Parasympathetic Hyperactivity Research Articles

Cardioneuroablation guided by extracardiac vagal stimulation for cardioinhibitory vasovagal syncope

Abstract Introduction Vasovagal Syncope (VVS) is often linked to abnormal autonomic reflexes, with hypervagotonia identified as a key mechanism, especially in cases with pronounced cardioinhibition. Cardioneuroablation (CNA), which involves radiofrequency ablation of cardiac vagal ganglia, targets parasympathetic hyperactivity, offering a promising treatment for recurrent VVS. This study evaluates the effectiveness and safety of anatomically guided CNA, which may provide an alternative treatment option to pacemaker implantation for younger patients with severe cardioinhibitory VVS. Methods Consecutive patients between January 2019 and October 2023 who underwent CNA at two cardiology centers were enrolled. All patients had a history of recurrent syncope, predominantly cardioinhibitory and unresponsive to conventional treatments. Patients showed no signs of conduction system disease, evidenced by normal rate responses in treadmill stress tests and 24-hour Holter monitoring. Electroanatomic mapping of the left atrium and pulmonary veins was performed. Extracardiac vagal stimulation (ECVS) through the right internal jugular vein, with or without atrial pacing, was utilized to assess baseline responses of the sinus and atrioventricular (AV) nodes. The ablation strategy was tailored based on rhythm disturbances triggered by ECVS, using sequential and anatomically guided ablation of ganglionated parasympathetic plexuses. Radiofrequency ablation, conducted with an irrigated catheter, was guided by the ablation index. Acute success was defined as the absence or significant reduction of cardiac parasympathetic response to ECVS, indicated by the elimination of asystole, severe bradycardia, or AV block. The primary endpoint was syncope recurrence during follow-up. Results The study included 25 patients (16 males; mean age 36 ± 12 years). All had documented cardioinhibition, identified through ECG monitoring (N=12), implantable loop recorders (N=5), or head-up tilt tests (N=8). The average number of syncopal episodes per patient in the year preceding ablation was 2.7, ranging from 1 to 10. Ablation was acutely successful in all cases. Post-ablation, there were no immediate complications related to the procedure, except for one convulsion deemed unrelated. Over a mean follow-up of 17 ± 14 months, 23 patients remained syncope-free. Two patients experienced syncope recurrence; despite undergoing a repeat ablation, they eventually required pacemaker implantation. Conclusion The results of this study suggest that CNA guided by ECVS, may offer a promising treatment for patients with refractory cardioinhibitory VVS. While the procedure showed a high rate of acute success and a notable reduction in syncope recurrence, further research is warranted to fully establish its role as an alternative to pacemaker implantation.

Stroke Related Brain-Heart Crosstalk: Pathophysiology, Clinical Implications, and Underlying Mechanisms.

The emergence of acute ischemic stroke (AIS) induced cardiovascular dysfunctions as a bidirectional interaction has gained paramount importance in understanding the intricate relationship between the brain and heart. Post AIS, the ensuing cardiovascular dysfunctions encompass a spectrum of complications, including heart attack, congestive heart failure, systolic or diastolic dysfunction, arrhythmias, electrocardiographic anomalies, hemodynamic instability, cardiac arrest, among others, all of which are correlated with adverse outcomes and mortality. Mounting evidence underscores the intimate crosstalk between the heart and the brain, facilitated by intricate physiological and neurohumoral complex networks. The primary pathophysiological mechanisms contributing to these severe cardiac complications involve the hypothalamic-pituitary-adrenal (HPA) axis, sympathetic and parasympathetic hyperactivity, immune and inflammatory responses, and gut dysbiosis, collectively shaping the stroke-related brain-heart axis. Ongoing research endeavors are concentrated on devising strategies to prevent AIS-induced cardiovascular dysfunctions. Notably, labetalol, nicardipine, and nitroprusside are recommended for hypertension control, while β-blockers are employed to avert chronic remodeling and address arrhythmias. However, despite these therapeutic interventions, therapeutic targets remain elusive, necessitating further investigations into this complex challenge. This review aims to delineate the state-of-the-art pathophysiological mechanisms in AIS through preclinical and clinical research, unraveling their intricate interplay within the brain-heart axis, and offering pragmatic suggestions for managing AIS-induced cardiovascular dysfunctions.

