Autonomic Nervous System Testing
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Evaluation of Chronic Autonomic Symptoms in Gulf War Veterans with Unexplained Fatigue
Evaluation of Chronic Autonomic Symptoms in Gulf War Veterans with Unexplained Fatigue • Principal Investigator: Dr. Mian Li, WRIISC-DC and Neurology Service at VAMC-DC; Associate Clinical Professor of Neurology • Co-Investigators: Drs Han Kang, Pamela Karasik, Clara Mahan, Friedhelm Sandbrink, Ping Zhai • Post-doctoral fellow: Changqing Xu • Study Coordinator (Volunteer Status): Wenguo Yao • Funded by VA Merit Review Clinical Science R & D • Research approved by local IRB/R & D and conducted in VAMC- DC with compliance of stipulated human research regulations and VA policies regarding report or dissemination of research and non- research information. 1 Rationale • GW veterans (7.7%) reported dizziness/imbalance. blurred vision, excessive fatigue, or tremor (Kang HK, et al. Illnesses among United States veterans of the Gulf War: a population- based survey of 30,000 veterans. J Occup Environ Med 2000; 42(5): 491-501 • Reported neurological symptoms are similar or identical to those from patients with diseases of autonomic nervous system • Ill group (deployed) with post-exertion fatigue • Control (deployed) without fatigue • Objective of this study • Autonomic parameters useful in treatment 2 Peripheral Autonomic Nervous System • Afferent Pathways • Efferent Components parasympathetic and sympathetic • Neurotoxin may preferentially affect small nerve fiber • Small fiber neuropathy vs Autonomic neuropathy • Long delay in diagnosing autonomic system disorder: a) unclear nature course of acquired autonomic disorders b) lack of appropriate -
Reliability of Quantitative Sudomotor Axon Reflex Testing and Quantitative Sensory Testing in Neuropathy of Impaired Glucose Regulation
ABSTRACT: Reproducible neurophysiologic testing paradigms are critical for multicenter studies of neuropathy associated with impaired glucose regulation (IGR), yet the best methodologies and endpoints remain to be established. This study evaluates the reproducibility of neurophysiologic tests within a multicenter research setting. Twenty-three participants with neuropathy and IGR were recruited from two study sites. The reproducibility of quantitative sudomotor axon reflex test (QSART) and quantitative sensory test (QST) (using the CASE IV system) was determined in a subset of patients at two sessions, and it was calculated from intraclass correlation coefficients (ICCs). QST (cold detection threshold: ICC ϭ 0.80; vibration detection threshold: ICC ϭ 0.75) was more reproducible than QSART (ICC foot ϭ 0.52). The performance of multiple tests in one setting did not improve reproducibility of QST. QST reproducibility in our IGR patients was similar to reports of other studies. QSART reproducibility was significantly lower than QST. In this group of patients, the reproducibility of QSART was unaccept- able for use as a secondary endpoint measure in clinical research trials. Muscle Nerve 39: 529–535, 2009 RELIABILITY OF QUANTITATIVE SUDOMOTOR AXON REFLEX TESTING AND QUANTITATIVE SENSORY TESTING IN NEUROPATHY OF IMPAIRED GLUCOSE REGULATION AMANDA PELTIER, MD,1 A. GORDON SMITH, MD,2,3 JAMES W. RUSSELL, MD, MS,4 KIRAN SHEIKH, MD,5 BILLIE BIXBY, BS,2 JAMES HOWARD, BS,2 JONATHAN GOLDSTEIN, MD,6 YANNA SONG, MS,7 LILY WANG, PhD,7 EVA L. FELDMAN, MD, -
B-Afferents: a Fundamental Division of the Nervous System Mediating Hoxneostasis?
Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 1990 Dichotomic classification of sensory neurons: Elegant but problematic Neuhuber, W L DOI: https://doi.org/10.1017/s0140525x00078882 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-154322 Journal Article Published Version Originally published at: Neuhuber, W L (1990). Dichotomic classification of sensory neurons: Elegant but problematic. Behav- ioral and Brain Sciences, 13(02):313-314. DOI: https://doi.org/10.1017/s0140525x00078882 BEHAVIORAL AND BRAIN SCIENCES (1990) 13, 289-331 Printed in the United States of America B-Afferents: A fundamental division of the nervous system mediating hoxneostasis? James C. Prechtl* Terry L* Powley Laboratory of Regulatory Psychobiology, Department of Psychological Sciences, Purdue University, West Lafayette, IN 47907 Electronic mail: [email protected]@brazil.psych.edu *Reprint requests should be addressed to: James C. Prechtl, Department of Neuroscience, A-001, University of California, San Diego, La Jolla, CA 92093 Abstract? The peripheral nervous system (PNS) has classically been separated into a somatic division composed of both afferent and efferent pathways and an autonomic division containing only efferents. J. N. Langley, who codified this asymmetrical plan at the beginning of the twentieth century, considered different afferents, including visceral ones, as candidates for inclusion in his concept of the "autonomic nervous system" (ANS), but he finally excluded all candidates for lack of any distinguishing histological markers. Langley's classification has been enormously influential in shaping modern ideas about both the structure and the function of the PNS. -
A Compendium of Research
NASA TECHNICAL NASA TM X-3308 MEMORANDUM CO CO I X c PHYSIOLOGIC RESPONSES TO WATER IMMERSION IN MAN: A COMPENDIUM OF RESEARCH James Kollias, Dena Van Derveer, Karen J. Dorchak, and John E. Greenleaf Ames Research Center Moffett Field, Calif. 94035 ^ *" /V NATIONAL AERONAUTICS AND SPACE ADMINISTRATION • WASHINGTON, D. C. • FEBRUARY 1976 1. Report No. 2. Government Accession No. 3. Recipient's Catalog No. NASA TM X-3308 4. Title and Subtitle 5. Report Date February 1976 PHYSIOLOGIC RESPONSES TO WATER IMMERSION IN MAN: 6. Performing Organization Code A COMPENDIUM OF RESEARCH 7. Author(s) 8. Performing Organization Report No. A-6038 James Kollias, Dena Van Derveer, Karen J. Dorchak, and John E. Greenleaf 10. Work Unit No. 9. Performing Organization Name and Address 970-21-14-05 NASA Ames Research Center 11. Contract or Grant No. Moffett Field, Calif. 94035 13. Type of Report and Period Covered 12. Sponsoring Agency Name and Address Technical Memorandum National Aeronautics and Space Administration 14. Sponsoring Agency Code Washington, D. C. 20546 15. Supplementary Notes 16. Abstract Since the advent of space flight programs, scientists have been searching for ways to reproduce the zero-gravity effects of weightlessness. Brief periods of weightlessness up to 1 minute were feasible using Keplerian trajectory, but comprehen- sive study of the prolonged effects of the weightless state necessitated the development of other methods. Thus far the two approaches most widely used have been complete bedrest and fluid immersion. Surprisingly, these simulated environments have produced essentially all of the symptoms found in astronauts. This compendium contains reports appearing in the literature through December 1973. -
The Effects of Sensory Denervation on the Responses of the Rabbit Eye to Prostaglandin E1, Bradykinin and Substance P J.M
Br. J. Pharmac. (1980), 69, 495-502 THE EFFECTS OF SENSORY DENERVATION ON THE RESPONSES OF THE RABBIT EYE TO PROSTAGLANDIN E1, BRADYKININ AND SUBSTANCE P J.M. BUTLER & B.R. HAMMOND Department of Experimental Ophthalmology, Institute of Ophthalmology, Judd Street, London, WCIH 9QS 1 Six to eight days after diathermic destruction of the fifth cranial nerve in the rabbit, the ocular hypertensive and miotic responses to intracameral administration of capsaicin, bradykinin, and prostaglandin E1 were greatly reduced or completely abolished. The response to substance P was not abolished. 2 A response could still be obtained to chemical irritants 36 h after coagulation of the nerve and it is deduced that manifestation of the response is dependent upon functional sensory nerve terminals, and is independent of central connections. 3 It is suggested that prostaglandin E1 and bradykinin act directly upon the sensory nerve endings and that propagation of the response is augmented by axon reflex. 