Parasympathetic Autonomic Function Research Articles

PECULIARITIES OF ORTHODONTIC TREATMENT FOR PATIENTS WITH GENERALIZED PERIODONTITIS AND PREDOMINANCE OF PARASYMPATHETIC NERVOUS SYSTEM ACTIVITY

The use of orthodontic treatment for patients with generalized periodontitis enhances the effectiveness of comprehensive care. However, it is important to consider the reduced capacity for alveolar bone regeneration in these patients. Therefore, as part of the complex treatment of generalized periodontitis, the inclusion of medications to support alveolar bone regeneration is essential. The course of various diseases can be influenced by the state of the patient’s autonomic nervous system. In this study, medications were administered to normalize parasympathetic nervous system activity in patients with generalized periodontitis undergoing orthodontic treatment. The objective of the study was to evaluate the effectiveness of orthodontic treatment in patients with generalized periodontitis, particularly those with a predominance of parasympathetic autonomic nervous system activity. This was assessed by the supplementary use of a combination of drugs designed to stimulate alveolar bone formation and regulate parasympathetic nervous system function. Materials and methods. This study involved 35 young patients (aged 18-35) with generalized periodontitis and a predominance of parasympathetic autonomic nervous system activity, all of whom presented with displacement of the maxillary frontal teeth. These patients underwent orthodontic treatment. To correct the state of the autonomic nervous system over the treatment of generalized periodontitis, patients were prescribed to take a complex of medicines including the preparation “Calcinova” for stimulating osteogenesis. A comprehensive periodontal examination, including the assessment of hygienic indices, was conducted to evaluate periodontal status throughout the treatment. Results. The periodontal examination revealed that almost all patients demonstated an improvement in oral health. Noticeable dynamics in the pathological process were observed as a result of the complex treatment. The analysis of these findings underscores the importance of orthodontic treatment for patients with generalized periodontitis, particularly when combined with methods to correct parasympathetic nervous system activity and promote osteogenesis. This approach was shown to positively affect periodontal tissues and enhance the effectiveness of generalized periodontitis treatment. Conclusions. Correction of parasympathetic autonomic nervous system function enhances the effectiveness of therapy. In this study, a complex of medications was used to improve parasympathetic nervous system activity. The addition of “Calcinova” to stimulate osteogenesis further contributed to achieving more stable treatment outcomes in patients with generalized periodontitis.

A Study of Parasympathetic Autonomic Function in Different Phases of the Menstrual Cycle among Young Adult Females

Background: The sex hormones, estrogen, and progesterone, as well as the gonadotropins, luteinizing hormone, and follicle-stimulating hormone produced from the anterior pituitary, govern the three stages of the menstrual cycle: menstrual, follicular, and luteal. Hormone fluctuations cause changes in autonomic function. There have been relatively few studies that show autonomic function modification throughout various periods of the menstrual cycle. Aim and Objectives: The current study was undertaken to investigate the difference in mean parasympathetic autonomic characteristics between the proliferative and secretory stages of the menstrual cycle. Materials and Methods: A total of 120 healthy young adult female volunteers were recruited among Kalinga Institute of Medical Sciences, Kalinga Institute of Nursing Sciences, and Kalinga Institute of Dental Sciences students. The study eliminated 20 students who were in the bleeding phase of their cycle. The electrocardiogram was captured, and parasympathetic parameters were determined using the fully automated CANWin instrument in the Department of Physiology. The data of the abovementioned parameters were compiled, tabulated, and entered into Microsoft Excel 2013 and statistically analyzed using STATA software 15.1. Results: The subjects’ mean ages, heights, and weights were 18.9 ± 0.70 years, 156.6 ± 5.25 cm, and 53.7 ± 8.63 kg, respectively. The mean resting heart rate in the secretory phase was substantially greater than in the proliferative phase, indicating sympathetic dominance. The 30:15 ratio between proliferative and secretory stages. The mean E: I ratio calculated from the slow deep breathing maneuver reveals a statistically significant difference between the proliferative and secretory phases. Conclusion: During the secretory phase, there is a considerable rise in parasympathetic activity among the individuals in the current study. Changes in parasympathetic activity throughout the follicular and secretory stages of the menstrual cycle may be caused by fluctuations in estrogen and progesterone levels.

Demonstrating new-onset or worsened sudomotor function post-COVID-19 on comparative analysis of autonomic function pre-and post-SARS-CoV-2 infection.

