can also occur in some autoimmune disorders, ophthalmic disorders, sleep disorders, and with certain organic lesions. In this context, a thorough review of the pathophysiology of HS in relation to neurological, ophthalmological, and dermatological conditions is necessary. In this mini-review, we aim to review the pathophysiological changes and underlying mechanisms in primary and secondary HS. Additionally, we discuss possible management approaches for patients with HS in light of the discussed pathological mechanisms. The main symptoms of HS that are correlated with autonomic nervous system impairments include sudden unilateral flushing of the face, neck, chest, and rarely arm, with concurrent contralateral anhidrosis. Despite reported co-occurring syndromes (such as cluster headaches), several studies have shown that HS could frequently overlap with other syndromes that are disruptive to the idiopathic nerve pathways. HS usually does not require any medical treatment. In some severe cases, symptomatic treatments could be needed. However, total symptomatic relief may not be achieved in many cases of HS. We therefore suggest an approach to comprehensive management of HS, which may lead to better long-term control of HS.


Assuntos
Doenças do Sistema Nervoso Autônomo , Rubor , Hipo-Hidrose , Disautonomias Primárias , Doenças do Sistema Nervoso Autônomo/patologia , Face/patologia , Rubor/patologia , Humanos , Hipo-Hidrose/complicações , Hipo-Hidrose/diagnóstico , Disautonomias Primárias/patologia , Doenças Raras/patologia
4.
Chronobiol Int ; 39(9): 1220-1225, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35786235

RESUMO

In diabetes kidney disease (DKD), orthostatic hypotension and supine hypertension often coexist, which, when uncontrolled, contributes to the progression of proteinuria and renal dysfunction. Chronotherapy and elevation of the head of the bed during sleep are feasible clinical measures and could contribute to the control of supine hypertension and proteinuria in this group of patients. This study consists of a series of cases, in which nine consecutive patients with DKD, dysautonomia and supine hypertension (intervention group) were instructed to use chronotherapy and inclination of the head of the bed in six degrees during sleep. These patients were compared with a historical control group. The primary outcome was proteinuria behavior. The intervention group had a significant drop in proteinuria levels, while there was an increase in proteinuria in the control group (variation in the proteinuria/creatininuria index in an isolated sample from the intervention group: -6.60 ± 3.90 g/g; variation in the group control: +1.70 ± 7.10 g/g, p = 0.008). Chronotherapy and six-degree inclination of the head of the bed during sleep were associated with a significant decrease in proteinuria in patients in the intervention group, with conversion of nephrotic into non-nephrotic proteinuria in most of these patients.


Assuntos
Diabetes Mellitus , Nefropatias Diabéticas , Hipertensão , Disautonomias Primárias , Ritmo Circadiano , Nefropatias Diabéticas/complicações , Humanos , Hipertensão/complicações , Disautonomias Primárias/complicações , Proteinúria/complicações
5.
Alerta (San Salvador) ; 5(2): 133-138, jul. 22, 2022.
Artigo em Espanhol | LILACS, BISSAL | ID: biblio-1380068

RESUMO

Las disautonomías son el resultado de un mal funcionamiento del sistema nervioso autónomo, entre las cuales se encuentra el síndrome de taquicardia ortostática postural, un problema de salud variable y complejo que tiene una prevalencia considerable, principalmente en adolescentes y mujeres. Este produce una amplia variedad de signos y síntomas que son similares a los de otras patologías, lo que, sumado a la falta de pruebas diagnósticas específicas, muchas veces retrasa el diagnóstico. A pesar de la existencia de criterios estandarizados para determinar la presencia del síndrome, existe aún una brecha en el conocimiento acerca del mismo. Esto dificulta el abordaje del padecimiento y, por consiguiente, su tratamiento oportuno. Conocer más sobre este síndrome y los factores que dificultan su diagnóstico temprano permitiría mejorar la atención de los pacientes y su calidad de vida


