Autonomic nervous system dysfunction and fatigue in multiple sclerosis: common pathophysiology or spurious association?

Clinical Autonomic Research -     

Autonomic nervous system activity associated with postural disturbances in patients with perilymphatic fistula: sympathetic or vagal origin?

The study focused on patients suffering from perilymphatic fistula (PLF), whether they had undergone surgery or not. Vestibular disturbances can be harmless but are associated with varying symptoms, demonstrating disorders within the autonomic nervous system (ANS). The aim was to test whether the orthosympathetic is involved as the vagal part is often suspected of eliciting a feeling of sickness. Non-invasive and uninterrupted recording of ANS activity represents an objectivation technique to evidence such disturbances. Electrodermal activity, thermovascular variables, instantaneous cardiac rate and blood pressure were recorded. Discomfort was triggered experimentally by applying various stimulations successively to the intact ear then to the PLF (or operated) side. Twelve subjects took part in the experiment. Two types of ANS activity were distinguished: (1) phasic responses during stimulation and (2) tonic evolution thereafter. Results show strong activation in orthosympathetic variables when the PLF side was stimulated. No further significant difference between the two sides was to be observed following surgery. After stimulation, a sudden increase in skin resistance was observed, associated with slight bradycardia. No vagal signs having been evidenced, actual nausea may result from brief inhibition of sympathetic activation resulting, in turn from primary over-activation of this system.     

Personality development characteristics of women with anorexia nervosa, their healthy siblings and healthy controls: What prevents and what relates to psychopathology?

This exploratory study assessed attachment and personality in anorexic women, non-affected siblings, and healthy controls, examining correlations with psychopathology. Thirty-eight anorexic subjects (31 females), thirty-one siblings (22 females), and fifty controls (35 females) participated. Personality development characteristics were assessed using the Attachment Style Questionnaire (ASQ), Temperament and Character Inventory (TCI), Eating Disorders Inventory (EDI-2), Symptom Checklist-90 (SCL-90), and other inventories for clinical assessment of EDs. Both anorexic probands and their siblings described lower maternal care and higher maternal overprotection than did controls. Healthy siblings were more similar to controls, but had lower scores than either controls or affected siblings on preoccupation with relationships (P < 0.005) and higher scores than controls on self-transcendence (P < 0.015) and obsessive-compulsive traits (P < 0.025). Logistic regression indicated that need for approval, persistence, resourcefulness, self-transcendence, state anger, pursuit of thinness, interpersonal distrust, social insecurity, and binge eating differentiated anorexic probands from siblings. The need for approval was related to several psychopathological characteristics. Low preoccupation with relationships, low need for approval, and high self-transcendence may have protected siblings from family and environmental stressors. High need for approval was independently related to psychopathological traits in anorexic siblings. Implications for prevention and treatment are discussed.     

Noncoding RNAs: couplers of analog and digital information in nervous system function?

The mammalian nervous system expresses numerous noncoding RNAs (ncRNAs). We propose that ncRNAs are capable of coupling the digital information universe of nucleic acids with the analog universe of cellular protein interactions. ncRNAs could contribute to the success of the organism's information processing in several ways. First, ncRNAs would allow for efficient coupling of energy with information, wherein less energy is required to represent and process more information, condensed in analog and digital form, into smaller spatial and temporal domains, ideal for the environments found in neural tissues. Second, ncRNAs would permit the rapid acquisition of information from the environment, along with the rapid flexible processing and elimination of that information when it is no longer necessary. Third, ncRNAs would facilitate accelerated evolution of an organism's information content and functional computational systems. This emerging panorama might open new dimensions of information processing in the nervous system.     

Performance and brain activity during the Wisconsin Card Sorting Test in adolescents with obsessive–compulsive disorder and adolescents with weight-restored anorexia nervosa

European Child & Adolescent Psychiatry - Anorexia nervosa (AN) and obsessive–compulsive disorder (OCD) both show a peak age of onset during adolescence and share a number of phenotypic...     

Autonomic function testing in multiple system atrophy: a prognostic biomarker? and other updates on recent autonomic research

Clinical Autonomic Research -     

Correction to: Autonomic function test during the COVID‑19 pandemic: is it safe and sound?

Clinical Autonomic Research -     

Physical recovery in anorexia nervosa: is this the sole purpose of a child and adolescent medical-psychiatric unit?