The autonomic nervous system in atrial fibrillation-pathophysiology and non-invasive assessment.

The autonomic nervous system plays a crucial role in atrial fibrillation pathophysiology. Parasympathetic hyperactivity result in a shortening of the action potential duration, a reduction of the conduction wavelength, and as such facilitates reentry in the presence of triggers. Further, autonomic remodeling of atrial myocytes in AF includes progressive sympathetic hyperinnervation by increased atrial sympathetic nerve density and sympathetic atrial nerve sprouting. Knowledge on the pathophysiological process in AF, including the contribution of the autonomic nervous system, may in the near future guide personalized AF management. This review focuses on the role of the autonomic nervous system in atrial fibrillation pathophysiology and non-invasive assessment of the autonomic nervous system.

Acute Effect of Positive Airway Pressure on Heart Rate Variability in Obstructive Sleep Apnea.

Autonomic dysregulation is associated with cardiovascular consequences in obstructive sleep apnea (OSA). This study aimed to investigate the effect of acute continuous positive airway pressure (CPAP) treatment on autonomic activity and to identify factors contributing to heart rate variability (HRV) changes in OSA. Frequency domain HRV parameters were calculated and compared between the baseline polysomnography and during the CPAP titration in 402 patients with moderate to severe OSA. There were significant reductions in total power, very low-frequency band power, low-frequency band power, and high-frequency band power during the CPAP titration as compared to the baseline polysomnography. This tendency was pronounced in male patients with severe OSA. Multivariate analysis found that changes in the apnea-hypopnea index and oxygen saturation were significantly associated with changes in sympathetic and parasympathetic activity, respectively. This study demonstrated that HRV parameters significantly changed during the CPAP titration, indicating a beneficial effect of CPAP in the restoration of sympathetic and parasympathetic hyperactivity in OSA. Prospective longitudinal studies should determine whether long-term CPAP treatment aids in maintaining the long-lasting improvement of the autonomic functions, thereby contributing to the prevention of cardiovascular and cerebrovascular diseases in patients with OSA.

PO-04-101 SIMPLIFIED CARDIONEUROABLATION TECHNIQUE FROM THE RIGHT ATRIUM ONLY

Functional bradyarrhythmias are caused by parasympathetic hyperactivity in the absence of an organic lesion of the cardiac conduction system. This leads to various types of blocks (atrioventricular block, sinus arrest) and the development of symptoms such as dizziness, severe weakness or syncope. At the moment, ablation of ganglionated plexi is practiced in the world to suppress vagal hyperreactivity and serves as an alternative to pacemaker implantation. Is to develop and study a new simplified technique of cardioneuroablation in patients with vasovagal bradyarrhythmias. Our method consists of the following steps: 1. Carotid sinus stimulation. We used frequent stimulation of the carotid sinus region through the jugular vein with a frequency of 3000 pulses per minute. 2. Ablation. In case of Atrio Ventricular Block we created ablation line from foramen ovale to coronary sinus. And for Sinus Node Disfunction – create ablation line in medial part of the confluence of the superior vena cava into the right atrium. 3. Carotid sinus stimulation to evaluate the result of ablation. In case of insufficient effect, additional ablation line were performed. The inclusion criterion was the transient nature of the heart rhythm disorder. We included 27 patients with symptomatic bradyarrhythmias in the study. Among them, 15 women and 12 men. Mean age 42±6.3 years. On the 24-hour ECG monitor, episodes of sinus node arrest were recorded in 10 patients, and atrioventricular blockades of various degrees were recorded in 17 patients. All operations were performed under general anesthesia. In all cases, stimulation of the corotid sinus induced atrioventricular block or sinus arrest for more than 3 seconds At follow-up for an average of 10.2±1.3 months, patients did not report symptoms. During the follow-up on daily ECG monitoring no blockade was recorded, except for one patient who had 2 episodes of 2nd degree AV block, type 1, at night. All patients noted an improvement in well-being and no syncope was noted during follow up. There were no complications. Cardioneuroablation is currently an alternative to pacemaker implantation. A simplified version of cardioneuroablation has shown significant efficacy, which may lead to a greater spread and use of this ablation technique and to mitigate the risks associated with excessive damage to the ganglia or the risks associated with pacemaker implantation.