Dysautonomias are the result of a malfunction of the autonomic nervous system, among which is the postural orthostatic tachycardia syndrome, a variable and complex health problem that has a considerable prevalence, mainly in adolescents and women. It produces a wide variety of signs and symptoms that are similar to those of other pathologies, which, added to the lack of specific diagnostic tests, often delays diagnosis. Despite the existence of standardized criteria to determine the presence of the syndrome, there is still a gap in knowledge about it. This hinders the approach to the condition and, consequently, its timely treatment. Understanding more about this syndrome and the factors that hinder its early diagnosis would improve patient care and quality of life


Assuntos
Sistema Nervoso Autônomo , Diagnóstico , Síndrome da Taquicardia Postural Ortostática , Taquicardia , El Salvador , Disautonomias Primárias
6.
Viruses ; 14(5)2022 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-35632776

RESUMO

Long-COVID-19 refers to the signs and symptoms that continue or develop after the "acute COVID-19" phase. These patients have an increased risk of multiorgan dysfunction, readmission, and mortality. In Long-COVID-19 patients, it is possible to detect a persistent increase in D-Dimer, NT-ProBNP, and autonomic nervous system dysfunction. To verify the dysautonomia hypothesis in Long-COVID-19 patients, we studied heart rate variability using 12-lead 24-h ECG monitoring in 30 Long-COVID-19 patients and 20 No-COVID patients. Power spectral analysis of heart rate variability was lower in Long-COVID-19 patients both for total power (7.46 ± 0.5 vs. 8.08 ± 0.6; p < 0.0001; Cohens-d = 1.12) and for the VLF (6.84 ± 0.8 vs. 7.66 ± 0.6; p < 0.0001; Cohens-d = 1.16) and HF (4.65 ± 0.9 vs. 5.33 ± 0.9; p = 0.015; Cohens-d = 0.76) components. The LF/HF ratio was significantly higher in Long-COVID-19 patients (1.46 ± 0.27 vs. 1.23 ± 0.13; p = 0.001; Cohens-d = 1.09). On multivariable analysis, Long-COVID-19 is significantly correlated with D-dimer (standardized ß-coefficient = 0.259), NT-ProBNP (standardized ß-coefficient = 0.281), HF component of spectral analysis (standardized ß-coefficient = 0.696), and LF/HF ratio (standardized ß-coefficient = 0.820). Dysautonomia may explain the persistent symptoms in Long COVID-19 patients. The persistence of a procoagulative state and an elevated myocardial strain could explain vagal impairment in these patients. In Long-COVID-19 patients, impaired vagal activity, persistent increases of NT-ProBNP, and a prothrombotic state require careful monitoring and appropriate intervention.


Assuntos
COVID-19 , Disautonomias Primárias , COVID-19/complicações , Eletrocardiografia , Frequência Cardíaca/fisiologia , Humanos
7.
Clin Immunol ; 240: 109039, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35569781

RESUMO

Nowadays intravenous immunoglobulin (IVIg) treatment is considered to play a promising role in the autoimmune disease therapy. Despite its significant beneficial effects, the precise mechanism of action needs further studies, as well as recommended dosage in the treatment of autoimmune dysautonomia. In some diseases, like Guillain-Barre syndrome (GBS) and chronic inflammatory demyelinating neuropathy (CIDP), IVIg has a strong evidence that allows to recommend and prescribe the medication, while in other diseases only single case studies are available that requires further research. The review summarizes the currently available information on the effectiveness of IVIg in primary autoimmune neuropathies and neurological complications of systemic diseases, as well as side effects, features of clinical use with an emphasis on doses and treatment protocols in dysautonomia. Being safe and effective therapy, immunologic treatment is one of the most promising tools to achieve clinical remission of dysautonomia and good quality of life in autoimmune patients.