Autonomic dysfunction including sudomotor abnormalities have been reported in association with SARS-CoV-2 infection. There are no previous studies that have compared autonomic function objectively in patients pre- and post- SARS-CoV-2 infection.We aimed to identify if SARS-CoV-2 virus is triggering and/or worsening dysautonomia by comparing autonomic function tests in a group of patients pre-and post-SARS-CoV-2 infection. Six participants were enrolled and divided into two groups. The first group of 4 participants reported worsened autonomic symptoms post-SARS-CoV-2 infection. These individuals had their first autonomic test prior to COVID-19 pandemic outbreak (July 2019-December 2019). Autonomic function testing was repeated in these participants, 6months to 1-year post-SARS-CoV-2 infection (June 2021).The second group of 2 participants reported new-onset autonomic symptoms post-COVID-19 infection and were also tested within 6months post-SARS-CoV-2 infection.All participants had mild COVID-19 infection per WHO criteria. They had no evidence of large fiber neuropathy as demonstrated by normal neurophysiological studies (EMG/NCS). They were all screened for known causes of autonomic dysfunction and without risk factors of hypertension/hyperlipidemia, thyroid dysfunction, diabetes/prediabetes, vitamin deficiencies, history of HIV, hepatitis, or syphilis, prior radiation or chemical exposure or evidence of monoclonal gammopathy, or autoimmune condition. Participants were female (age: 21-37y) and all endorsed orthostatic intolerance (6/6). Gastrointestinal symptoms (⅚), new-onset paresthesias, (3/6), and sexual dysfunction (2/6) were reported. Parasympathetic autonomic function remained stable 6-months to 1-year post-COVID-19 infection and no parasympathetic dysfunction was demonstrated in participants with new-onset dysautonomia symptoms. Postural orthostatic tachycardia was noted in half of the patients, being observed in one patient pre- SARS-CoV-2 infection and persisting post-SARS-CoV-2 infection; while new-onset postural tachycardia was observed in 1/3rd of patients. Sympathetic cholinergic (sudomotor) dysfunction was demonstrated in ALL participants. Worsened, or new-onset, sudomotor dysfunction was demonstrated in those with mild or normal sudomotor function on pre-COVID-19 autonomic testing. Sympathetic adrenergic and cholinergic dysautonomia probably account for some of the symptoms of Long COVID-19. Sudomotor dysfunction was demonstrated as consistently worsened or new-sequelae to COVID-19 infection. COVID-19 may be responsible for triggering new-onset or worsened small-fiber neuropathy in this sample, supporting previously reported studies with similar findings. However, the findings in our study are preliminary, and studies with larger sample size are needed to confirm these observations.

Application of Physiological Autonomic Activity Tracking GUI and Computational Algorithms for Measuring Persistent Vagal Nerve Dysfunction After Recovery from SARS‐CoV‐2 Infection

Post‐Acute Sequelae of SARS‐CoV‐2 infection (PASC) is now recognized as a constellation of symptoms such as postural hypotension, anxiety, and “brain fog” in addition to autonomic nervous system dysfunction such as tachycardia and labile hypertension. Better quantification of these conditions, specifically, autonomic nervous system dysfunction, is desired for future diagnostics, treatment modalities, and gaining a further understanding of PASC. This research has led to application of a novel autonomic activity tracking algorithm and GUI suite from previous work, see Figure 1, to study the physiological autonomic activity in six patients who had recovered from acute SARS‐CoV‐2 infection a mean of six months prior but were still experiencing symptoms. By measuring skin sympathetic nervous activity (SKNA), heart rate variability, and the cutaneous electrogastrogram (EGG), all before and after a water meal challenge, the data was fed into a custom analysis pipeline, shown in Figure 1. Each of the PASC patients were compared to a mean response of 34 healthy controls, each undergoing a 20‐minute baseline recording and another 20‐minute recording after ingestion of an 8 oz water test meal. All six patients showed significantly abnormal heart rate variability on frequency domain analysis in predominantly the low frequency (LF) and very low frequency (VLF) bands, and less so in the high frequency (HF) band, suggesting sympathetic nerve dysfunction. Three patients showed a significant decrease in SKNA while two showed a significant increase. All patients showed an abnormal cutaneous EGG. As shown in Figure 2, the temporal responses of aSKNA, VLF, LF, HF, and EGG for the PASC patients revealed that on average they were statistically different (p<0.05) from the healthy controls’ responses respectively during 98.4%, 78.4%, 86.76%, 47.9%, and 86.1% of the 40‐minute time period in testing, 20 minutes of baseline and 20 minutes after ingestion. In conclusion, we are looking at the sympathetic, parasympathetic, and enteric nervous systems synced temporally for applications with classification and further stratification of PASC based on the temporal dynamics of their autonomic nervous system mediated coordination from digestion. This shows that SARS‐CoV02 infection appears to have a significant effect on sympathetic and parasympathetic autonomic nervous system function and may be responsible for the disturbances noted in PASC. This work provides the framework and example of use for further applications in autonomic disorder physiological response exploration and furthermore can be expanded to other areas of neuromodulation.