Association between spectral analysis of heart rate variability and pulmonary function tests in bronchial asthma patients.

The parasympathetic vagus nerve supplies the heart and lung. The Parasympathetic activity modifies the heart rate and force of contraction in the heart and Airway bronchial smooth muscle constriction and hypersecretion of mucus in the lungs. There is a link between these two components. Hence this study is designed to find the association between Spectral analysis of heart rate variability and pulmonary function tests in bronchial asthma patients. In this study, 30 asthmatic patients were recruited from the respiratory medicine outpatient department and 30 healthy volunteers were included. Pulmonary function tests and heart rate variability was recorded in the physiology department. The pulmonary function parameters were found significantly reduced in the asthmatic patient and it shows obstructive lung diseases. Heart rate variability parameters were found a statistically significantly decreased mean HR, VLF ms2, and LF ms2 in the asthmatic patients when compared to controls. HF ms2 was found significantly increased in the asthmatic patient. These HF ms2 were increased to represent parasympathetic hyperactivity. This study concluded there is parasympathetic dominance in asthmatic patients. The parasympathetic activity might be one of the reasons for increases the airway bronchoconstriction and hypersecretion of mucus. There is a negative correlation was found between FEV1 value and HF ms2. A decrease in the FEV1 value leads to an increase in HF ms2.

Cardiac Remodeling and Its Determinants in Anorexia Nervosa Adolescents: Impact of Weight Recovery.

Cardiovascular alterations in anorexia nervosa (AN) adolescents include bradycardia and decreased systolic blood pressure and left ventricular mass. However, their determinants remain poorly understood. We assessed the associations between morphological and functional left ventricular (LV) remodeling, autonomic control by heart rate variability (HRV) analysis, thyroid hormones and brain natriuretic peptide (BNP) levels in AN female adolescents without or with weight recovery (WR). Fifty-nine female adolescents including 16 AN patients without WR (mean age 13.9 years (10–16)), 10 AN patients with WR (15.7 years (12–18)) and 33 controls (14.1 years (10–18)) underwent night heart rate (HR) recording to measure HRV (and especially SD1/SD2, the ratio between instantaneous (SD1) and long-term (SD2) standard deviation of R-R intervals, reflecting sympatho-vagal balance), speckle tracking echocardiography to assess LV global longitudinal strain (GLS) and blood test for dosage of tri-iodothyronine (T3) hormone and NT-proBNP. Compared to controls, AN patients without WR presented with lower HR (55 ± 7 vs. 68 ± 6 bpm; p < 0.001), parasympathetic hyperactivity, and higher GLS (−19.2 ± 1.8 vs. −16.9 ± 2.8%; p = 0.009). These alterations were partly abolished in AN patients with WR. In a multivariate regression analysis, T3 was the main factor explaining the variance of SD1/SD2, a sympatho-vagal balance marker. NT-proBNP levels were not correlated with cardiac alterations. AN patients had parasympathetic hyperactivity linked with their rate of T3, and a higher GLS. These alterations were partly restored in AN patients with WR.