Assuntos
Síndrome de Guillain-Barré , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Disautonomias Primárias , Humanos , Imunoglobulinas Intravenosas , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/induzido quimicamente , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/tratamento farmacológico , Disautonomias Primárias/tratamento farmacológico , Qualidade de Vida
9.
Ann Clin Transl Neurol ; 9(6): 778-785, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35393771

RESUMO

BACKGROUND: The association between autonomic dysfunction and long-COVID syndrome is established. However, the prevalence and patterns of symptoms of dysautonomia in long-COVID syndrome in a large population are lacking. OBJECTIVE: To evaluate the prevalence and patterns of symptoms of dysautonomia in patients with long-COVID syndrome. METHODS: We administered the Composite Autonomic Symptom Score 31 (COMPASS-31) questionnaire to a sample of post-COVID-19 patients who were referred to post-COVID clinic in Assiut University Hospitals, Egypt for symptoms concerning for long-COVID syndrome. Participants were asked to complete the COMPASS-31 questionnaire referring to the period of more than 4 weeks after acute COVID-19. RESULTS: We included 320 patients (35.92 ± 11.92 years, 73% females). The median COMPASS-31 score was 26.29 (0-76.73). The most affected domains of dysautonomia were gastrointestinal, secretomotor, and orthostatic intolerance with 91.6%, 76.4%, and 73.6%, respectively. There was a positive correlation between COMPASS-31 score and long-COVID duration (p < 0.001) and a positive correlation between orthostatic intolerance domain score and post-COVID duration (p < 0.001). There was a positive correlation between orthostatic intolerance domain score and age of participants (p = 0.004). Two hundred forty-seven patients (76.7%) had a high score of COMPASS-31 >16.4. Patients with COMPASS-31 >16.4 had a longer duration of long-COVID syndrome than those with score <16.4 (46.2 vs. 26.8 weeks, p < 0.001). CONCLUSIONS: Symptoms of dysautonomia are common in long-COVID syndrome. The most common COMPASS-31 affected domains of dysautonomia are gastrointestinal, secretomotor, and orthostatic intolerance. There is a positive correlation between orthostatic intolerance domain score and patients' age.


Assuntos
COVID-19 , Intolerância Ortostática , Disautonomias Primárias , COVID-19/complicações , COVID-19/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Disautonomias Primárias/epidemiologia , Disautonomias Primárias/etiologia , Síndrome
10.
Artigo em Russo | MEDLINE | ID: mdl-35394733

RESUMO

Autonomic dysfunction is frequently observed in people with epilepsy. Ictal and postictal dysautonomia is not only manifestation of autonomic seizures, but could be a life threatening condition in some cases and contribute to sudden unexpected death (SUDEP). Interictal decrease of autonomic activity is associated with duration and severity of epilepsy, it is the most prominent in focal and drug-resistant epilepsy. Progress in our understanding of the underlying mechanisms, development of the autonomic assessment methods, and its integration in novel technical solutions for seizure detection will improve the quality of care for people with epilepsy.


Assuntos
Epilepsia , Disautonomias Primárias , Morte Súbita Inesperada na Epilepsia , Morte Súbita/etiologia , Eletroencefalografia/métodos , Epilepsia/complicações , Humanos , Disautonomias Primárias/complicações , Disautonomias Primárias/etiologia , Convulsões/complicações
11.
BMC Infect Dis ; 22(1): 214, 2022 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-35241011

RESUMO

BACKGROUND: The emergence of dysautonomia as a consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; or COVID-19) is becoming more prevalent. We have seen evidence in several post-COVID patients and in the literature of varying degrees of autonomic dysfunction. Symptoms, among others, include inappropriate tachycardia, sweating, anxiety, insomnia and blood pressure variability from the effects of excessive catecholamine, as well as cognitive impairment, fatigue, headaches and orthostatic intolerance from decreased brain perfusion. CASE PRESENTATION: We present a case of severe dysautonomia in a previously healthy 27-year-old runner. About five weeks after her initial mild COVID-19 infection, the patient began to develop weakness, which progressed into severe post-exertional fatigue, slowed cognition, headaches, blurred vision and generalized body aches. She also endorsed palpitations, especially when getting up from a seated or lying position as well as with mild exertion. She became reliant on her husband for help with her activities of daily living. Exam was significant for orthostasis; laboratory workup unremarkable. Over the following months, the patient's symptoms have improved slowly with fluid and sodium intake, compression stockings and participating in a graduated exercise program. CONCLUSIONS: Dysautonomia as a consequence of infection with COVID-19 is becoming increasingly discussed, especially as more patients recover from COVID-19. This is a case of a non-hospitalized patient with a mild initial presentation and significant, debilitating dysautonomia symptoms. More research on its pathophysiology, especially in relation to a precedent viral insult, as well as its treatment, is needed.


