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Autonomic Neuroscience: Basic & Clinical

Qi Fu, Benjamin D Levine
Recent research has demonstrated that cardiovascular deconditioning (i.e., cardiac atrophy and hypovolemia) contributes significantly to the Postural Orthostatic Tachycardia Syndrome (POTS) and its functional disability. Therefore, physical reconditioning with exercise training and volume expansion via increased salt and fluid intake should be initiated early in the course of treatment for patients with POTS if possible. The use of horizontal exercise (e.g., rowing, swimming, recumbent bike, etc.) at the beginning is a critical strategy, allowing patients to exercise while avoiding the upright posture that elicits their POTS symptoms...
July 4, 2018: Autonomic Neuroscience: Basic & Clinical
Glen A Cook, Paola Sandroni
Primary headache syndromes and chronic pain syndromes are common in patients with postural tachycardia syndrome (POTS). There is overlap in potential mechanisms for migraine, chronic pain, and POTS symptomatology. Management of chronic pain and headaches in POTS requires a judicious use of pharmacotherapies that takes into account patient comorbidities and co-existing symptoms. Patient-centric, non-pharmacologic modalities include physical exercise, cognitive behavioral therapies, and treatment of sleep disorders...
June 12, 2018: Autonomic Neuroscience: Basic & Clinical
Lauren E Stiles, Jaclyn Cinnamon, Irina Balan
Diagnosing and treating postural orthostatic tachycardia syndrome (POTS) can be a frustrating experience for patients and physicians alike. Experienced patient leaders solicited input from the large online POTS community to identify patient suggestions and concerns, with the goal of improving the patient-physician relationship and outcomes in POTS. This review article offers practical tips to improve POTS patient care and links to credible resources for your patients. The authors emphasize the urgent need for improved physician education, a tailored treatment approach, and expanded research efforts...
June 7, 2018: Autonomic Neuroscience: Basic & Clinical
Jeffrey R Boris
Postural orthostatic tachycardia syndrome (POTS) affects up to 3,000,000 people in the United States, with at least one-third of them developing POTS before the age of 18. POTS as a disorder is similar in adult and pediatric populations, but there are factors specific to pediatric patients that affect how it presents and how it is experienced that make pediatric POTS different. This review discusses the both the similarities in this population to their adult counterparts and the unique challenges faced by pediatric POTS patients, including management of schooling and education as well as the complex interactions between these pediatric patients and their parents...
May 12, 2018: Autonomic Neuroscience: Basic & Clinical
Kate Morgan, Catherine Chojenta, Meredith Tavener, Angela Smith, Deb Loxton
PURPOSE: Postural Orthostatic Tachycardia Syndrome is most commonly seen in women of child bearing age, however little is known about its effects in pregnancy. METHOD: A systematic review was conducted in March 2015 and updated in February 2018. Medline, Embase, PsychInfo, CINHAL, and the Cochrane Library were searched from database inception. The site and bibliographies were searched. MeSH and Emtree headings and keywords included; Postural Orthostatic Tachycardia Syndrome, Postural Tachycardia Syndrome, and were combined with pregnancy and pregnancy related subject headings and keywords...
May 9, 2018: Autonomic Neuroscience: Basic & Clinical
Mitchell G Miglis, Fiona Barwick
Fatigue is common in POTS, and patients often report unrefreshing sleep. These symptoms are directly correlated with a reduced quality of life, however the treatment of sleep disorders in this population remains a challenge. This article will review the current literature on the prevalence of sleep disorders in POTS, their association with the underlying pathophysiology of POTS, and current treatment paradigms.
May 8, 2018: Autonomic Neuroscience: Basic & Clinical
Amanda J Miller, Satish R Raj
Postural tachycardia syndrome (POTS) is a disorder characterized by the presence of orthostatic symptoms (including lightheadedness, palpitations, nausea, dyspnea, and tremulousness) as well as excessive upright tachycardia. POTS predominantly affects women of childbearing age. Treating POTS involves a multi-faceted approach using non-pharmacological and pharmacological interventions. There are no pharmacological treatments that are currently United States Food and Drug Administration (FDA) approved for POTS due to lack of randomized controlled trials...
May 4, 2018: Autonomic Neuroscience: Basic & Clinical
Steven Vernino, Lauren E Stiles
There is growing interest in the role of autoimmunity in postural orthostatic tachycardia syndrome (POTS). In recent years, investigators have described an increased rate of co-morbid autoimmune disease, and the presence of several neural receptor autoantibodies and non-specific autoimmune markers in POTS. Case reports on the efficacy of immunotherapy in highly selected POTS patients continue to appear in the literature, while no prospective clinical trials have occurred to date. This article summarizes the current state of knowledge on the role of autoimmunity in POTS, the clinical implications of these findings, and prospects for future research...
