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Rostral ventrolateral medulla, retropontine region and autonomic regulations
The rostral half of the ventrolateral medulla (RVLM) and adjacent ventrolateral retropontine region (henceforth RVLMRP) have been divided into various sectors by neuroscientists interested in breathing or autonomic regulations. The RVLMRP regulates respiration, glycemia, vigilance and inflammation, in addition to blood pressure. It contains interoceptors that respond to acidification, hypoxia and intracranial pressure and its rostral end contains the retrotrapezoid nucleus (RTN) which is the main central respiratory chemoreceptor. (Source: Autonomic Neuroscience: Basic and Clinical)
Source: Autonomic Neuroscience: Basic and Clinical - November 19, 2021 Category: Neuroscience Authors: Patrice G. Guyenet, Ruth L. Stornetta Source Type: research

Autonomic dysfunction and cardiovascular risk in post-traumatic stress disorder
Patients with post-traumatic stress disorder (PTSD) have an increased risk for cardiovascular disease. The underlying mechanisms are unclear but impaired autonomic function may contribute. However, research in this field has shown contradictory results and the causal links between PTSD, autonomic dysfunction, and cardiovascular risk remain unknown. This brief review summarizes the current knowledge on alterations in autonomic function and cardiovascular risk in patients with PTSD. (Source: Autonomic Neuroscience: Basic and Clinical)
Source: Autonomic Neuroscience: Basic and Clinical - November 19, 2021 Category: Neuroscience Authors: Qi Fu Source Type: research

Syncope and the aging patient: Navigating the challenges
Syncope in the elderly patient is a common presentation and the most common causes are usually non-cardiac. Older adults however are more challenging dilemmas as their presentation is complicated by co-morbidities, mainly cardiovascular and neurodegenerative disorders. Frailty and cognitive impairment add to the ambiguity of the presentation, and polypharmacy is often a major modifiable contributing factor. Vasovagal syncope is a common presentation throughout life even as we age. It has a favorable prognosis and conservative management usually suffices. (Source: Autonomic Neuroscience: Basic and Clinical)
Source: Autonomic Neuroscience: Basic and Clinical - November 18, 2021 Category: Neuroscience Authors: Tarek Hatoum, Robert S. Sheldon Source Type: research

Stress, the autonomic nervous system, and sudden death
The existence of an important relationship between stress, the autonomic nervous system, and sudden cardiac death (SCD) has been long recognized. In the present essay we review the large number of conditions, acting at individual or at population level, that have been causally associated to SCD and discuss the mechanistic and translational value of the studies exploring such associations. These conditions include external stressors (earthquakes, wars) and internal stressors (anger, fear, loss of a loved one) and emotions of even opposite sign. (Source: Autonomic Neuroscience: Basic and Clinical)
Source: Autonomic Neuroscience: Basic and Clinical - November 18, 2021 Category: Neuroscience Authors: Maria Teresa La Rovere, Alessandra Gorini, Peter J. Schwartz Source Type: research

Central sympathetic network for thermoregulatory responses to psychological stress
In mammals, many types of psychological stressors elicit a variety of sympathoexcitatory responses paralleling the classic fight-or-flight response to a threat to survival, including increased body temperature via brown adipose tissue thermogenesis and cutaneous vasoconstriction, and increased skeletal muscle blood flow via tachycardia and visceral vasoconstriction. Although these responses are usually supportive for stress coping, aberrant sympathetic responses to stress can lead to clinical issues in psychosomatic medicine. (Source: Autonomic Neuroscience: Basic and Clinical)
Source: Autonomic Neuroscience: Basic and Clinical - November 18, 2021 Category: Neuroscience Authors: Kazuhiro Nakamura, Shaun F. Morrison Source Type: research

