Neurogenic orthostatic hypotension induced by tizanidine
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - September 18, 2019 Category: Research Source Type: research

Strategies to improve the quality of life in patients with hereditary transthyretin amyloidosis (hATTR) and autonomic neuropathy
ConclusionsManagement of autonomic dysfunction in patients with hAATR is feasible and can result in improved qualify of life. Novel disease-modifying treatments for hAATR may contribute to improve autonomic dysfunction, although specific studies are required. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - September 10, 2019 Category: Research Source Type: research

Early sympathetic neural responses during a cold pressor test linked to pain perception
AbstractPurposeThere is considerable interindividual variability in the perception of pain. Given that pain management is a major public health problem, gaining insight into the underlying physiology of these perceptual differences is important. We tested the hypothesis that when interindividual variability in initial muscle sympathetic nerve activity (MSNA) responses to a cold pressor test (CPT) is identified, the divergent responses will be linked to differences in pain perception in healthy young men and women.MethodsIn the supine position, blood pressure (BP) and MSNA were measured at baseline and during a 2-min CPT. I...
Source: Clinical Autonomic Research - September 7, 2019 Category: Research Source Type: research

Cardiovascular autonomic responses in patients with Parkinson disease to pedunculopontine deep brain stimulation
ConclusionPPN stimulation can modulate the cardiovascular system in patients with PD. In this study, it reduced the postural fall in systolic blood pressure during head-up tilt and improved the cardiovascular response during Valsalva, presumably by altering the neural control of baroreflex activation. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - September 6, 2019 Category: Research Source Type: research

30th international symposium on the autonomic nervous system
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - September 6, 2019 Category: Research Source Type: research

Correction to: ST ‑segment changes during tilt table testing for postural tachycardia syndrome: correlation with exercise stress test results
Unfortunately, the 3rd author name was incorrectly published in the original publication. The complete correct name is given below. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - September 6, 2019 Category: Research Source Type: research

Human papillomavirus (HPV) vaccine and autonomic disorders: a position statement from the American Autonomic Society
ConclusionCertain conditions are prevalent in the same populations that are vaccinated with the HPV vaccine (peri-pubertal males and females). This association, however, is an insufficient proof of causality. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - September 2, 2019 Category: Research Source Type: research

Characteristics and natural history of autonomic involvement in hereditary ATTR amyloidosis: a systematic review
ConclusionThe development of autonomic dysfunction impacts morbidity, disease progression, and mortality in patients with hereditary ATTR amyloidosis. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - August 31, 2019 Category: Research Source Type: research

Orthostatic hypotension in hereditary transthyretin amyloidosis: epidemiology, diagnosis and management
ConclusionsWhen recognized, neurogenic orthostatic hypotension can be treated. Discontinuation of potentially aggravating medications, patient education and non-pharmacologic approaches should be applied first. Droxidopa (Northera®), a synthetic norepinephrine precursor, has shown efficacy in controlled trials of neurogenic orthostatic hypotension in patients with hereditary TTR amyloidosis and is now approved in the US and Asia. Although they may be useful to ameliorate autonomic dysfunction in hereditary TTR amyloidosis, the impact of disease-modifying treatments on neurogenic orthostatic hypotension is still uninves...
Source: Clinical Autonomic Research - August 26, 2019 Category: Research Source Type: research

Diagnosis and treatment of urinary and sexual dysfunction in hereditary TTR amyloidosis
ConclusionUrinary and sexual dysfunction are highly prevalent in ATTR patients. Comprehensive assessment and multidisciplinary management are keys to avoiding upper urinary tract damage and improving patients ’ quality of life. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - August 26, 2019 Category: Research Source Type: research

Diagnosis and treatment of heart failure in hereditary transthyretin amyloidosis
AbstractAmyloidosis describes a family of related disease states associated with the extracellular tissue deposition of fibrils composed of low-molecular-weight subunits of a variety of proteins circulating as constituents of plasma. Depending on the disease subtype, fibrillar deposits in a several organs including the heart, kidney, liver, and peripheral nerves cause organ dysfunction and associated morbidity and mortality. The most common amyloid fibril deposits associated with cardiac manifestations are of monoclonal light-chain or transthyretin (ATTR) types. This review will focus on the ATTR types of cardiac amyloidos...
Source: Clinical Autonomic Research - August 26, 2019 Category: Research Source Type: research

Diagnosis and treatment of gastrointestinal dysfunction in hereditary TTR amyloidosis
ConclusionsEarly detection and treatment of gastrointestinal disturbances is key to the successful treatment of this devastating disease. Gastroenterologists play a valuable role in both the diagnosis and the timely management of gastrointestinal symptoms in hereditary transthyretin amyloidosis and should, therefore, be part of a multidisciplinary and comprehensive approach to this disorder. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - August 26, 2019 Category: Research Source Type: research