April 26, 2018: Autonomic Neuroscience: Basic & Clinical
Zhongxiang Cai, Mingyan Dai, Yijie Zhang, Hui Zhong, Tuantuan Tan, Mingwei Bao
OBJECTIVE: To investigate the effects of thyroid hormones on cardiac autonomic nervous activity and ventricular repolarization dynamicity in hyperthyroidism. METHODS: 57 consecutive patients first diagnosed of hyperthyroidism (HT group) and 55 age and sex-matched healthy volunteers (Control group) from March 2012 to March 2013 in our center were enrolled. All subjects underwent standard 12‑lead ECG and 24 h Holter recording at baseline. For the HT group, free triiodothyronine (FT3 ), free thyroxine (FT4 ) and thyroid stimulating hormone (TSH) were monitored, and after they returned to normal all the examinations were redone...
September 2018: Autonomic Neuroscience: Basic & Clinical
Jung-Ick Byun, Jangsup Moon, Do-Yong Kim, Hyerim Shin, Jun-Sang Sunwoo, Jung-Ah Lim, Tae-Joon Kim, Woo-Jin Lee, Han Sang Lee, Jin-Sun Jun, Kyung-Il Park, Soon-Tae Lee, Keun-Hwa Jung, Ki-Young Jung, Manho Kim, Sang Kun Lee, Kon Chu
INTRODUCTION: Severity of orthostatic intolerance and the benefit of medical treatment in patients with delayed OH have not been elucidated. This study aimed to compare the symptom severity between classic and delayed OH and evaluate the efficacy of midodrine or pyridostigmine in patients with delayed OH. METHODS: This was an adjunctive study of previously reported randomized, open-label clinical trials evaluating the efficacy and safety of midodrine or pyridostigmine for classic OH...
September 2018: Autonomic Neuroscience: Basic & Clinical
Hideki Tokuhisa, Hisayoshi Murai, Yoshitaka Okabe, Takuto Hamaoka, Hiroyuki Sugimoto, Yusuke Mukai, Oto Inoue, Shin-Ichiro Takashima, Takeshi Kato, Soichiro Usui, Hiroshi Furusho, Shuichi Kaneko, Masayuki Takamura
Augmented sympathetic nerve activity is associated with heart failure with preserved left ventricular ejection fraction (HFpEF). Lipophilic statins reduce sympathetic nerve activity in patients with heart failure with reduced left ventricular ejection fraction. However, little is known about whether all types of statins, regardless of solubility, reduce sympathetic nerve activity in HFpEF. We evaluated the effect of atorvastatin, a lipophilic statin, and rosuvastatin, a hydrophilic statin, on muscle sympathetic nerve activity (MSNA) in HFpEF patients...
September 2018: Autonomic Neuroscience: Basic & Clinical
Yang Mi, Qin Wu, Wanru Yuan, Fuxue Chen, Dongshu Du
The lack of precise therapies for stress-induced hypertension highlights the need to explore the process of blood pressure changes. Studies have shown that neuroinflammation in the central nervous system is associated with hypertension, although the mechanisms remain elusive. Microglia, are known to play dualistic protective and destructive roles, representing logical but challenging targets for improving stress-induced hypertension. Here, as a model, we used rats with stress-induced hypertension, and found that a switch from an immunoregulatory (M2) to a pro-inflammatory (M1) dominant response occurred in microglia during development of stress-induced hypertension...
September 2018: Autonomic Neuroscience: Basic & Clinical
Johanna Stenqvist, Thomas Carlsson, Michael Winder, Patrik Aronsson
Cholesterol rich membrane invaginations, caveolae, have important roles in various cellular activities, one of them being signal transduction. This signaling pathway seems to be affected during various bladder disorders and the current study aimed to elucidate the plausible involvement of caveolae mediated signal transduction during cyclophosphamide induced cystitis. Furthermore, the urothelial cholinergic part of ATP-evoked contractions and its possible link to caveolae were investigated. Cholinergic, as well as purinergic, contractile responses in rat urinary bladders were examined using a classic organ bath set-up with full-thickness strip preparations or a whole bladder model that enabled luminal administration of substances...
September 2018: Autonomic Neuroscience: Basic & Clinical
Calvin S Pohl, Elizabeth M Lennon, Yihang Li, Morgan P DeWilde, Adam J Moeser
The cholinergic system plays a central role in regulating critical gastrointestinal functions, including motility, secretion, barrier and immune function. In rodent models of acute, non-infectious gastrointestinal injury, the cholinergic system functions to inhibit inflammation; however, during inflammation local expression and regulation of the cholinergic system is not well known, particularly during infectious enteritis. The objective of this study was to determine the intrinsic expression of the enteric cholinergic system in pig ileum following an acute challenge with Salmonella enterica serovar Typhimurium DT104 (S...