Assuntos
COVID-19 , Disautonomias Primárias , Atividades Cotidianas , Adulto , COVID-19/complicações , Exercício Físico , Feminino , Humanos , Disautonomias Primárias/diagnóstico , Disautonomias Primárias/etiologia , SARS-CoV-2
12.
J Neurosci ; 42(17): 3659-3675, 2022 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-35304427

RESUMO

Traumatic spinal cord injury (SCI) above the major spinal sympathetic outflow (T6 level) disinhibits sympathetic neurons from supraspinal control, causing systems-wide "dysautonomia." We recently showed that remarkable structural remodeling and plasticity occurs within spinal sympathetic circuitry, creating abnormal sympathetic reflexes that exacerbate dysautonomia over time. As an example, thoracic VGluT2+ spinal interneurons (SpINs) become structurally and functionally integrated with neurons that comprise the spinal-splenic sympathetic network and immunological dysfunction becomes progressively worse after SCI. To test whether the onset and progression of SCI-induced sympathetic plasticity is neuron activity dependent, we selectively inhibited (or excited) thoracic VGluT2+ interneurons using chemogenetics. New data show that silencing VGluT2+ interneurons in female and male mice with a T3 SCI, using hM4Di designer receptors exclusively activated by designer drugs (Gi DREADDs), blocks structural plasticity and the development of dysautonomia. Specifically, silencing VGluT2+ interneurons prevents the structural remodeling of spinal sympathetic networks that project to lymphoid and endocrine organs, reduces the frequency of spontaneous autonomic dysreflexia (AD), and reduces the severity of experimentally induced AD. Features of SCI-induced structural plasticity can be recapitulated in the intact spinal cord by activating excitatory hM3Dq-DREADDs in VGluT2+ interneurons. Collectively, these data implicate VGluT2+ excitatory SpINs in the onset and propagation of SCI-induced structural plasticity and dysautonomia, and reveal the potential for neuromodulation to block or reduce dysautonomia after severe high-level SCI.SIGNIFICANCE STATEMENT In response to stress or dangerous stimuli, autonomic spinal neurons coordinate a "fight or flight" response marked by increased cardiac output and release of stress hormones. After a spinal cord injury (SCI), normally harmless stimuli like bladder filling can result in a "false" fight or flight response, causing pathological changes throughout the body. We show that progressive hypertension and immune suppression develop after SCI because thoracic excitatory VGluT2+ spinal interneurons (SpINs) provoke structural remodeling in autonomic networks within below-lesion spinal levels. These pathological changes can be prevented in SCI mice or phenocopied in uninjured mice using chemogenetics to selectively manipulate activity in VGluT2+ SpINs. Targeted neuromodulation of SpINs could prevent structural plasticity and subsequent autonomic dysfunction in people with SCI.


Assuntos
Disreflexia Autonômica , Disautonomias Primárias , Traumatismos da Medula Espinal , Animais , Disreflexia Autonômica/etiologia , Feminino , Humanos , Interneurônios/patologia , Masculino , Camundongos , Disautonomias Primárias/complicações , Medula Espinal/patologia
13.
Rev. bras. hipertens ; 29(1): 6-9, 10 març. 2022.
Artigo em Português | LILACS | ID: biblio-1367446