Patients with anorexia nervosa are discharged from inpatient medical psychiatric wards on achievement of their target weight ("physical recovery") or even earlier. However, recent studies have consistently revealed that a very high percentage relapse, usually within a year. We hypothesized that the more rapid pace of physical compared with psychological recovery in anorexia nervosa creates a gap or interim stage when inpatients are particularly vulnerable. This phase has its own identifiable characteristics and prognostic value. To counter this problem, we formulated a treatment model where patients in the "physical recovery" stage participate in a follow-up program within the inpatient unit itself concomitant with individual psychotherapy at the outpatient community service. The program helps to preserve the strong therapeutic alliance established during hospitalization and to maintain the patient's base of security against the loss of the "anorectic solution." The program provides a full range of services--inpatient, day-treatment and follow-up, adapting itself to the changing needs of the patient. It has been in effect in our unit for three years, and the rate of relapse has decreased dramatically. Further controlled studies are needed to confirm these findings.     

Nervous NDRGs: the N-myc downstream–regulated gene family in the central and peripheral nervous system

neurogenetics - The N-Myc downstream-regulated gene (NDRG) family consists of four members (NDRG1, NDRG2, NDRG3, NDRG4) that are differentially expressed in various organs and function in important...     

Assessment of autonomic nervous system function in patients with Behçet' s disease by spectral analysis of heart rate variability

The purpose of this study was to evaluate the autonomic nervous system (ANS) function in patients with Behcet's disease by using power spectral analysis of heart rate variability (HRV). The study population consisted of 71 patients with Behcet's disease, and 26 normal volunteers. HRV was measured by power spectral analysis in supine and standing position. In supine position, Behcet's patients had increased low frequency component in absolute (LF) and normalized units (LF nU) but had lower values of high frequency component in absolute (HF) and normalized units (HF nU) than the controls (P < 0.05). In standing position, higher values were obtained in LF and LF nU but lower values of HF and HF nU in Behcet's patients than controls (P < 0.05). LF/HF was significantly higher in patients both in supine (2.5 +/- 1.0 vs. 1.2 +/- 0.8, P = 0.001) and standing (21.9 +/- 7 vs. 1.8 +/- 0.3, P < 0.001) positions. Our data suggest that patients with Behcet's disease may have asymptomatic ANS dysfunction, which is in the form of increased sympathetic and decreased parasympathetic modulation, and power spectral analysis of HRV is beneficial in assessing the ANS function.     

Causalgia and reflex sympathetic dystrophy: does the sympathetic nervous system contribute to the generation of pain?

The striking response of causalgia and reflex sympathetic dystrophy (RSD) to sympatholytic procedures together with signs of autonomic nervous system abnormalities suggest that the sympathetic efferent system can generate or enhance pain (sympathetically maintained pain, SMP). This concept is supported by human and animal experiments indicating that sympathetic activity and catecholamines can activate primary afferent nociceptors. Some clinical evidence, however, calls the SMP concept into question and alternative explanations have been advanced. In this review, we describe the clinical features of causalgia and RSD and the evidence for sympatholytic efficacy. The major barrier to proving the SMP concept is that all available sympatholytic procedures are problematic. We conclude that, although the weight of current evidence supports the SMP concept and its relevance to causalgia and RSD, it remains unproven by scientific criteria. More careful adherence to diagnostic criteria and well-controlled trials of sympatholysis are needed to finally settle the issue.     

The role of the sympathetic nervous system in anxiety: Is it possible to relieve anxiety with endoscopic sympathetic block?

The function of the autonomic nervous system is divided so that the parasympathetic system spares central nervous system energy and the sympathetic system makes extra energy available and consumes it. The sympathetic nervous system then prepares our body for emergency and it always functions when our conscious or even unconscious mind notices a need for defence or to provide energy. A surgical procedure, where the upper thoracic sympathetic ganglions are ablated, either with cauterization or clamping with metallic clips, has been used to treat sweating of the hands and facial blushing for decades. Instead of ablating large areas of sympathetic trunk, which can cause severe side-effects such as reflex sweating of the body, the surgical procedure is nowadays carried out in a more precise symptom-mediating level of uppermost thoracic sympathetic ganglia. Blushing, hyperhidrosis of palms and head, and trembling are common in social phobia, and they seem to be provoked by the activation of the sympathetic nervous system. Preliminary studies show that some social phobia patients may benefit from the endoscopic sympathetic block (ESB). If the patient with generalized social phobia has not received help with adequate medication or psychotherapy, the ESB may be a new possible treatment of choice.