4 In view of the ability of substance P to induce miosis in the denervated eyes, it is presumed that its actions are not mediated via sensory nerves. 5 It is considered possible that the mediator(s) released from sensory nerve endings after chemical irritation or antidromic stimulation may act in the same way as substance P with regard to the miotic effect. 6 Synthetic substance P will only produce ocular hypertension in doses which induce a maximal miotic response. This may either be a question of access or a partial resemblance to the endogenous mediator. Introduction The anterior segment of the rabbit eye responds to nitrogen mustard were reduced after retrobulbar an- mechanical or chemical irritation by miosis, vasodila- aesthesia and abolished after postganglionic division tation and a breakdown of the blood-aqueous barrier. -
Aging of the Autonomic Nervous System
Autonomic Nervous System in Old Age Interdisciplinary Topics in Gerontology Vol. 33 Series Editors Patrick R. Hof, New York, N.Y. Charles V. Mobbs, New York, N.Y. Editorial Board Constantin Bouras, Geneva Christine K. Cassel, New York, N.Y. Anthony Cerami, Manhasset, N.Y. H. Walter Ettinger, Winston-Salem, N.C. Caleb E. Finch, Los Angeles, Calif. Kevin Flurkey, Bar Harbor, Me. Laura Fratiglioni, Stockholm Terry Fulmer, New York, N.Y. Jack Guralnik, Bethesda, Md. Jeffrey H. Kordower, Chicago, Ill. Bruce S. McEwen, New York, N.Y. Diane Meier, New York, N.Y. Jean-Pierre Michel, Geneva John H. Morrison, New York, N.Y. Mark Moss, Boston, Mass. Nancy Nichols, Melbourne S. Jay Olshansky, Chicago, Ill. James L. Roberts, San Antonio, Tex. Jesse Roth, Baltimore, Md. Albert Siu, New York, N.Y. John Q. Trojanowski, Philadelphia, Pa. Bengt Winblad, Huddinge Autonomic Nervous System in Old Age Volume Editors George A. Kuchel, Farmington, Conn. Patrick R. Hof, New York, N.Y. 11 figures and 9 tables, 2004 Basel · Freiburg · Paris · London · New York · Bangalore · Bangkok · Singapore · Tokyo · Sydney George A. Kuchel, MD FRCP UConn Center on Aging University of Connecticut Health Center Farmington, Conn., USA Patrick R. Hof, MD Associate Professor, Kastor Neurobiology of Aging Laboratories Dr. Arthur Fishberg Research Centre for Neurobiology Mount Sinai School of Medicine New York, N.Y., USA Library of Congress Cataloging-in-Publication Data Autonomic nervous system in old age / volume editors, George A. Kuchel, Patrick R. Hof. p. ; cm. – (Interdisciplinary topics in gerontology, ISSN 0074–1132 ; v. 33) Includes bibliographical references and index. -
Metabolic and Other Causes of Dysautonomia, Orthostatic
AUTONOMIC DISORDERS AND AUTONOMIC TESTING Kamal R. Chémali, MD Associate Professor of Clinical Neurology Eastern Virginia Medical School Director, Sentara Neuromuscular and Autonomic Center Director, Sentara Music and Medicine Center Kevin McNeeley Sentara Autonomic Laboratory Coordinator The Upright Posture • Significant stress on the body to maintain adequate cerebral flow • Pooling of 500ml to 1000ml of blood • Decreased venous return to the heart • Reduced cardiac output and blood pressure • Compensatory baroreflex activation (CNS, afferent and efferent PNS pathways) • When this system fails, OH, cerebral hypoperfusion, syncope occur The 3 Orthostatic Syndromes Orthostatic Postural Reflex Hypotension Tachycardia Syncope Definition Gradual, Sustained ↑HR>30 1st 10’ Sudden ↓sBP>20 or ↓dBP>10 up; no ↓ BP ↓BP & HR BP Pattern Physiology Arterial denervation – Venous return Brainstem main impact diastole impact systole threshold CV reflexes Usually abnormal Usually normal Usually nl Associated Disease-based Syndromic Syndromic Dysauton. Poor prognosis Good Prognosis SFN Type Severe, Diffuse Mild, Focal None Somatic Small Fiber System Small fiber anterolateral system Large fiber dorsal column – medial lemniscal system CCF 2001 Purves: Neuroscience. 2004 Case 1 (Somatic Small Fiber Neuropathy) • A 48 year-old man presents to your clinic because of a burning sensation in his toes that started 3 months ago and has progressed to involve the entire foot up to the ankle bilaterally. He denies any past medical history but has gained 25 lbs in the past year, due to overeating and inactivity. • On examination, he has a mild sensory gradient to pinprick and temperature in stockings distribution up to the ankles. Vibration is mildly reduced at the toes and joint position sense is intact. -
Autonomic Symptom Burden Is an Independent Contributor to Multiple Sclerosis Related Fatigue