Increased markers of cardiac vagal activity in leucine-rich repeat kinase 2-associated Parkinson ’s disease
ConclusionsIncreased beat-to-beat HRV inLRRK2 G2019S mutation carriers compared with controls and idiopathic PD patients may indicate augmented cardiac autonomic cholinergic activity, suggesting early impairment of central vagal feedback loops in LRRK2-associated PD. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - August 23, 2019 Category: Research Source Type: research

ST-segment changes during tilt table testing for postural tachycardia syndrome: correlation with exercise stress test results
ConclusionIn a cohort of young, female, otherwise healthy patients with POTS, ST-segment changes occurred in a significant portion (18%) of patients during TTT. When evaluated with exercise stress testing, these patients had no evidence of underlying ischemia on ETT or ESE. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - August 21, 2019 Category: Research Source Type: research

Tafamidis for autonomic neuropathy in hereditary transthyretin (ATTR) amyloidosis: a review
ConclusionAlthough the current evidence is scarce, tafamidis might be effective in arresting the progression of autonomic neuropathy in patients with ATTR amyloidosis. Tafamidis might be more effective at the early stage of the disease; however, individual responses must be monitored. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - August 12, 2019 Category: Research Source Type: research

Novel RNA-targeted therapies for hereditary ATTR amyloidosis and their impact on the autonomic nervous system
AbstractPurposeTransthyretin-mediated hereditary amyloidosis (hATTR amyloidosis) is a multisystemic disease with heterogeneous clinical presentation. Hallmarks of the disease are sensory-motor and autonomic neuropathy and cardiomyopathy. Two disease-modifying drugs, inotersen (an antisense oligonucleotide) and patisiran (a small interfering RNA agent), were recently approved for the treatment of hATTR polyneuropathy. We here review the results of the RNA-targeted therapy clinical trials with special emphasis on the endpoints measuring autonomic symptoms and function.MethodsLiterature review. We used the terms “autono...
Source: Clinical Autonomic Research - August 9, 2019 Category: Research Source Type: research

Orthostatic heart rate does not predict symptomatic burden in pediatric patients with chronic orthostatic intolerance
ConclusionThere are minimal statistically significant differences and no clinical differences between patients as a function of HR increase during standing. Thus, a 40-bpm threshold for adolescents on standing test may be too high, or a specific HR criteria threshold is neither predictive nor definitive in diagnosing POTS. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - August 5, 2019 Category: Research Source Type: research

The microbiome in autonomic medicine and other updates in recent autonomic research
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - July 30, 2019 Category: Research Source Type: research

Cardiac sympathetic innervation in the MPTP non-human primate model of Parkinson disease
AbstractPurposeSystemic administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) induces degeneration of dopaminergic neurons and reproduces the motor features of Parkinson disease (PD); however, the effect of MPTP on extranigral structures has been poorly studied. The aim of this research was to study the cardiac sympathetic innervation of control and MPTP-treated monkeys in order to describe the influence of MPTP toxicity on cardiac tissue.MethodsEight monkeys were included in the study and divided into two groups, four monkeys serving as controls and four forming the MPTP group. Sections from the anterior l...
Source: Clinical Autonomic Research - July 23, 2019 Category: Research Source Type: research

The Schellong test: detecting orthostatic blood pressure and heart rate changes in German-speaking countries
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - July 4, 2019 Category: Research Source Type: research

Heart rate variability is depressed in the early transitional period for newborns with complex congenital heart disease
AbstractPurposeTo compare early changes in autonomic nervous system (ANS) tone between newborns with complex congenital heart disease (CHD) and newborns without CHD.MethodsWe performed a case –control study of heart rate variability (HRV) in newborns with complex CHD [transposition of the great arteries (TGA) or hypoplastic left heart syndrome (HLHS)] and low-risk control newborns without CHD. Cases with CHD were admitted following birth to a pediatric cardiac intensive care unit and h ad archived continuous ECG data. Control infants were prospectively enrolled at birth. ECG data in cases and controls were analyzed f...
Source: Clinical Autonomic Research - June 25, 2019 Category: Research Source Type: research

Alcohol-induced autonomic dysfunction: a systematic review
ConclusionCurrent literature includes studies of highly heterogeneous populations, consuming differing volumes of alcohol over variable periods of time and utilising a number of different autonomic test batteries and criteria to diagnose autonomic dysfunction. Therefore, further research using homogeneous methods for measuring autonomic dysfunction in the field is needed. Despite this limitation, our review demonstrated that autonomic dysfunction is very common among alcohol abusers. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - June 20, 2019 Category: Research Source Type: research

A case of autonomic failure in post-craniectomy syndrome of the trephined
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - June 19, 2019 Category: Research Source Type: research