Priapism, a symptoms of claudication of the cauda equina in spinal stenosis

Keywords: Priapism, Cauda Equina Syndrome, Spinal Stenosis Purpose: This paper was written following the authors clinical management of a patient whom had features of incomplete CES in combination with the symptom priapism. The literature regarding this phenomenon appeared sparse therefore the authors sought to improve their own understanding and share their findings. The aim was to discuss the relationship between spinal stenosis, cauda equina syndrome and priapism using available literature. The objective was to contribute to the evidence base and raise awareness of this rare clinical finding. Methods: A narrative review was completed with a structured search by a clinical librarian. A structured search of Medline, Embase and CINAHL was undertaken by a clinical librarian. In addition, the following resources were searched; BMJ Case Reports, UpToDate, BMJ Best Practice, TRIP Database, NHS Evidence and Google Advanced Search. The following search terms were utilised; cauda equine, cauda equina syndrome, spin* stenosis, lumbar stenosis, priapism and erection. For quality assurance, the authors used the revised SANRA tool. Results: This revealed 40 cases of intermittent priapism reported in the English literature. There appears to be an association with lumbar spine stenosis and priapism but there is a paucity of literature documenting cases of priapism as a feature of CES. Priapism can be an atypical presentation of lumbar spine stenosis/transient cauda equina compression. Increased intrathecal pressure secondary to direct compression and/or local nerve root ischemia at a stenotic level of the sacral cauda equina, this may lead to parasympathetic hyperactivity and subsequent priapism. Albeit transient, the manifestation of priapism suggests that the patient is experiencing sexual dysfunction from cauda equina compression and patients should be appropriately safety netted and managed depending upon their overall clinical picture. The literature appears to demonstrate decompressive surgery is a viable treatment option. Conclusion(s): Cases of priapism secondary to transient ischemia of the cauda equina nerve roots exist. Greater awareness of this clinical finding may help clinicians in their contextual reasoning in patients with suspected CES particularly in patients with suspected spinal stenosis. There is a paucity of literature on sexual dysfunction in patients with acute CES. It could also be beneficial for further research looking at the correlation between imaging and sexual dysfunction and priapism. Impact: This project may raise awareness of patients with priapism may have subcritical compression of the cauda equina; and that the increased mechanical pressure on the cauda equina induced by walking in patients with spinal stenosis may contribute to priapism as a transient autonomic disorder. These patients should be appropriately safety netted and managed according to their overall clinical picture. Funding acknowledgements: This work was not funded.

Heart rate-based indices to detect parasympathetic hyperactivity in functionally overreached athletes. A meta-analysis.

Investigations into the sensitivity of heart rate-(HR) derived indices for tracking parasympathetic nervous system (PNS) changes in functionally overreached (F-OR) endurance-trained athletes have produced equivocal findings. Lack of clarity may be a result of methodological inconsistencies. Therefore, the aims of this systematic review and meta-analysis were (a) to determine the sensitivity of resting and post-exercise vagal-related HR variability (HRV) and HR recovery (HRR) indices to detect PNS modulation in F-OR and non-overreached (non-OR) athletes, and (b) to investigate the influence of methodological factors on the sensitivity of HR-based indices to detect PNS hyperactivity in F-OR athletes. We searched CENTRAL, Scopus, PubMed, Embase, and Web of Science up to May 2020 for the following terms: male and female endurance-trained athletes, controlled and uncontrolled studies that carried out an overload training period, and PNS modulation measured in resting and post-exercise, pre- and post-overload training period. A random-effects model of standardized mean difference (SMD) was estimated for each outcome measure based on the training-induced fatigue status (F-OR vs non-OR athletes), and the influence of methodological issues to detect PNS hyperactivity in F-OR was assessed by subgroup analyses. Pooled analysis showed that resting vagal-related HRV indices did not detect PNS hyperactivity in F-OR athletes (SMD+ = -0.01; 95% confidence interval [CI] = -0.51, 0.50), and no statistical difference (P=.600) was found with non-OR athletes (SMD+ = 0.15; 95% CI = -0.14, 0.45). However, subgroup analysis based on HRV parameter showed a moderate statistical increase in weekly averaged HRV in F-OR athletes (SMD+ = 0.81; 95% CI=0.35, 1.26), while isolated HRV values did not reach statistical significance (SMD+ = -0.45; 95% CI = -0.96, 0.06). We observed a moderate and statistically significant increase in HRR indices among F-OR athletes (SMD+ = 0.65; 95% CI=0.44, 0.87), no changes for non-OR athletes (SMD+ = 0.10; 95% CI=-0.15, 0.34), and statistically significant differences between F-OR and non-OR athletes (P<.001). Insufficient data prevented meta-analysis for post-exercise vagal-related HRV indices. Our findings show that when methodological factors are considered, HR-based indices are sensitive to increased PNS modulation in F-OR.