Clinical Autonomic Research (2019) 29:321–328 https://doi.org/10.1007/s10286-018-0563-6 RESEARCH ARTICLE Autonomic symptom burden is an independent contributor to multiple sclerosis related fatigue Magdalena Krbot Skorić1,2 · Luka Crnošija1 · Ivan Adamec1 · Barbara Barun1,3 · Tereza Gabelić1,3 · Tomislav Smoljo3 · Ivan Stanić3 · Tin Pavičić3 · Ivan Pavlović3 · Jelena Drulović4 · Tatjana Pekmezović5 · Mario Habek1,3 Received: 13 June 2018 / Accepted: 30 August 2018 / Published online: 12 September 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Objectives To investigate a possible association between autonomic dysfunction and fatigue in people with multiple sclerosis. Methods In 70 people with multiple sclerosis early in the disease course (51 females, mean age 33.8 ± 9.1), quantitative sudomotor axon refex tests, cardiovascular refex tests (heart rate and blood pressure responses to the Valsalva maneuver and heart rate response to deep breathing), and the tilt table test were performed. Participants completed the Composite Autonomic Symptom Score 31, the Modifed Fatigue Impact Scale, and the Epworth Sleepiness Scale, as well as the Beck Depression Inventory. Cutof scores of ≥ 38 or ≥ 45 on the Modifed Fatigue Impact Scale were used to stratify patients into a fatigued subgroup (N = 17 or N = 9, respectively). Results We found clear associations between fatigue and scores in subjective tests of the autonomic nervous system: fatigued patients scored signifcantly worse on Composite Autonomic Symptom Score 31, and there was a strong correlation between the Modifed Fatigue Impact Scale and the Composite Autonomic Symptom Score 31 (rs = 0.607, p < 0.001). On the other hand, we found only modest associations between fatigue and scores in objective tests of the autonomic nervous system: there was a clear trend for lower sweating outputs at all measured sites, which reached statistical signifcance for the distal leg and foot. -
The Tilt Table Test in Autonomic Medicine
Clinical Autonomic Research (2019) 29:215–230 https://doi.org/10.1007/s10286-019-00598-9 REVIEW ARTICLE Autonomic uprising: the tilt table test in autonomic medicine William P. Cheshire Jr.1 · David S. Goldstein2 Received: 25 January 2019 / Accepted: 21 February 2019 / Published online: 5 March 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract This perspective piece on head-up tilt table testing is part of a series on autonomic function testing. The tilt table can be a useful diagnostic test, but methodologies vary, and the results are sometimes misinterpreted. The intent here is not to review comprehensively the utility of various tilt table testing protocols but to convey a number of general points that may give perspective and have practical clinical value, based on an understanding of autonomic physiology and our long clini- cal and research experience in the evaluation of autonomic disorders. The goals of tilt table testing are to assess orthostatic hypotension (OH), chronic orthostatic intolerance (COI), and unexplained syncope. The testing is useful for distinguishing neurogenic from non-neurogenic OH, identifying failure of the sympathetic noradrenergic system in autonomic neuropathies and ganglionopathies, and assessing barorefex-sympathoneural function in α-synucleinopathies. For COI, the testing can provide objective data related to the patient’s symptoms, diagnose postural tachycardia syndrome (POTS), and distinguish POTS from other causes of tachycardia. Provocative tilt table testing can help understand bases for recurrent transient loss of consciousness in patients with syncope, distinguish neurally mediated syncope from psychogenic pseudosyncope, and separate syncope-related convulsion from epileptic seizures. For each of these purposes, the goals, formats, endpoints, and clinical utility are diferent. -
Syncope and Atypical Seizures
Syncope and Atypical Seizures Ravi Mandapati, M.D., FACC.; FHRS Director, Specialized Program for Arrhythmias in Congenital Heart Disease UCLA Cardiac Arrhythmia Center David Geffen School of Medicine at UCLA Director, Pediatric Cardiac Electrophysiology Loma Linda University Medical Center Syncope • Sy ncope is a transient loss of consciousness d ue to transient global cerebral hypo perfusion characterized by rapid onset, short duration, and spontaneous complete recovery. • Without qualifying transient global hypo perfusion, the definition of syncope becomes wide enough to include disorders such as epileptic seizures and concussion. •January 14-15, 2011 SCA Conference •1 Seizures are frequently and inappropriately