Phosphorus Supplementation Mitigates Perivascular Adipose Inflammation-Induced Cardiovascular Consequences in Early Metabolic Impairment.

BackgroundThe complexity of the interaction between metabolic dysfunction and cardiovascular complications has long been recognized to extend beyond simple perturbations of blood glucose levels. Yet, structured interventions targeting the root pathologies are not forthcoming. Growing evidence implicates the inflammatory changes occurring in perivascular adipose tissue (PVAT) as early instigators of cardiovascular deterioration.Methods and ResultsWe used a nonobese prediabetic rat model with localized PVAT inflammation induced by hypercaloric diet feeding, which dilutes inorganic phosphorus (Pi) to energy ratio by 50%, to investigate whether Pi supplementation ameliorates the early metabolic impairment. A 12‐week Pi supplementation at concentrations equivalent to and twice as much as that in the control diet was performed. The localized PVAT inflammation was reversed in a dose‐dependent manner. The increased expression of UCP1 (uncoupling protein1), HIF‐1α (hypoxia inducible factor‐1α), and IL‐1β (interleukin‐1β), representing the hallmark of PVAT inflammation in this rat model, were reversed, with normalization of PVAT macrophage polarization. Pi supplementation restored the metabolic efficiency consistent with its putative role as an UCP1 inhibitor. Alongside, parasympathetic autonomic and cerebrovascular dysfunction function observed in the prediabetic model was reversed, together with the mitigation of multiple molecular and histological cardiovascular damage markers. Significantly, a Pi‐deficient control diet neither induced PVAT inflammation nor cardiovascular dysfunction, whereas Pi reinstatement in the diet after a 10‐week exposure to a hypercaloric low‐Pi diet ameliorated the dysfunction.ConclusionsOur present results propose Pi supplementation as a simple intervention to reverse PVAT inflammation and its early cardiovascular consequences, possibly through the interference with hypercaloric‐induced increase in UCP1 expression/activity.

Interictal autonomic changes in persons with epilepsy (PWE) on carbamazepine (CBZ) versus other anti-seizure drug monotherapy: A cross-sectional study

ObjectiveEpilepsy is one of the most prevalent neurological conditions and carbamazepine is a commonly used anti-seizure drug (ASD), especially in developing nations. There are reports of carbamazepine causing atrioventricular conduction defects and autonomic dysfunctions and its implication in Sudden Unexpected Death in Epilepsy (SUDEP) is controversial. We planned this study to assess the effect of carbamazepine (CBZ) on autonomic function compared to other ASDs in persons with epilepsy. MethodsIn this cross-sectional study, we assessed the sympathetic and parasympathetic autonomic functions in persons with epilepsy (PWE) on CBZ versus other anti-seizure monotherapy using tests of heart rate variability including its time-, frequency- and non-linear domains, heart rate response to deep breathing, valsalva maneuver, and blood pressure response to isometric handgrip. ResultsPersons with epilepsy on CBZ monotherapy did not show a significant reduction in the time domain parameter SDRR compared to other ASDs used as monotherapy (mean ± SD, 38.04 ± 18.75 ms vs 44.37 ± 20.35 ms; p = 0.125). However, PWE on CBZ had significantly lower time-domain measurements including RMSSD (mean ± SD 31.95 ± 17.29 ms vs 42.02 ± 22.29 ms; p = 0.018), SDSD (mean ± SD 31.91 ± 17.26 ms vs 41.96 ± 22.27 ms; p 0.018), and pNN50 [median (IQR) 05.45(0.69–25.37) vs 16.38(2.32–36.83); p = 0.030]. Frequency domain measures of HRV, heart rate responses to deep breathing, valsalva maneuver and tilt-testing and BP responses to valsalva and tilt-testing were not significantly different between the groups. ConclusionThe findings of our study indicate reduced parasympathetic activity in persons on CBZ monotherapy compared to other ASDs, which may pose risk of SUDEP. Carbamazepine may thus be avoided in those at risk of autonomic dysfunction and SUDEP.