Red ear syndrome in children: Review of literature and report of three cases

BackgroundRed ear syndrome (RES) is a neurological syndrome that is characterized by attacks of redness and pain that is localized in the earlobe, accompanied by a burning sensation, swelling or otalgia. The exact pathophysiology of RES is not known. Several pediatric cases have been described. They show an extreme variability in clinical presentation and therapeutic response, and therefore there are numerous difficulties in the diagnostic-therapeutic approach and in the comprehension of the physiopathology. The goal of this report is to present three clinical cases of red ear syndrome in children. These cases show various characteristics that can give useful indications regarding the differential diagnosis and the pathogenetic mechanisms that are involved, particularly when they are compared with cases published in the literature. Case-reportsWe report three pediatric RES cases: 1) a boy whose condition offered a typical example of the association that occurs between migraine and RES. 2) a girl with idiopathic RES. 3) a child who suffered RES attacks that showed many similarities with trigeminal autonomic cephalalgias. ConclusionOur clinical series shows the different ways in which RES can be expressed and they support the reported scientific literature. We suggest that the different forms of RES have a common final autonomic pathogenetic mechanism that is activated by parasympathetic hyperactivity and sympathetic inhibition. The different temporal characteristics, frequency, etc. may depend on the activation of distinct physiopathological modules that are related to the pain circuits, as suggested by the modular theory which describes that groups of neurons are defined as a module, where each module is responsible for a symptom and the individual's headache is defined by the activated modules.

A Randomized Controlled Study of the Effectiveness of Electrophysiological Monitoring of Dexmedetomidine in Patients with Brain Damage of Various Origins

Background.At the same time, the main effect of the use of this drug is the elimination of the autonomic nervous system dysfunction and sympatholysis. It seems important to search for a method of indications and selection of a dose of dexmedetomidine in intensive care.Aims to improve the clinical effectiveness of the electrophysiological navigation of the prolonged use of dexmedetomidine in patients with brain pathology of various origins.Methods.The study included 83 patients 2050 days after the traumatic brain injury, anoxic damage; consequences of acute disorders of cerebral. 37 patients comprised the 1st intervention group with a clinical course of dexmedetomidine (male 28; female 9; average age 49.62.3 years) and 46 patients comprised the 2nd control group without pharmacological correction with dexmedetomidine (male 23; female 23, average age 512.5 years). Criteria for the inclusion of prolonged infusion of the drug dexmedetomidine (Orion Pharma, Finland) are based on heart rate variability (HRV) indicators characteristic of sympathetic hyperactivity, the target task of titration of doses of dexmedetomidine served as the parameters for achieving normal HRV indicators, the appearance of parasympathetic hyperactivity served as the basis for reducing the dosage of the drug or stopping it of application. HRV parameters were recorded before dexmetomedine infusion-initially, on 13; 45; 910; 1520 days of drug administration.Results.The starting dose of dexmedetomidine with sympathetic hyperactivity in patients was 0.12 to 0.24 g.kg1.hr1(average dose 0.160.01; total 200 mg/day). According to digital data from HRV, the effective dose of dexmedetomidine ED50 was 0.260.03 g.kg1.hr1(total daily 353.835.1 g) and was achieved on day 910 using dexmedetomidine.Conclusions.The protective role of dexmedetomidine with correction of sympathetic hyperactivity based on electrophysiological navigation according to the HRV is reliable in the following indicators: The improvement of consciousness; a significant decrease in the incidence of distress lung syndrome; septic shock; mortality.

An update on the microbiology, immunology and genetics of seborrheic dermatitis.