RESUMO

Homem de 53 anos, hipertenso e portador de bronquite, admitido em um serviço de urgência no dia 15 de dezembro de 2020 devido sintomas gripais, febre e cefaleia iniciados há oito dias. Após constatação de acometimento pulmonar importante mediante tomografia computadorizada (TC) de tórax, sugestivo de infecção pelo vírus SARS-CoV2, o paciente foi internado em unidade de terapia intensiva. Foi intubado no décimo dia de internação, e, dois dias após, evoluiu com labilidade pressórica importante, recorrendo ao uso de noradrenalina e nitroprussiato, além de outros anti-hipertensivos, conforme a necessidade. O quadro predominante foi a hipertensão arterial sistêmica, manifestada principalmente com a mudança de decúbito, sendo o maior valor pressórico registrado de 240x90 mmHg. A disautonomia também se manifestou por ausência de dejeções, sudorese excessiva e espasmos musculares. A frequência cardíaca se manteve estável e dentro dos parâmetros de normalidade.A partir do trigésimo dia de internação, observou-se melhora progressiva do quadro e reestabelecimento da homeostase. Obteve alta após 59 dias de internação, sem sequelas significativas. A explicação mais razoável para o caso é o aumento da resistência vascular periférica, por ação da angiotensina II, associada à supressão do sistema parassimpático, o que explica, também, a incompetência do barorreflexo para compensação da frequência cardíaca. Adicionalmente, o paciente estava em uso de carvedilol. Este caso enfatiza o desafio diagnóstico precoce da disautonomia em pacientes críticos, devido a carência de ferramentas adequadas para uso na prática cotidiana. A estimulação vagal pode constituir opção terapêutica eficaz, mas carece de mais estudos


A 53-year-old male, hypertensive and with bronchitis, was admitted to the emergency department on December 15, 2020 due to flu-like symptoms, fever and headache that started eight days ago. After finding significant lung involvement by chest computed tomography (CT) suggestive of SARS-CoV2 virus infection, the patient was admitted to the intensive care unit. He was intubated on the tenth day of hospitalization, and, 2 days later, he evolved with significant pressure lability, using norepinephrine and nitroprusside, in addition to other antihypertensive drugs, as needed. The predominant state was hypertension, expressed mainly when there is interference from the patient's position in bed. The highest pressure value recorded was 240x90 mmHg. Dysautonomy was also manifested by the absence of stools, excessive sweating and muscle spasms. Heart rate remains stable and within normal limits. From the thirtieth day of hospitalization onwards, there was an evolution with progressive improvement and restoration of homeostasis. He was discharged after 59 days of hospitalization, without sequelae. The most reasonable explanation for the case is the increase in peripheral vascular resistance, due to the action of angiotensin II, associated with the suppression of the parasympathetic system, which also explains the incompetence of the baroreflex to compensate the heart rate. Additionally, the patient was using carvedilol. This case emphasizes the importance of tools that early identify dysautonomy, prepare the team. Vagal stimulation can be an effective therapeutic option, but further studies are needed


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Disautonomias Primárias/tratamento farmacológico , COVID-19/tratamento farmacológico , Hipertensão/tratamento farmacológico
14.
BMC Neurol ; 22(1): 106, 2022 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-35305594

RESUMO

BACKGROUND: Lambert-Eaton myasthenic syndrome (LEMS) is a type of paraneoplastic syndrome that may initially manifest itself with proximal weakness and gait abnormalities. Approximately up to 50% of LEMS patients have a primary autonomic dysfunction. CASE PRESENTATION: We present here a case of a 75-year-old male with symmetric proximal muscle weakness, dry mouth and constipation. The cutaneous response to scratch and upright tilt-table testing were positive. A repetitive nerve stimulation test showed that there was a decremental response of compound muscle action potential (CMAP) amplitude at 3 Hz while an incremental response at 20 Hz. The presence of antibodies against voltage-gated calcium channels (VGCC) confirmed the diagnosis. Because of the prominent symptom of autonomic disorder, the patient further underwent the test of skin sympathetic response (SSR). Lower amplitude and longer response duration were found in palms, while it evoked no response in soles. CONCLUSIONS: In this case, we present the detailed results of SSR test on a patient suffering LEMS with autonomic disorder. Since autonomic dysfunction has a significant impact on clinical management and SSR test is an effective detection method, we recommend that SSR test be performed on patients with LEMS regularly.