Autonomic and Somatic Nerve Functions in Type 2 Diabetes Mellitus Patients: Electrophysiological Aspects.

Objectives: To investigate the relationship between neurophysiological sensory and motor nerve function parameters, assessed by nerve conduction studies (NCS) with parasympathetic autonomic function and by heart rate variability (HRV) tests in patients with type 2 diabetes mellitus (T2DM). Material and Methods: A total of 161 T2DM patients underwent NCS. Cardiac autonomic response was assessed by HRV tests to deep breathing (HRV DB), to Valsalva manoeuvre, and during postural change from lying to standing. Results: The amplitude of motor response in the median nerve, tibial nerve, and peroneal nerve was associated with reduced HRV DB (p = 0.0001). The amplitude of motor response in the median nerve, tibial nerve, and peroneal nerve was associated with reduced HRV Valsalva (p = 0.0001). The correlation between the amplitude of response in all sensory nerves (sural, median, and ulnar) and HRV DB was statistically significant (p = 0.0001). Conclusion: The results indicate that there is a correlation in T2DM patients between the damage of small myelinated and unmyelinated nerve fibres from cardiac autonomic nerves, assessed by HRV tests and damage of large motor and sensory fibres, assessed by NCS. Based on the above results, a combination of NCS and HRV tests should be considered in the neurophysiological approach to diabetic neuropathy.

Effect modification of omega-3 fatty acids on short-term associations between ambient air temperature and heart rate variability

BACKGROUND AND AIM: Although the biological mechanisms remain uncertain, non-optimal air temperatures have been associated with cardiovascular mortality. Dietary intake of omega-3 fatty acids (n-3 FA) has been correlated with cardiovascular health. This panel study aimed to examine whether n-3 FA would modify associations between ambient air temperature and autonomic function measured by changes in heart rate variability (HRV). METHODS: Six-two healthy adults (age: 25–55 years) residing in North Carolina, U.S. were recruited into low (n=28) and high (n=34) omega-3 groups based on dietary n-3 FA intake and blood levels of omega-3 index. Each participant underwent 3-5 examinations separated by at least one week between October 2016 and September 2019. HRV was measured using 5-minute resting electrocardiography recorded at each examination. Daily meteorological data were obtained from a central air monitoring station. We applied mixed-effects models with a distributed lag non-linear approach to assess associations between air temperature (lag 0-6 days) and HRV stratified by omega-3 levels. RESULTS:We observed inverse U-shape relationships between HRV indices and temperature in the low omega-3 group, which were significant for high temperatures. No associations were observed in the high omega-3 group. An increase from 10 °C (approximate optimum temperature) to the 95th percentile (28 °C) of temperature was associated with decreases in standard deviation of NN intervals [SDNN, -40.6% (95% CI: -63.7, -2.7)], root mean square of successive RR interval differences [RMSSD, -63.9% (95% CI: -82.7, -24.8)], and high-frequency power [HF, -82.7% (95% CI: -97.2, 5.2)]. The between-group differences were significant for RMSSD and HF. CONCLUSIONS:Non-optimal air temperatures, especially high temperatures were associated with decreased parasympathetic autonomic function that might explain the temperature effects on cardiovascular events. In addition, n-3 FA intake was associated with beneficial effects on autonomic function against non-optimal temperatures. This abstract does not necessarily reflect EPA policy. KEYWORDS: Cardiovascular diseases, Climate, Environmental epidemiology, Short-term exposure, Temperature

Correlations between left ventricular rotational mechanics and parasympathetic autonomic function-results from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study.

Left ventricular (LV) twist is calculated from the net difference of counterclockwise apical and clockwise basal rotation during systole. The current study was designed to evaluate correlations between autonomic function and LV rotational mechanics in healthy subjects. The present study comprised 18 healthy subjects (mean age: 36±12 years, 12 men). Three-dimensional speckle tracking echocardiography (3DSTE) could be used for non-invasive evaluation of LV rotation and twist. Autonomic function was assessed by means of 5 standard cardiovascular reflex tests. During 3DSTE, basal LV rotation proved to be -3.24±2.02 degree, while apical LV rotation was 9.08±3.04 degree, therefore LV twist was 11.70±6.80 degree. Valsalva test showed significant correlations with LV basal (r=0.529, P=0.019) and apical rotations (r=-0.534, P=0.022), and LV twist (r=-0.467, P=0.044). Heart rate response to deep breathing significantly correlated with LV twist, as well (r=-0.452, P=0.052). The other tests had no any relationship with rotational characteristics. Correlations exist between parasympathetic autonomic function and 3DSTE-derived LV rotation and twist in healthy subjects.