The underlying mechanism of seborrheic dermatitis (SD) is poorly understood but major scientific progress has been made in recent years related to microbiology, immunology and genetics. In light of this, the major goal of this article was to summarize the most recent articles on SD, specifically related to underlying pathophysiology. SD results from Malassezia hydrolysation of free fatty acids with activation of the immune system by the way of pattern recognition receptors, inflammasome, IL-1β and NF-kB. M. restricta and M. globosa are likely the most virulent subspecies, producing large quantities of irritating oleic acids, leading to IL-8 and IL-17 activation. IL-17 and IL-4 might play a big role in pathogenesis, but this needs to be further studied using novel biologics. No clear genetic predisposition has been established; however, recent studies implicated certain increased-risk human leucocyte antigen (HLA) alleles, such as A*32, DQB1*05 and DRB1*01 as well as possible associations with psoriasis and atopic dermatitis (AD) through the LCE3 gene cluster while SD, and SD-like syndromes, shares genetic mutations that appear to impair the ability of the immune system to restrict Malassezia growth, partially due to complement system dysfunction. A paucity of studies exists looking at the relationship between SD and systemic disease. In HIV, SD is thought to be secondary to a combination of immune dysregulation and disruption in skin microbiota with unhindered Malassezia proliferation. In Parkinson's disease, SD is most likely secondary to parasympathetic hyperactivity with increased sebum production as well as facial immobility which leads to sebum accumulation.

Monitoring of the Effectiveness of Intensive Care and Rehabilitation by Evaluating the Functional Activity of the Autonomic Nervous System in Patients with Brain Damage

Purpose: evaluation of the clinical significance of parametric monitoring of the effectiveness of intensive care and rehabilitation based on the analysis of the functional state of the autonomous nervous system in patients with brain damage of different genesis.Materials and methods. The study included 66 patients on day 20—50 after the traumatic brain injury; anoxic damage; and stroke consequences. The isolation of clinical groups and subsequent analysis of clinical status is based on the analysis of the functional state of the autonomic nervous system based on the dynamics of the heart rate variability (HRV) parameters. Findings obtained in studies of 500 patients in the postoperative period with a 5-minute HRV were tested as normal and abnormal ANS parameters [1]. Parasympathetic hyperactivity was measured within the limits for SDNN (standard deviation of all normal-to-normal R-R intervals) &gt; 41.5 ms; for rMSSD (root-meansquare of the successive normal sinus R-R interval difference) &gt; 42.4 ms; for pNN50% (the percentage of interval differences in successive NN intervals greater than 50 ms (NN50) / total number of NN intervals) &gt; 8.1%; for SI (Baevsky stress index, in normalized units) &lt; 80 n. u.; for TP (total power of variance of all NN intervals) &gt; 2000 ms2. Sympathetic hyperactivity was determined within the limits for following parameters: SDNN, &lt; 4.54 ms; rMSSD, &lt; 2.25 ms; pNN50%, &lt; 0.109%; SI, &gt; 900 n. u.; TP &lt; 200 ms2. Normal HRV parameters were selected within the limits of the values for: SDNN [13.31-41.4ms]; rMSSD [5.78—42.3 ms]; pNN50% [0.110—8.1%]; SI [80—900 nu]; for TP [200—2000 ms2]. To verify the parasympathetic or sympathetic hyperactivity within these limits, 3 of 5 parameters were chosen [1].Results. Based on the dynamics of the HRV parameters before the intensive care and on days 30—60 of the intensive therapy and rehabilitation of patients with traumatic and non-traumatic brain injuries, 5 main clinical groups of patients were identified. Group 1 (n=27) consisted of patients with normal parameters of the ANS functional activity (both at the time of admission to the hospital and on the 30—60th day of the intensive therapy and rehabilitation). Group 2 (n=9) included patients with the baseline sympathetic hyperactivity of the ANS at admission to the intensive care unit and normal functional activity of the ANS on the 30—60th day of the intensive care and rehabilitation. Group 3 (n=8) included patients with baseline normal functional state of the ANS and the signs of sympathetic hyperactivity of the ANS on the 30—60th day of the intensive care and rehabilitation. Group 4 (n=15) consisted of patients with signs of sympathetic hyperactivity of the ANS both initially and on the 30—60th day of the intensive care and rehabilitation. Group 5 (n=7) included patients with signs of parasympathetic hyperactivity of the ANS (according to the parameters of HRV) both at baseline, at admission to the intensive care unit, and on the 30—60th day of the intensive care and rehabilitation.Conclusion: The normalization of HRV parameters is accompanied by patients’ recovery from the vegetative state and coma to minimal consciousness or normal consciousness; the index of disability rate decreases, the social reintegration grows, according to the DRS scale (M. Rappaport, 1982); dependence on mechanical ventilation reduces, and the muscle tone normalizes.