September 2018: Autonomic Neuroscience: Basic & Clinical
Lívia P Carvalho, Luciana Di Thommazo-Luporini, Renata G Mendes, Ramona Cabiddu, Paula A Ricci, Renata P Basso-Vanelli, Manoel C Oliveira-Junior, Rodolfo P Vieira, José C Bonjorno-Junior, Cláudio R Oliveira, Rafael L Luporini, Audrey Borghi-Silva
Obesity is often associated with increased risk of cardiometabolic morbidities and mortality. However, evidence shows that some obese individuals are more likely to develop such risk factors early in life, including those with Metabolic Syndrome (MetS). Whether the presence of MetS in obese people impairs cardiac autonomic modulation (CAM) remains to be investigated. METHODS: Cross-sectional study. Sixty-six subjects were classified as normal-weight (NW, n = 24) or obese (BMI ≥ 30 kg·m-2 ): metabolically healthy (MHO, n = 19) vs unhealthy (MUHO, n = 23: NCEP/ATPIII-MetS criteria)...
September 2018: Autonomic Neuroscience: Basic & Clinical
Alexandra Büki, György Kalmár, Gabriella Kekesi, Gyorgy Benedek, László G Nyúl, Gyongyi Horvath
Patients with schizophrenia show impairments in autonomic regulation, including pupillomotor control. The aim of this study was to explore the changes of pupillary light reflex in a new substrain (WISKET) with several schizophrenia-like alterations. Male WISKET rats housed individually (for four weeks) and treated with ketamine (for 3 × 5 days) after weaning and naive group-housed Wistar rats (controls) were involved in the study. The pupillary light reflex was studied in two series after sedation (diazepam) or anesthesia (chloral hydrate)...
September 2018: Autonomic Neuroscience: Basic & Clinical
Tatiana Dias de Carvalho, Thais Massetti, Talita Dias da Silva, Tânia Brusque Crocetta, Regiani Guarnieri, Luiz Carlos Marques Vanderlei, Carlos Bandeira de Mello Monteiro, David M Garner, Celso Ferreira
INTRODUCTION: Down syndrome (DS) results in many changes, including dysfunction in cardiac autonomic modulation. Heart rate variability (HRV) analysis evaluates the autonomic function and it is a predictor of adverse cardiovascular events. OBJECTIVE: To present results of a systematic review and a meta-analysis about heart rate variability in individuals with DS. METHOD: A systematic review was performed on PubMed, PubMed Central and Web of science databases...
September 2018: Autonomic Neuroscience: Basic & Clinical
Tatsuo Takamiya, Yukiko Kubo, Peyman Benharash, Wei Zhou
Augmentation of cardiac sympathetic tone has been shown to induce ventricular arrhythmias. Acupuncture has been clinically used to treat hypertension, angina pectoris, and atrial arrhythmias. However, the effects of acupuncture on ventricular electrophysiology and autonomic tone remain unknown. We hypothesized that acupuncture attenuates cardiac excitability and corrects the imbalance of autonomic tone during sympathetic hyperactivity. Fourteen Yorkshire pigs were randomized to electroacupuncture (EA, 2 Hz, 0...
September 2018: Autonomic Neuroscience: Basic & Clinical
Felipe X Cepeda, Matthew Lapointe, Can Ozan Tan, J Andrew Taylor
BACKGROUND: Prior work has found that linear heart rate variability (HRV) indices do not accurately reflect cardiac vagal control, and nonlinear indices of HRV have been proposed as alternative tools that may better capture cardiac vagal effects. We used progressive low dose atropine to induce changes in cardiac vagal tone to test the hypotheses that nonlinear HRV indices accurately reflect cardiac vagal control, and that their changes in response to low dose atropine correlate with those in RR interval...
September 2018: Autonomic Neuroscience: Basic & Clinical
Camille Fauchon, Vincent Pichot, Isabelle Faillenot, Benjamin Pommier, Luis Garcia-Larrea, Roland Peyron, Florian Chouchou
Although modulation of cardiac activity may be influenced by several factors, interaction between autonomic nociceptive responses and the high-level of cortical processes is not clearly understood. Here, we studied in 26 subjects whether empathetic or unempathetic contexts could interact with autonomic pain responses. RR intervals variability was used to approach parasympathetic and sympathetic responses to painful thermal stimulations, according to contexts evoked by experimenters' comments. We observed that unempathetic context increased sympathetic reactivity to comments and to painful stimulations without any parasympathetic change...
July 2018: Autonomic Neuroscience: Basic & Clinical
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