Correlation between cotinine urinary levels & cardiovascular autonomic function tests among smokeless tobacco chewers: A cross-sectional study.

Background & objectives:Cardiovascular disease (CVD), the leading cause of death worldwide is responsible for over 17 million deaths globally, of which 10 per cent deaths have been expected due to consumption of tobacco. The association between CVD and chewing of tobacco is limited and remains arguable. The aim of this study was to find out the correlation between urinary cotinine level and cardiovascular autonomic function tests of tobacco chewers.Methods:In the present study, 600 participants, 300 smokeless tobacco chewers (STC) and 300 non-tobacco chewers (NTC), between 18 and 65 yr were selected. Various parameters such as anthropometric, systolic blood pressure (SBP), diastolic blood pressure (DBP), autonomic function tests and urinary cotinine levels were measured.Results:Significant difference (P<0.001) was noted in STC and NTC for anthropometric parameters, SBP, DBP and urinary cotinine levels. Sympathetic and parasympathetic autonomic function test showed significant difference on comparison in STC and NTC groups, except in Valsalva ratio. Correlations with urinary cotinine levels were significant for sympathetic autonomic functions, SBP fall (r=0.138, P=0.016), DBP rise (r=−0.141, P≤0.014); parasympathetic autonomic function, heart rate (HR) response to standing (r=−0.208, P≤0.003), deep breathing (r=−0.473, P≤0.001) and Valsalva ratio (r=−0.396, P≤0.0001).Interpretation & conclusions:Correlation between urinary cotinine levels and autonomic function tests elucidates the linkage involving autonomic nervous system damage which can be considered as an important associated relationship for early diagnosis of CVD health risk factors among smokeless tobacco (ST) users.

Correlation of C1q/TNF-Related Protein-3 with Cardiac Autonomic Tone and Metabolic Parameters in Obesity.

ObjectivesThe current study aimed at investigating the correlation of circulating levels of serum C1q/TNF-related protein-3 (CTRP3) with cardiac autonomic functions and metabolic parameters in obesity.MethodsThirty drug naïve subjects newly diagnosed with obesity and body mass index (BMI) 25 - 35 kg/m2 of both genders aged 19 - 40 years, with no associated comorbidity were recruited as cases. Same number of age, gender and socioeconomic status matched subjects with BMI 19 - 23 kg/m2 were taken as controls. Autonomic function test results including heart rate variability (HRV) were recorded in both groups. Serum metabolic parameters -CTRP3, leptin, adiponectin, insulin, blood glucose, glycated hemoglobin (HbA1c), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, and triglycerides were also determined and compared between the groups.ResultsSignificantly lower circulating levels of CTRP3 (P ≤ 0.001) and adiponectin (P = 0.025), and significantly higher mean of BMI (P < 0.001), fasting blood glucose (P < 0.001), LDL-cholesterol (P < 0.05), serum triglycerides (P < 0.001), insulin (P = 0.003), HOMA-IR (homeostasis model assessment of insulin resistance) (P < 0.001), and leptin (P = 0.043) were observed in the group with obesity compared to the controls. CTRP3 levels inversely correlated with serum triglyceride (r = -0.09, P < 0.001), atherogenic index (r = -0.37, P = 0.04), leptin (r = -0.39, P = 0.02), and positively with adiponectin (r = 0.42, P = 0.02) in the group with obesity. Significant reduction in the results of parasympathetic autonomic function tests (pNN50, RMSSD, excitation: inhibition (E:I) ratio, 30:15 ratio, and Valsalva ratio) and an increase in sympathovagal balance (low frequency to high frequency (LF:HF) ratio) was also observed (P < 0.05). CTRP3 levels were also positively correlated with parasympathetic indices (pNN50: r = 0.17, P < 0.05); 30:15 ratio: (r = 0.62, P < 0.01), and inversely correlated with LF: HF ratio (r = -0.35, P < 0.01) in the group with obesity.ConclusionsHigher circulating levels of CTRP3 promoted a favorable autonomic and metabolic profile in obesity. Hence, CTRP3 may be considered as a potential novel biomarker to facilitate the prognosis of obesity and its comorbidities.