Modern aspects of the relationship between the functional state of the autonomic nervous system and clinical and laboratory indices of the bodyʼs homeostasis in brain injuries

A review of the literature is devoted to the analysis of the role of the autonomic nervous system as the main regulator of the bodyʼs homeostasis in heterotopic (anoxia, craniocerebral trauma, cerebral circulation disorder) brain damage. First of all, clinical, pathophysiological definitions and methods of pharmacological correction of manifestations of sympathetic and parasympathetic hyperactivity (paroxysmal sympathetic hyperactivity — PSH, paroxysmal parasympathetic hyperactivity — PPH) are considered first. An important aspect of the review is the evaluation of publications devoted to the prevention and therapy of systemic inflammatory response and secondary neuroinflammation based on functional adaptive responses of the autonomic nervous system. The mechanisms of the so-called cholinergic anti-inflammatory pathway to systemic and local inflammatory reactions are discussed. The aspects of the influence of the norm and pathology of the autonomic nervous system on the metabolism and energy balance of the organism are described in detail. The prospects of normalizing the nutritional status through therapeutic effects on the structures of the autonomic nervous system located in the hypothalamic zones of the brain, changes in the regulatory influences of parasympathetic and sympathetic nerves, the innervating liver, intestine, and pancreas are estimated. The interactions of peripheral structures of the autonomic nervous system and microbiota are considered separately. The relationship is shown in detail and possible mechanisms of the functional status of the sympathetic or parasympathetic nervous system in muscular dystonia, respiratory insufficiency and veining are discussed from the point of view of evaluation and correction of the most important constant of autonomic instability in the form of peripheral chemoreceptor insufficiency.

Evaluation of autonomic nervous system function in children with overactive bladder syndrome.

We aimed to evaluate the autonomic nervous system activity in children with overactive bladder (OAB) syndrome. Included in the study were 40 children with overactive bladder and 28 healthy controls. Autonomic tests were performed on all participants, including heart rate interval variation (RRIV), heart rate response to valsalva maneuver, and sympathetic skin response (SSR). Mean valsalva rates in the overactive bladder and control groups were 1.53 ± 0.29 and 1.30 ± 0.18, respectively, a statistically significant difference (P < 0.001). Also significantly different were deep breathing RRIV values of the study and control groups: 56.65 ± 14.66 and 47.92 ± 10.15, respectively (P = 0.008). No statistical differences were found in SSR when OAB patients were compared with controls (P > 0.05). This study demonstrated a parasympathetic hyperactivity in children with OAB, results suggesting a dysfunction in their autonomic nervous systems. Neurourol. Urodynam. 36:673-676, 2017. © 2016 Wiley Periodicals, Inc.

Faecal Incontinence in Gullain-Barre Syndrome with Bulbar Palsy-A Case Report with Review of Literature

Autonomic dysfunction is common in association with Guillain-Barre Syndrome. Cardiovascular involvement is the most common in this context. But isolated faecal incontinence as parasympathetic hyperactivity is the rarest event. In this case report, we documented a case of Guillain-Barre Syndrome with bulbar palsy and diarrhoea for 3 weeks without detectable pathology and not responding to conventional therapies.

Contextualizing Parasympathetic Hyperactivity in Functionally Overreached Athletes With Perceptions of Training Tolerance