Induced pluripotent stem cells in multiple system atrophy: recent developments and scientific challenges
AbstractMultiple system atrophy (MSA) is a rare and fatal neurodegenerative disease, with no known genetic cause to date. Oligodendroglial α-synuclein accumulation, neuroinflammation, and early myelin dysfunction are hallmark features of the disease and have been modeled in part in various preclinical models of MSA, yet the pathophysiology of MSA remains elusive. Here, we review the role and scientific challenges of induced pluripoten t stem cells in the detection of novel biomarkers and druggable targets in MSA. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - June 11, 2019 Category: Research Source Type: research

Autonomic dysfunction in myalgic encephalomyelitis and chronic fatigue syndrome: comparing self-report and objective measures
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - May 21, 2019 Category: Research Source Type: research

Complex regional pain syndrome: a focus on the autonomic nervous system
ConclusionsWe conclude that alterations in the sympathetic nervous system contribute to CRPS pathology. Understanding these alterations may be an important step towards providing appropriate treatments for CRPS. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - May 18, 2019 Category: Research Source Type: research

Autoimmune autonomic neuropathies and ganglionopathies: epidemiology, pathophysiology, and therapeutic advances
AbstractAutonomic disorders can be the result of autoimmunity. The classic, well-characterized example is autoimmune autonomic ganglionopathy (AAG), in which antibodies against the ganglionic nicotinic acetylcholine receptor impair autonomic transmission, causing autonomic failure, which responds to immunotherapy. However, a number of other autoimmune disorders cause autonomic failure through a variety of mechanisms. In this article, we review autoimmune disorders causing impairment of the peripheral autonomic nervous system (ganglia and nerves), including AAG, other autoimmune autonomic neuropathies, paraneoplastic autono...
Source: Clinical Autonomic Research - May 15, 2019 Category: Research Source Type: research

Do astronauts get postural tachycardia syndrome? And other updates on recent autonomic research
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - May 14, 2019 Category: Research Source Type: research

Ethnic differences in lifetime cumulative incidence of syncope: the Malaysian elders longitudinal research (MELoR) study
ConclusionEthnic differences exist for lifetime cumulative incidence of syncope in community-dwelling individuals aged 55  years and over in an urban area in Southeast Asia. Future studies should now seek to determine potential genetic, cultural and lifestyle differences which may predispose to syncope. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - May 11, 2019 Category: Research Source Type: research

Post-stroke short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA): response to lamotrigine and sphenopalatine ganglion block
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - May 11, 2019 Category: Research Source Type: research

Physical activity and dietary interventions in diabetic neuropathy: a systematic review
ConclusionsRecent research indicates that dietary interventions are effective in modifying diabetic neuropathy in animal models, and there are promising data that they may also ameliorate diabetic neuropathy in humans. It has been known for some time that lifestyle interventions can prevent the development of diabetic neuropathy in type 2 diabetes mellitus subjects. However, there is emerging evidence that lifestyle interventions are effective in individuals with established diabetic neuropathy. In addition to the observed clinical value of lifestyle interventions, there is emerging evidence of effects on biochemical pathw...
Source: Clinical Autonomic Research - May 10, 2019 Category: Research Source Type: research

A practical guide to active stand testing and analysis using continuous beat-to-beat non-invasive blood pressure monitoring
ConclusionImpairments in neurocardiovascular control are an attributable cause of falls and syncope across the lifespan. The simple active stand test provides the clinician with a powerful tool for assessing individuals at risk of such common disorders. However, its simplicity belies the complexity of its interpretation. Care must therefore be taken in administering and interpreting the test in order to maximise its clinical benefit and minimise its misinterpretation. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - May 10, 2019 Category: Research Source Type: research

Physical activity and dietary interventions in diabetic neuropathy: a systemic review
ConclusionsRecent research indicates that dietary interventions are effective in modifying diabetic neuropathy in animal models, and there are promising data that they may also ameliorate diabetic neuropathy in humans. It has been known for some time that lifestyle interventions can prevent the development of diabetic neuropathy in type 2 diabetes mellitus subjects. However, there is emerging evidence that lifestyle interventions are effective in individuals with established diabetic neuropathy. In addition to the observed clinical value of lifestyle interventions, there is emerging evidence of effects on biochemical pathw...
Source: Clinical Autonomic Research - May 10, 2019 Category: Research Source Type: research

Immune and autonomic nervous system interactions in multiple sclerosis: clinical implications
AbstractMultiple sclerosis is characterized by a wide spectrum of clinical manifestations, among which dysfunction of the autonomic nervous system represents an important cause of multiple sclerosis-related disability. The aim of this review is to provide an overview of autonomic dysfunction in people with multiple sclerosis, and to discuss the interactions between the immune and autonomic nervous systems and the effects of these interactions on various aspects of multiple sclerosis. Autonomic dysfunction in people with multiple sclerosis can be demonstrated clinically and on a molecular level. Clinically, it can be demons...
Source: Clinical Autonomic Research - April 8, 2019 Category: Research Source Type: research