Prevalence and patterns of cardiac autonomic dysfunction in male patients with type 2 diabetes mellitus and chronic Charcot’s neuroarthropathy: a cross-sectional study from South India

Our study aimed to look at the prevalence and patterns of cardiac autonomic neuropathy related dysfunction in male patients of type 2 diabetes mellitus with chronic Charcot’s foot. A total of 74 male patients with type 2 diabetes mellitus were included in this study. Three groups of patients were selected: Group 1 included patients with chronic Charcot’s foot (n = 24), group 2 included patients with diabetic peripheral neuropathy without chronic Charcot’s foot (n = 22) and group 3 included patients without peripheral neuropathy or chronic Charcot’s foot (n = 28). The autonomic functions were tested using a personal computer-based cardiac autonomic neuropathy (CANS-504) analyser. The combined sympathetic (SNS) and parasympathetic autonomic function (PNS) abnormalities were detected in about 70.8% in the chronic Charcot’s group, 55.6% in the peripheral neuropathy group and 35.7% in the non-neuropathic group. In patients with chronic Charcot’s foot (n = 24), 29.2% had normal, 20.8% had borderline and 50% had abnormal PNS functions, while 4.2% had normal, 16.7% had borderline and 79.2% had abnormal SNS functions. The Meary’s angle (183.18 ± 73.83 vs 157.98 ± 14.11; p < 0.196) and Calcaneal pitch (7.07 ± 3.30 vs 8.5 ± 1.88; p < 0.219) were greater in the subjects with combined autonomic neuropathy, suggesting more structural deformity in them. Cardiac autonomic neuropathy-related dysfunction was found to be more common in type 2 diabetes patients with chronic Charcot’s foot. This study has highlighted that patients with diabetic mellitus and chronic Charcot’s foot should be screened comprehensively in order to prevent complications related to cardiac autonomic dysfunction.

Evaluation of cardiac autonomic function in overweight males: A cross-sectional study

Background and Aim: Cardiovascular autonomic function tests (CAFTs) are non-invasive tests that can assess both sympathetic and parasympathetic autonomic functions. Autonomic dysfunction may be considered as a risk factor for obesity and vice versa. For measurement of obesity, body mass index (BMI) is a simple, valid and inexpensive method. Hence, this study was designed to evaluate the effect of obesity based on BMI criteria on autonomic nervous system based on CAFT in young adult males. Methods: A cross-sectional study was carried out on 43 young adult males in the age group of 18–25 years with an age-matched control (n = 43) group. After initial screening, anthropometric measurements were recorded. CAFTs were performed and recorded by the Cardiac Autonomic Neuropathy Analysis System (CANWin). Unpaired t- test was done to compare the parameters of study and control groups in Microsoft Excel® 2010. Results: Parasympathetic test parameters of study and control groups when expressed in mean ± standard deviation were not found statistically significant (P > 0.05). The fall in systolic blood pressure (BP) in orthostatic test of study group (12.19 ± 4.8 mmHg) was significantly (P = 0.0001) higher than that of control group (7.33 ± 5.16 mmHg). Increase in diastolic BP in isometric handgrip exercise test of study group (11.84 ± 5.39 mmHg) was significantly less (P = 0.004) than that of control group (16.39 ± 8.71 mmHg). Conclusion: Overweight young males have altered sympathetic activity but parasympathetic activity did not show any significant difference when compared to normal weight males.

Postnatal Cardiac Autonomic Nervous Control in Pediatric Congenital Heart Disease.

Congenital heart disease is the most common congenital defect. During childhood, survival is generally good but, in adulthood, late complications are not uncommon. Abnormal autonomic control in children with congenital heart disease may contribute considerably to the pathophysiology of these long term sequelae. This narrative review of 34 studies aims to summarize current knowledge on function of the autonomic nervous system in children with a congenital heart defect. Large scale studies that measure both branches of the nervous system for prolonged periods of time in well-defined patient cohorts in various phases of childhood and adolescence are currently lacking. Pending such studies, there is not yet a good grasp on the extent and direction of sympathetic and parasympathetic autonomic function in pediatric congenital heart disease. Longitudinal studies in homogenous patient groups linking autonomic nervous system function and clinical outcome are warranted.