Assuntos
Síndrome Miastênica de Lambert-Eaton , Síndromes Paraneoplásicas , Disautonomias Primárias , Idoso , Humanos , Síndrome Miastênica de Lambert-Eaton/complicações , Síndrome Miastênica de Lambert-Eaton/diagnóstico , Masculino
15.
Sci Rep ; 12(1): 5136, 2022 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-35332217

RESUMO

There is increasing evidence that autonomic dysfunction is an important factor in the progression of glaucoma. Mechanism of the association between autonomic dysfunction and progression of glaucoma is poorly understood. Since blood circulation is basically regulated by the autonomic nervous system, autonomic dysfunction may contribute to unstable or fluctuating blood pressure. Therefore, It is hypothesized that autonomic dysfunction may contribute to impaired ocular blood flow and lead to glaucoma progression. However, no clinical study yet has evaluated the relationship between ocular blood flow and autonomic nervous function. We enrolled 152 open angle glaucoma patient. Ocular blood flow was assessed by measuring vessel density (VD) using optical coherence tomography angiography, and autonomic nervous function was evaluated with heart-rate variability (HRV) parameters. The low frequency/high frequency (LF/HF) ratio, which is one of the HRV parameters, quantified the degree of sympathovagal balance. This indicator could represent autonomic dysfunction. Higher LF/HF ratio was associated with reduction of the deep parapapillary VD (R = - 0.243, P = 0.003). Linear regression analysis showed a significant negative association between parapapillary choroidal VD and LF/HF ratio (ß = - 0.249; 95% confidential interval = - 1.193 to - 0.249; P = 0.002) in multivariate analysis. We demonstarted the association between impaired ocular blood flow (parapapillary choroidal vessel density) and autonomic dysfunction (LF/HF ratio). This study could help understand the role of the autonomic dysfunction in pathophysiology of glaucoma progression.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma de Baixa Tensão , Disautonomias Primárias , Corioide/diagnóstico por imagem , Hemodinâmica , Humanos
16.
J Parkinsons Dis ; 12(3): 1059-1067, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35124662

RESUMO

BACKGROUND: Autonomic dysfunction and depression are common non-motor symptoms of Parkinson's disease (PD) that confer poorer prognosis. These PD symptoms may have overlapping pathophysiologic underpinnings. OBJECTIVE: To investigate associations between autonomic and depression symptoms in early PD, and their evolution over time. METHODS: We obtained data from the Parkinson's Progression Markers Initiative, a prospective open-access database of early PD. Regression analyses were used to model effects of depression on autonomic symptoms in controls and in PD at baseline, visit 6 (24 months after baseline), and visit 12 (60 months after baseline), correcting for multiple comparisons. RESULTS: Data from 421 people with PD at baseline, 360 at visit 6, 300 at visit 12, and 193 controls were included. When controlling for age, depression, and anti-hypertensive medications, depression predicted autonomic symptoms in all groups. Accounting for motor symptoms did not alter these associations. When comparing groups, the influence of depression on autonomic symptoms was stronger in all PD groups compared to controls, and strongest in PD at visit 12. Depression predicted the presence of orthostatic hypotension only in the PD group at visit 12. CONCLUSION: We demonstrated the important impact of depression on autonomic symptoms in early and middle stages of PD, which are independent of motor symptoms. Though the physiologic basis of these two PD symptoms are not fully understood, our findings add to pathologic evidence of a shared mechanistic substrate, separate from that responsible for PD motor symptoms. These findings may influence clinical management and development of novel therapies.


Assuntos
Doenças do Sistema Nervoso Autônomo , Hipotensão Ortostática , Doença de Parkinson , Disautonomias Primárias , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/etiologia , Depressão/etiologia , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/etiologia , Estudos Prospectivos
18.
Auton Neurosci ; 239: 102944, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35158161

RESUMO

Cardiovascular and psychiatric disorders are among the most commonly treated conditions worldwide. Research in neurocardiology, psychiatry, and epidemiology have defined bidirectional relationships between psychiatric disorders and heart disease, affirming the role of impaired autonomic nervous system, or dysautonomia in the prognosis and development in these disorders. These studies have fueled rapid clinical translation of experimental findings, with potential to complement existing pharmacological therapies. In this review, we comprehensively discuss the state-of-the-art investigations and novel treatment approaches for stress-related dysautonomias, emphasizing the effects of stress on the cardiac neuronal hierarchy. Increasing evidence suggests that autonomic modulation stands as an attractive therapeutic strategy in the treatment of dysautonomias that could complement existing therapies and possibly reduce the burden of drug-related side effects and treatment-resistant conditions. Further investigations regarding treatment optimization, selectivity, usability, and ethical concerns are required.