Dynamic cerebrovascular autoregulation in patients prone to postural syncope: Comparison of techniques assessing the autoregulation index from spontaneous variability series
Three approaches to the assessment of cerebrovascular autoregulation (CA) via the computation of the autoregulation index (ARI) from spontaneous variability of mean arterial pressure (MAP) and mean cerebral blood flow velocity (MCBFV) were applied: 1) a time domain method (TDM); 2) a nonparametric method (nonPM); 3) a parametric method (PM). Performances were tested over matched and surrogate unmatched pairs. Data were analyzed at supine resting (REST) and during the early phase of 60 ° head-up tilt (TILT) in 13 subjects with previous history of postural syncope (SYNC, age: 28 ± 9 yrs.; 5 males) and 13 control indi...
Source: Autonomic Neuroscience: Basic and Clinical - November 18, 2021 Category: Neuroscience Authors: Francesca Gelpi, Vlasta Bari, Beatrice Cairo, Beatrice De Maria, Davide Tonon, Gianluca Rossato, Luca Faes, Alberto Porta Source Type: research

Severe dysautonomia in glycine receptor antibody-positive progressive encephalomyelitis with rigidity and myoclonus (PERM): A case report
We report a 59-year-old man who presented with progressive encephalomyelitis causing diplopia, bulbar palsy, severe dysautonomia, followed by stiffness and myoclonic cluster. Laboratory tests showed mild pleocytosis, with markedly elevated plasma levels of norepinephrine, epinephrine, and arginine vasopressin. Glycine-receptor antibodies were identified in both serum and CSF. Despite a poor response to methylprednisolone, immunoglobulins, and plasma exchange, α-blocker stabilized dysautonomia. (Source: Autonomic Neuroscience: Basic and Clinical)
Source: Autonomic Neuroscience: Basic and Clinical - November 15, 2021 Category: Neuroscience Authors: Yasuaki Mizutani, Shunsuke Adachi, Shoko Nakano, Kazutaka Hayashi, Atsuhiro Higashi, Kouichi Kikuchi, Toshiki Maeda, Kenichiro Murate, Sayuri Shima, Takahiro Iizuka, Akihiro Ueda, Mizuki Ito, Hirohisa Watanabe Tags: Short Communication Source Type: research

Transcutaneous vagus nerve stimulation (tVNS) in stroke: the evidence, challenges and future directions
Stroke is one of the leading causes of death and disability globally. A significant proportion of stroke survivors are left with long term neurological deficits that have a detrimental effect on personal wellbeing and wider socioeconomic impacts. As such, there is an unmet need for novel therapies that improve neurological recovery after stroke. Invasive vagus nerve stimulation (VNS) paired with rehabilitation has been shown to improve upper limb motor function in chronic stroke. However, invasive VNS requires a surgical procedure and therefore may not be suitable for all stroke patients. (Source: Autonomic Neuroscience: Basic and Clinical)
Source: Autonomic Neuroscience: Basic and Clinical - November 13, 2021 Category: Neuroscience Authors: Sheharyar S. Baig, Marharyta Kamarova, Ali Ali, Li Su, Jesse Dawson, Jessica N. Redgrave, Arshad Majid Source Type: research

Salt supplementation in the management of orthostatic intolerance: Vasovagal syncope and postural orthostatic tachycardia syndrome
Salt supplementation is a common non-pharmacological approach to the management of recurrent orthostatic syncope or presyncope, particularly for patients with vasovagal syncope (VVS) or postural orthostatic tachycardia syndrome (POTS), although there is limited consensus on the optimal dosage, formulation and duration of treatment. Accordingly, we reviewed the evidence for the use of salt supplementation to reduce susceptibility to syncope or presyncope in patients with VVS and POTS.We found that short-term (~3  months) salt supplementation improves susceptibility to VVS and associated symptoms, with little effect on sup...
Source: Autonomic Neuroscience: Basic and Clinical - November 10, 2021 Category: Neuroscience Authors: E.L. Williams, S.R. Raj, R. Schondorf, W.K. Shen, W. Wieling, V.E. Claydon Source Type: research

Toward rebalancing blood pressure instability after spinal cord injury with spinal cord electrical stimulation: A mini review and critique of the evolving literature
High-level spinal cord injury commonly leads to blood pressure instability. This manifests clinically as orthostatic hypotension (OH), where blood pressure can drop to the point of loss of consciousness, and autonomic dysreflexia (AD), where systolic blood pressure can climb to over 300  mmHg in response to an unperceived noxious stimulus. These blood pressure fluctuations can occur multiple times a day, contributing to increased vessel shear stress and heightened risk of cardiovascular disease. The pathophysiology of both of these conditions is rooted in impairments in regulatio n of spinal cord sympathetic preganglioni...
Source: Autonomic Neuroscience: Basic and Clinical - November 10, 2021 Category: Neuroscience Authors: Madeleine Burns, Ryan Solinsky Tags: Review Source Type: research