Neurophysiological autonomic evaluation in central nervous system disorders

Disorders of the autonomic nervous system (ANS) can be primary or secondary, causing irreversible or intermittent autonomic dysfunction. Autonomic neurophysiological investigation is crucial for diagnosis and understanding pathophysiological processes which aid treatment. This lecture will focus on CNS disorders with ANS involvement, such as multiple system atrophy (MSA), Parkinson’s Disease with autonomic failure (PD + AF), and spinal cord injury (SCI). Examples will be provided of major intermittent ANS conditions, autonomic mediated syncope (AMS) and the postural tachycardia syndrome (PoTS) where there maybe a substantial CNS component. Neurophysiological evaluation include tests with a range of manouevres to assess sympathetic and parasympathetic cardiovascular autonomic function to determine underactivity or overactivity. Responses to specific stimuli (food, exercise and carotid massage) may be needed. Plasma catecholamines can provide important information. Combining approaches can be of diagnostic value, as the growth hormone response to Clonidine, usually abnormal in MSA. The sympathetic skin response (SSR) is valuable in certain disorders. Examples will be provided in the major disorders where autonomic evaluation enables diagnosis and aids management of autonomic dysfunction.

Study of Changes in Sympathetic and Parasympathetic Autonomic Functions in Patients of Depression in Rural Western Maharashtra

Introduction: The deficiency of monoaminergic neurotransmission is important key pathology of depression. With these changes in excitatory neurotransmission in brain it can be hypothesised that this alteration may result into changes in various sympathetic and parasympathetic parameters like Blood pressure, Heart rate and expiratory and inspiratory ratio. Methodology: It is a Case Control Observational Study done in collaboration with department of Psychaitry and all patients of depression satisfying the inclusion and exclusion criteria were studied for the changes in Blood pressure using handgrip test and Orthostatic Hypotensive Test while changes resting heart rate was recorded. Result and conclusion: There was increase in heart rate found in depression whereas blood pressure diastolic and systolic were found to be lower than a normal individual. KEYWORDS: Neurotransmission, Depression, Sympathetic and Parasympathetic, Blood Pressure, Heart Rate, Orthostatic Hypotensive Test.

Alterations in Amygdala-Prefrontal Functional Connectivity Account for Excessive Worry and Autonomic Dysregulation in Generalized Anxiety Disorder

BackgroundGeneralized anxiety disorder (GAD) is characterized by the core symptom of uncontrollable worry. Functional magnetic resonance imaging studies link this symptom to aberrant functional connectivity between the amygdala and prefrontal cortex. Patients with GAD also display a characteristic pattern of autonomic dysregulation. Although frontolimbic circuitry is implicated in the regulation of autonomic arousal, no previous study to our knowledge combined functional magnetic resonance imaging with peripheral physiologic monitoring in these patients to test the hypothesis that core symptoms of worry and autonomic dysregulation in GAD arise from a shared underlying neural mechanism. MethodsWe used resting-state functional magnetic resonance imaging and the measurement of parasympathetic autonomic function (heart rate variability) in 19 patients with GAD and 21 control subjects to define neural correlates of autonomic and cognitive responses before and after induction of perseverative cognition. Seed-based analyses were conducted to quantify brain changes in functional connectivity with the right and left amygdala. ResultsBefore induction, patients showed relatively lower connectivity between the right amygdala and right superior frontal gyrus, right paracingulate/anterior cingulate cortex, and right supramarginal gyrus than control subjects. After induction, such connectivity patterns increased in patients with GAD and decreased in control subjects, and these changes tracked increases in state perseverative cognition. Moreover, decreases in functional connectivity between the left amygdala and subgenual cingulate cortex and between the right amygdala and caudate nucleus predicted the magnitude of reduction in heart rate variability after induction. ConclusionsOur results link functional brain mechanisms underlying worry and rumination to autonomic dyscontrol, highlighting overlapping neural substrates associated with cognitive and autonomic responses to the induction of perseverative cognitions in patients with GAD.

Assessment of parasympathetic autonomic functions in ulcerative colitis patients

Background: Ulcerative colitis has been reported to be associated with autonomic dysfunction, mainly of vagal involvement.&#x0D; Objectives: To Determine whether there is a parasympathetic dysfunction in ulcerative colitis patients in remission state or not.Results: For all of the three tests, patients group gave significantly lower results (P˂ 0.05) which was the least level of significance. Materials and methods: Three standardized tests of parasympathetic function, based on heart rate variation in response to certain stimuli (heart rate response to Valsalva maneuver, to deep breathing and to standing from supine position) were used on 54 ulcerative colitis patients in remission, and 41 healthy volunteers as a control group.&#x0D; Conclusion: Ulcerative colitis is associated with vagal dysfunction which could be a hidden cause for the underlying inflammatory status because of the recently established anti-inflammatory role of vagus nerve.