Inspiratory- and expiratory-gated transcutaneous vagus nerve stimulation have different effects on heart rate in healthy subjects: preliminary results
ConclusionsExpiratory-gated and non-respiratory-gated taVNS exert clear cardioinhibitory effects in healthy subjects with high pre-stimulatory HR, whereas inspiratory-gated taVNS does not affect HR. Cardiac and vascular effects of taVNS depend on pre-stimulatory HR. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - April 2, 2019 Category: Research Source Type: research

Dopamine transporter imaging versus myocardial MIBG scintigraphy for the diagnosis of prodromal synucleinopathies —and other updates on autonomic research
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - March 23, 2019 Category: Research Source Type: research

The autonomic signatures of epilepsy: diagnostic clues and novel treatment avenues
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - March 22, 2019 Category: Research Source Type: research

Frequency and factors related to drooling in Chinese patients with multiple system atrophy: a cross-sectional study
ConclusionsDrooling is relatively common among Chinese MSA patients, and parkinsonism-associated MSA and hypomimia appear to be independent risk factors for drooling. The severity of this symptom correlates with the presence of severe motor symptoms, anxiety, depression, and sleep disorders. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - March 12, 2019 Category: Research Source Type: research

Does clip removal help for compensatory hyperhidrosis complicating thoracic sympathetic clipping?
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - March 11, 2019 Category: Research Source Type: research

Where is the brain in all of this?
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - March 9, 2019 Category: Research Source Type: research

Autonomic uprising: the tilt table test in autonomic medicine
AbstractThis 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 clinical and research experience in the evaluation of autonomic disorders. The goals of tilt table testing are to assess orthostatic h...
Source: Clinical Autonomic Research - March 5, 2019 Category: Research Source Type: research

Epidemiology and pathophysiology of autonomic seizures: a systematic review
ConclusionsAutonomic seizure symptoms and signs are relevant in clinical epileptology and open a unique window on the functional organization and pathophysiology of the central autonomic network. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - February 25, 2019 Category: Research Source Type: research

Quantitative magnetic resonance evaluation of the trigeminal nerve in familial dysautonomia
AbstractPurposeFamilial dysautonomia (FD) is a rare autosomal recessive disease that affects the development of sensory and autonomic neurons, including those in the cranial nerves. We aimed to determine whether conventional brain magnetic resonance imaging (MRI) could detect morphologic changes in the trigeminal nerves of these patients.MethodsCross-sectional analysis of brain MRI of patients with genetically confirmed FD and age- and sex-matched controls. High-resolution 3D gradient-echo T1-weighted sequences were used to obtain measurements of the cisternal segment of the trigeminal nerves. Measurements were obtained us...
Source: Clinical Autonomic Research - February 19, 2019 Category: Research Source Type: research

Gastrointestinal function in dementia with Lewy bodies: a comparison with Parkinson disease
ConclusionGastric emptying was prolonged in dementia with Lewy bodies compared to Parkinson disease. (Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - February 11, 2019 Category: Research Source Type: research

Moving forward the in vivo diagnosis of the synucleinopathies
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - February 5, 2019 Category: Research Source Type: research

Chewing-induced asystole: a manifestation of the trigeminal cardiac reflex in stroke recovery
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - January 28, 2019 Category: Research Source Type: research

Progress in defining autonomic consequences of seizure activity including sudden death
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - January 25, 2019 Category: Research Source Type: research

The Clinical Autonomic Research journal 2019 and onward
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - January 17, 2019 Category: Research Source Type: research

Improvement of daytime hypercapnia with nocturnal non-invasive ventilation in familial dysautonomia
(Source: Clinical Autonomic Research)
Source: Clinical Autonomic Research - January 12, 2019 Category: Research Source Type: research

Induced pluripotent stem cells for disease modeling, cell therapy and drug discovery in genetic autonomic disorders: a review
AbstractThe autonomic nervous system (ANS) regulates all organs in the body independent of consciousness, and is thus essential for maintaining homeostasis of the entire organism. Diseases of the ANS can arise due to environmental insults such as injury, toxins/drugs and infections or due to genetic lesions. Human studies and animal models have been instrumental to understanding connectivity and regulation of the ANS and its disorders. However, research into cellular pathologies and molecular mechanisms of ANS disorders has been hampered by the difficulties in accessing human patient-derived ANS cells in large numbers to c...
Source: Clinical Autonomic Research - January 10, 2019 Category: Research Source Type: research