Assuntos
Disautonomias Primárias , Estimulação do Nervo Vago , Sistema Nervoso Autônomo , Coração , Frequência Cardíaca/fisiologia , Humanos
19.
Obes Surg ; 32(5): 1681-1688, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35133603

RESUMO

INTRODUCTION: With the increasing performance of bariatric surgery, rare complications are becoming prevalent. We review the diagnosis and treatment of dysautonomia after bariatric surgery and the limited treatment options available. We summarize the suggested mechanisms and explain why a complete understanding of the etiology has yet to be determined. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was performed. RESULTS: Of 448 studies identified in the literature search, 4 studies were reviewed, describing 87 patients diagnosed with dysautonomia. We present a patient who developed severe dysautonomia following conversion of sleeve gastrectomy to gastric bypass. CONCLUSION: Treatment needs to focus on optimizing nutrition, avoiding hypoglycemia, and optimizing volume status.


Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Hipoglicemia , Obesidade Mórbida , Disautonomias Primárias , Cirurgia Bariátrica/efeitos adversos , Gastrectomia , Derivação Gástrica/efeitos adversos , Humanos , Hipoglicemia/complicações , Hipoglicemia/terapia , Obesidade Mórbida/cirurgia , Disautonomias Primárias/diagnóstico , Disautonomias Primárias/etiologia , Disautonomias Primárias/terapia
20.
Neurophysiol Clin ; 52(1): 81-93, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35058123

RESUMO

OBJECTIVES: We aimed to assess and compare autonomic function in Parkinson's disease (PD) associated with the leucine-rich repeat kinase (LRRK2) G2019S mutation (LRRK2-PD) and non-LRRK2 PD, by the study of heart rate variability (HRV) and sympathetic skin responses (SSR). METHODS: In a cross-sectional three-year study, fifty LRRK2-PD and fifty clinically matched non-LRRK2 PD patients were included. Cardiac parasympathetic functions were assessed using heart rate variation to deep breathing (HR-DB), to the Valsalva maneuver (HR-V) and to standing (HR-S) and the sympathetic autonomic system by sympathetic skin responses (SSR). RESULTS: Neurophysiological, parasympathetic and sympathetic dysautonomia were found in 78%, 69% and 37% of all PD patients respectively. Rates of dysautonomia in the LRRK2-PD and non-LRRK2 PD patient subgroups were 76% vs 80% (p = 0.405) for neurophysiological, 62% vs 76% (p = 0.123) for parasympathetic and 38% vs 36% (p = 0.500) for sympathetic dysautonomia. HR-S was the most frequently altered parameter in both groups, and was significantly associated with the tremor-dominant (TD) motor phenotype of PD in the total cohort (p = 0.004) and in LRRK2-PD (p = 0.015). In LRRK2-PD patients, female gender was associated with parasympathetic dysfunction (p = 0.024), and with altered HR-DB (p = 0.022). Early-onset parkinsonism was also significantly associated with preserved neurophysiological autonomic functions (p = 0.044) in LRRK2-PD. In non-LRRK2 PD patients, male gender was associated with early parasympathetic (p = 0.043) and sympathetic dysfunction (p = 0.007). CONCLUSION: Our study showed a roughly similar neurophysiological autonomic profile in non-LRRK2 PD and LRRK2-PD. The latter had some peculiarities with more marked parasympathetic dysfunction and more altered HR-DB in females, more altered HR-S in the TD-motor phenotype, and preserved autonomic functions in early-onset parkinsonism. These preliminary findings would require further investigations on larger genetically homogeneous cohorts to explore the multiple facets of autonomic dysfunction in PD.


Assuntos
Doença de Parkinson , Disautonomias Primárias , Estudos Transversais , Feminino , Frequência Cardíaca , Humanos , Leucina/genética , Serina-Treonina Proteína Quinase-2 com Repetições Ricas em Leucina/genética , Masculino , Mutação , Disautonomias Primárias/complicações
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