classified as syncope Seizures •Sheldon et al. Diagnosis of Syncope and Seizures, JACC 2002 •January 14-15, 2011 SCA Conference •2 Seizures •Sheldon et al. Diagnosis of Syncope and Seizures, JACC 2002 Breath holding spells • Infantile reflex syncopal attacks or pallid breath holding spells elicited by noxious stimuli are caused by vagally mediated cardiac inhibition. • Cyanotic breath holding spells that occur with expiratory cessation of respiration during crying •January 14-15, 2011 SCA Conference •3 Neurally Mediated Reflex Syncope/Triggers • Emotion/pain • Prolonged standing • Micturition • Post exercise • Hyperventilation and straining • Stretching • Coughing • Standing up suddenly • Deglution Syncope : Mechanical /Structural • Aortic Stenosis • Hypertrophic cardiomyopathy • Anomalous coronary artery • Severe pulmonary -
Selecthealth Medical Policies Physical Medicine Policies
SelectHealth Medical Policies Physical Medicine Policies Table of Contents Policy Title Policy Last Number Revised Acute Inpatient Rehabilitation 443 12/20/18 Chiropractic Care (Adult) 643 09/08/21 Computerized Microprocessor-Controlled Knee Prostheses (OttoBock C-Leg, 233 08/21/17 Endolite Adaptive Prosthesis, Ossur Prosthesis) Diagnostic and Therapeutic Interventions for Spinal Pain 626 07/21/21 Epidural Adhesiolysis (Percutaneous or Endoscopic) for the Treatment of 249 11/29/12 Chronic Back Pain Functional Anaesthetic Discography 422 08/13/09 Functional Electrical Stimulation (FES); Neuromuscular Electrical 413 01/12/09 Stimulation (NMES) Infusion Pumps (External or Implantable) 609 07/31/17 Lymphedemia Therapy 147 04/21/11 Manipulation Under Anesthesia (MUA) for Management of Back and Pelvic Pain 425 10/12/09 Negative Pressure Wound Therapy 185 05/27/21 Nonsurgical Spinal Compression for the Treatment of Chronic Low Back Pain 323 10/31/06 Percutaneous Electrical Nerve Stimulation (PENS) 162 12/19/09 Percutaneous Sacroplasty 433 12/26/09 Phonophoresis 306 05/20/06 Physical Therapy (PT); Occupational Therapy (OT) 518 10/11/18 Platelet Rich Plasma (PRP) Grafting for Bone and Soft Tissue Healing/ 315 12/17/09 Autologous Platelet-Derived Preparations Pressure Specified Sensory Device (PSSD) for Assessment of 217 02/18/10 Peripheral Neuropathy Pulsed Electrical Stimulation with an Integrated Unloading Brace 251 10/19/17 (e.g., BioniCare® Stimulator) Radiofrequency Ablation (RFA) of the Dorsal Root Ganglion (DRG) of the Spine 226 05/15/15 Radiofrequency Ablation (RFA) of the Genicular Nerve 557 11/04/20 Radiofrequency Ablation (RFA) of the Sacroiliac (SI) Joint 389 01/01/20 Sanexas Therapy 649 07/13/21 Table of Contents Continued on Page 2.. -
Assessment of Gastrointestinal Autonomic Dysfunction: Present and Future Perspectives
Journal of Clinical Medicine Review Assessment of Gastrointestinal Autonomic Dysfunction: Present and Future Perspectives Ditte S. Kornum 1,2,* , Astrid J. Terkelsen 3, Davide Bertoli 4, Mette W. Klinge 1, Katrine L. Høyer 1,2, Huda H. A. Kufaishi 5, Per Borghammer 6, Asbjørn M. Drewes 4,7, Christina Brock 4,7 and Klaus Krogh 1,2 1 Department of Hepatology and Gastroenterology, Aarhus University Hospital, DK8200 Aarhus, Denmark; [email protected] (M.W.K.); [email protected] (K.L.H.); [email protected] (K.K.) 2 Steno Diabetes Centre Aarhus, Aarhus University Hospital, DK8200 Aarhus, Denmark 3 Department of Neurology, Aarhus University Hospital, DK8200 Aarhus, Denmark; [email protected] 4 Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, DK9100 Aalborg, Denmark; [email protected] (D.B.); [email protected] (A.M.D.); [email protected] (C.B.) 5 Steno Diabetes Centre Copenhagen, Gentofte Hospital, DK2820 Gentofte, Denmark; [email protected] 6 Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, DK8200 Aarhus, Denmark; [email protected] 7 Steno Diabetes Centre North Jutland, Aalborg University Hospital, DK9100 Aalborg, Denmark * Correspondence: [email protected] Abstract: The autonomic nervous system delicately regulates the function of several target organs, including the gastrointestinal tract. Thus, nerve lesions or other nerve pathologies may cause autonomic dysfunction (AD). Some of the most common causes of AD are diabetes mellitus and α-synucleinopathies such as Parkinson’s disease. Widespread dysmotility throughout the gastroin- Citation: Kornum, D.S.; Terkelsen, testinal tract is a common finding in AD, but no commercially available method exists for direct A.J.; Bertoli, D.; Klinge, M.W.; Høyer, K.L.; Kufaishi, H.H.A.; Borghammer, verification of enteric dysfunction.