Heart-rate variability (HRV) as a measure of autonomic function may increase in response to training interventions leading to increases or decreases in performance, making HRV interpretation difficult in isolation. This study aimed to contextualize changes in HRV with subjective measures of training tolerance. Supine and standing measures of vagally mediated HRV (root-mean-square difference of successive normal RR intervals [RMSSD]) and measures of training tolerance (Daily Analysis of Life Demands for Athletes questionnaire, perception of energy levels, fatigue, and muscle soreness) were recorded daily during 1 wk of light training (LT), 2 wk of heavy training (HT), and 10 d of tapering (T) in 15 male runners/ triathletes. HRV and training tolerance were analyzed as rolling 7-d averages at LT, HT, and T. Performance was assessed after LT, HT, and T with a 5-km treadmill time trial (5TTT). Time to complete the 5TTT likely increased after HT (effect size [ES] ± 90% confidence interval = 0.16 ± 0.06) and then almost certainly decreased after T (ES = -0.34 ± 0.08). Training tolerance worsened after HT (ES ≥ 1.30 ± 0.41) and improved after T (ES ≥ 1.27 ± 0.49). Standing RMSSD very likely increased after HT (ES = 0.62 ± 0.26) and likely remained higher than LT at the completion of T (ES = 0.38 ± 0.21). Changes in supine RMSSD were possible or likely trivial. Vagally mediated HRV during standing increased in response to functional overreaching (indicating potential parasympathetic hyperactivity) and also to improvements in performance. Thus, additional measures such as training tolerance are required to interpret changes in vagally mediated HRV.

Reduced cranial parasympathetic tone during the remission phase of cluster headache.

Cluster headache (CH) attacks are accompanied by cranial autonomic symptoms indicative of parasympathetic hyperactivity and sympathetic dysfunction ipsilateral to the pain. We aimed to assess cranial autonomic function in CH patients during the remission phase of cluster headache. During a remission phase, 38 episodic CH patients underwent the following: dynamic pupillometry, measurement of the superficial temporal artery diameter by ultrasound, and measurement of the retinal vessel diameters from digital retinal photographs. Pupillometry was also performed on 30 age- and sex-matched healthy controls. Thirty patients were included (27 men, three women, mean age 50.2 years ± 12.6). Seven patients reported occasional side shift of their headache, but with a clear predominating side. Significantly reduced average pupillary constriction velocity and retinal venular diameter on the CH pain side were found. There was no asymmetry of the superficial temporal artery diameters. Compared to healthy controls, cluster patients displayed bilaterally reduced pupillary average and maximum constriction velocities, reduced constriction in percentage and increased latency of the light reflex. The present findings indicate a bilaterally reduced cranial parasympathetic tone in CH patients in remission phase, with significant lateralization to the CH pain side. This implies a central origin, and a central pathophysiological model of CH is discussed.

Evidence of Parasympathetic Hyperactivity in Functionally Overreached Athletes

We analyzed HR variability (HRV) to detect alterations in autonomic function that may be associated with functional overreaching (F-OR) in endurance athletes. Twenty-one trained male triathletes were randomly assigned to either intensified training (n = 13) or normal training (n = 8) groups during 5 wk. HRV measures were taken daily during a 1-wk moderate training (baseline), a 3-wk overload training, and a 1-wk taper. All the subjects of the intensified training group demonstrated a decrease in maximal incremental running test performance at the end of the overload period (-9.0% ± 2.1% of baseline value) followed by a performance supercompensation after the taper and were therefore diagnosed as F-OR. According to a qualitative statistical analysis method, a likely to very likely negative effect of F-OR on HR was observed at rest in supine and standing positions, using isolated seventh-day values and weekly average values, respectively. When considering the values obtained once per week, no clear effect of F-OR on HRV parameters was found. In contrast, the weekly mean of each HRV parameter showed a larger change in indices of parasympathetic tone in the F-OR group than the control group in supine position (with a 96%/4%/0% chance to demonstrate a positive/trivial/negative effect on Ln RMSSD after the overload period; 77%/22%/1% on LnHF) and standing position [98%/1%/1% on Ln RMSSD; 99%/0%/1% on LnHF; 95%/1%/4% on Ln(LF + HF)]. During the taper, theses responses were reversed. Using daily HRV recordings averaged over each week, this study detected a progressive increase in the parasympathetic modulation of HR in endurance athletes led to F-OR. It also revealed that due to a wide day-to-day variability, isolated, once per week HRV recordings may not detect training-induced autonomic modulations in F-OR athletes.

Evidence of Parasympathetic Hyperactivity in Functionally Overreached Athletes

Evidence of Parasympathetic Hyperactivity in Functionally Overreached Athletes