Regulation of acute reflectory hyperinflammation in viral and other diseases by means of stellate ganglion block. A conceptual view with a focus on Covid-19
Whereas the autonomic nervous system (ANS) and the immune system used to be assigned separate functions, it has now become clear that the ANS and the immune system (and thereby inflammatory cascades) work closely together. During an acute immune response (e. g., in viral infection like Covid-19) the ANS and the immune system establish a fast interaction resulting in “physiological” inflammation. Based on our knowledge of the modulation of inflammation by the ANS we propose that a reflectory malfunction of the ANS with hyperactivity of the sympathetic nervous system (SNS) may be involved in the generation of acute hyper...
Source: Autonomic Neuroscience: Basic and Clinical - November 9, 2021 Category: Neuroscience Authors: Lorenz Fischer, Hans Barop, Sabina Maria Ludin, Hans-Georg Schaible Tags: Review Source Type: research

SUDEP risk and autonomic dysfunction in genetic epilepsies
The underlying pathophysiology of sudden unexpected death in epilepsy (SUDEP) remains unclear. This phenomenon is likely multifactorial, and there is considerable evidence that genetic factors play a role. There are certain genetic causes of epilepsy in which the risk of SUDEP appears to be increased relative to epilepsy overall. For individuals with pathogenic variants in genes including SCN1A, SCN1B, SCN8A, SCN2A, GNB5, KCNA1 and DEPDC5, there are varying degrees of evidence to suggest an increased risk for sudden death. (Source: Autonomic Neuroscience: Basic and Clinical)
Source: Autonomic Neuroscience: Basic and Clinical - November 9, 2021 Category: Neuroscience Authors: Ahmed N. Sahly, Michael Shevell, Lynette G. Sadleir, Kenneth A. Myers Source Type: research

Vagus nerve afferent stimulation: Projection into the brain, reflexive physiological, perceptual, and behavioral responses, and clinical relevance
The afferent vagus nerves project to diverse neural networks within the brainstem and forebrain, based on neuroanatomical, neurophysiological, and functional (fMRI) brain imaging evidence. In response to afferent vagal stimulation, multiple homeostatic visceral reflexes are elicited. Physiological stimuli and both invasive and non-invasive electrical stimulation that activate the afferent vagus elicit perceptual and behavioral responses that are of physiological and clinical significance. In the present review, we address these multiple roles of the afferent vagus under normal and pathological conditions, based on both ani...
Source: Autonomic Neuroscience: Basic and Clinical - November 9, 2021 Category: Neuroscience Authors: Barry R. Komisaruk, Eleni Frangos Source Type: research

Management of vasovagal syncope
Vasovagal syncope (VVS) is a very common form of fainting. Treatment begins with patient education about the mechanism of fainting, and the non-lethal nature of vasovagal syncope. In this article, we review several non-pharmacological approaches that form the foundation of our current treatments. These include increases in dietary salt and water intake, the use of compression garments, physical counter-maneuvers and tilt-training. When these approaches are inadequate, medications can sometimes be effective. (Source: Autonomic Neuroscience: Basic and Clinical)
Source: Autonomic Neuroscience: Basic and Clinical - November 4, 2021 Category: Neuroscience Authors: Brennan A. Ballantyne, Sevan Letourneau-Shesaf, Satish R. Raj Source Type: research

Pain, purines and Geoff
The story of purinergic neurotransmission and regulation is intimately linked to studies of the somatosensory system. Burnstock's contributions to the discovery of ATP as a primary afferent neurotransmitter, as well as a signal of peripheral tissue damage that depolarised sensory neurons initiated a new period of pain research. The neuro-immune interactions that occur after tissue damage and are important for pain have now also been found to involve purinergic signalling, and adenosine has been demonstrated to have significant analgesic effects. (Source: Autonomic Neuroscience: Basic and Clinical)
Source: Autonomic Neuroscience: Basic and Clinical - October 29, 2021 Category: Neuroscience Authors: John N. Wood Source Type: research