Prospective randomized controlled intervention trial: Comprehensive Yogic Breathing Improves Cardiac autonomic functions and Quality of life in Diabetes

Aims and Objectives: To assess the effect of Comprehensive Yogic Breathing Program on glycemic control, quality of life, and cardiac autonomic functions in diabetes. Material and Methods: This is a prospective randomized controlled intervention trial. Cardiac autonomic functions were assessed in 120 diabetics. Patients were randomized into two groups, one group receiving standard therapy for diabetes (n = 56) and the other group receiving standard therapy for diabetes and comprehensive yogic breathing program (n = 64). Standard therapy included advice on diet, walk, and oral antidiabetic drugs. Comprehensive yogic breathing program was an interactive session in which Sudarshan kriya yoga, a rhythmic cyclical breathing, preceded by Pranayam was taught under guidance of a certified teacher. Change in fasting, post prandial blood sugars, glycated hemoglobin, and quality of life were assessed. Cardiac autonomic function tests were done before and six months after intervention. Results: There was significant improvement in psychological (P = 0.006) and social domains (P = 0.04) and total quality of life (P = 0.02) in the group practicing comprehensive yogic breathing program as compared to the group following standard therapy alone. In the group following breathing program, the improvement in sympathetic cardiac autonomic functions was statistically significant (P = 0.01), while the change in the standard group was not significant (P = 0.17). When both parasympathetic and sympathetic cardiac autonomic functions were considered, there was a trend toward improvement in patients following comprehensive yogic breathing program (P = 0.07). In the standard therapy group, no change in cardiac autonomic functions was noted (P = 0.76). The parameters of glycemic control were comparable in both groups. Conclusion: There was significant improvement in quality of life and cardiac autonomic functions in the diabetes patients practicing comprehensive yogic breathing program compared to those following standard treatment alone.

Wernicke’s encephalopathy in a patient with triple A (Allgrove) syndrome

Triple A syndrome (AAAS, Allgrove syndrome, OMIM 231550) is a rare autosomal recessive disease characterized by the classic triad of alacrima, achalasia and adrenocorticotrophic hormone (ACTH)-resistant adrenal insufficiency. Recently, the underlying gene was identified on chromosome 12q13 [6, 12] and the gene product was named ALADIN (alacrima, achalasia, adrenal insufficiency, neurologic disorder) [3, 10]. The protein is highly expressed in neuroendocrine cells, intestinal tissue, and brain. It is assumed that involvement of the nervous system is a primary feature of the underlying genetic defect, but regarding neurological and autonomic dysfunctions, patients show a highly variable phenotype. There is only a small correlation between phenotype and genotype, even in siblings [4, 5, 8]. Therefore, additional unfavorable effects on appearance and progress of the symptoms must be assumed. Wernicke’s encephalopathy (WE) is an often unrecognized, potentially fatal disease with a triad of mental status changes, ocular abnormalities, and gait ataxia. Although WE is often associated with chronic alcohol abuse, it may occur in everyone who develops thiamine deficiency [2]. To our knowledge, the appearance of WE in a patient with AAAS has not been previously reported. We describe a case with a gastrointestinal dysfunction beyond reported feature of achalasia in AAAS and discuss a possible role of thiamine deficiency regarding the progress of neurologic disorders in patients with AAAS. A 34 year-old female patient with known AAAS was admitted with fatigue syndrome and dizziness that had been worsening for 5 days. For the 2 weeks previous to admission, the patient had refused to eat due to her father’s death. Additionally, she had not increased her daily corticosteroid medication of 15/5/5 mg hydrocortisone although it was a very stressful episode. After having been admitted, the patient suffered from diplopia. Neurological examination revealed upbeat nystagmus, horizontal gaze palsy, worsening of gait ataxia, and mild confusion. Actual neurophysiologic examinations confirmed previously known predominant axonal motor neuropathy with mild sensory abnormalities, delayed central motor function, and a markedly impaired parasympathetic and sympathetic autonomic function. Exacerbation of chronic adrenal insufficiency caused by pneumonia was initially suspected. The patient received 2 g ceftriaxone per day and 100 mg hydrocortisone intravenous in descending dosage to prevent Addison’s crisis. MRI of the brain was conducted for assignment of ocular abnormalities, ataxia and confusion. T2-weighted FLAIR images revealed signal elevation in the medial thalami and periaqueductal gray, which is compatible with H. Kunte (&) A. Numann L. Harms Department of Neurology, Charite-Universitatsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany e-mail: hagen.kunte@charite.de