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Autonomic dysfunction has been occasionally described in varicella-zoster virus (VZV) infection, while few systematic reviews are available. We systematically review autonomic dysfunction due to VZV infection.This study followed the PRISMA guideline, and three databases were researched and included cross-sectional studies in full-length publications in the English language using appropriate search keywords.A total of 102 articles were identified initially; finally 45 studies were used for review, comprising pupillomotor dysfunction in 4, sudomotor dysfunction in 2, cardiovascular dysfunction in 2, gastrointestinal dysfunction in 14, and urogenital dysfunction in 23. They can be summarized as (1) VZV infection rarely produces orthostatic hypotension, which involves diffuse sympathetic dysfunction by polyneuropathy. (2) In contrast, VZV infection produces dysfunction of the bladder and the bowel, which involves segmental parasympathetic or sympathetic dysfunction by dorsal root ganglionopathy.Awareness of VZV-related autonomic dysfunction is important, because such patients may first visit a gastroenterology or urology clinic. Close collaboration among neurologists, dermatologists, gastroenterologists, and urologists is important to start early antiviral agents and maximize bowel and bladder care in such patients.

We here described the frequency and nature of voiding and storage bladder symptoms in depression/anxiety, for which we propose the name "bladder somatic symptom disorder (SSD)" because such symptoms most probably have brain mechanisms. SSD was formerly called as various terms including "somatoform disorder", "medically unexplained physical symptoms", "functional somatic syndrome" and "hysterical neurosis/hysteria". Bladder SSD has the following specific features that are distinguishable from "true" neurologic/organic bladder dysfunction: 1) situation-dependence (close association with life event in some), 2) urodynamically increased bladder sensation/hypersensitivity and 3) absence of neurologic/organic diseases, in addition to 4) other stress symptoms (insomnia, etc.), are key clues to the possibility of bladder SSD. Urodynamics in these patients showed, to a lesser extent, underactive bladder without post-void residual. These findings might reflect the biological changes of the depressive brain; e.g., decreases in serotonin and GABA, and possible increases in CRH. Treatment of bladder SSD can follow that of general depression/anxiety, with the potential addition of anticholinergic or selective beta3 bladder drugs.

Disorders of the nervous system can produce a variety of gastrointestinal (GI) dysfunctions. Among these, lesions in various brain structures can cause appetite loss (hypothalamus), decreased peristalsis (presumably the basal ganglia, pontine defecation center/Barrington's nucleus), decreased abdominal strain (presumably parabrachial nucleus/Kolliker-Fuse nucleus) and hiccupping and vomiting (area postrema/dorsal vagal complex). In addition, decreased peristalsis with/without loss of bowel sensation can be caused by lesions of the spinal long tracts and the intermediolateral nucleus or of the peripheral nerves and myenteric plexus. Recently, neural diseases of inflammatory etiology, particularly those affecting the PNS, are being recognized to contribute to GI dysfunction. Here, we review neuroinflammatory diseases that potentially cause GI dysfunction. Among such CNS diseases are multiple sclerosis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein associated disorder, and autoimmune encephalitis. Peripheral nervous system diseases impacting the gut include Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, acute sensory-autonomic neuropathy/acute motor-sensory-autonomic neuropathy, acute autonomic ganglionopathy, myasthenia gravis and acute autonomic neuropathy with paraneoplastic syndrome. Finally, collagen diseases, such as Sjogren syndrome and systemic sclerosis, and celiac disease affect both CNS and PNS. These neuro-associated GI dysfunctions may predate or present concurrently with brain, spinal cord or peripheral nerve dysfunction. Such patients may visit gastroenterologists or physicians first, before the neurological diagnosis is made. Therefore, awareness of these phenomena among general practitioners and collaboration between gastroenterologists and neurologists are highly recommended in order for their early diagnosis and optimal management, as well as for systematic documentation of their presentations and treatment.

The pontine storage centre (PSC) and the pontine micturition centre (PMC) are known to be critical for urinary filling and emptying, respectively. In the present study, firing patterns of 45 neurons in the PSC area where electrical stimulation induced inhibition of the micturition reflex were analyzed in 20 male decerebrated and paralyzed cats. The electrically determined PSC area was widespread in the dorsolateral pontine reticular formation (P0-P4), ventrolateral to the PMC. Four major types of neurons were detected according to urinary storage/micturition cycles: tonic storage neurons (38%), phasic storage neurons (40%), tonic micturition neurons (9%) and phasic micturition neurons (13%). These four types of neurons were intermingled in the PSC. However, the tonic and phasic micturition neurons tended to be located within a limited area (P2-P3). These neurons were further classified into augmenting, constant and decrementing firing patterns. Some increased their firing prior to the storage/micturition phase initiation. Such preceding pattern was more frequently found in the tonic neurons than in the phasic neurons. In conclusion, the PSC neurons with diverse heterogeneous discharge patterns suggest that these neurons may organize a complex neuronal circuitry, which is critical in the neural control of the urinary continence.

Although patients with Parkinson's disease (PD) experience pelvic organ dysfunction of the urinary bladder, bowel and genital organs, an accurate incidence of the dysfunction and its characteristics have yet to be ascertained. We devised a detailed questionnaire on these three pelvic organ functions in PD patients and control subjects, in our search for a hallmark that would distinguish between the two groups. The PD group comprised 115 patients; 52 men and 63 women, age range 35-69 (average 59) years old, average duration of illness 6 years, median Hoehn and Yahr stage 3. All were taking levodopa with/without dopamine agonists. The control group comprised 391 local individuals who were undergoing an annual health survey; 271 men and 120 women, age range 30-69 (average 48) years old. The questionnaire had three parts: bladder (nine questions), bowel (four questions), and sexual (three questions for women, five for men) function. Each question was scored from 0 (none) to 3 (severe) with an additional quality of life (QOL) index scored from 0 (satisfied) to 3 (extremely dissatisfied). The completion rate was 100% for bladder and bowel functions, whereas for sexual function, it was 95% (control) and 88% (PD) for men and 82% (control) and 60% (PD) for women. As compared with the control group, the frequency of dysfunction in the PD group was significantly higher for urinary urgency (women 42%, men 54%), daytime frequency (28%, 16%), nighttime frequency (53%, 63%), urgency incontinence (25%, 28%), retardation (44% of men), prolongation/poor stream (men 70%), straining (women 28%); constipation (63%, 69%), difficulty in expulsion (men 57%), diarrhea (men 21%); decrease in libido (84%, 83%), decrease in sexual intercourse (55%, 88%), decrease in orgasm (men 87%), and in men, decreases in erection (79%) and ejaculation (79%). The QOL index for the PD patients was significantly higher for bladder (27%, 28%) and bowel (46%, 59%) but not for sexual dysfunction, despite the group's high prevalence of sexual dysfunction. In the PD patients, fecal incontinence was associated with urinary incontinence. Stress urinary incontinence and a decrease in libido were more common in women than in men. Bladder and bowel dysfunction, but not sexual dysfunction increased with the Hoehn and Yahr stage. Sexual dysfunction, but neither bladder nor bowel dysfunction, increased with age. Patients taking levodopa and bromocriptine more frequently had bladder (voiding phase) dysfunction than those taking levodopa only. The findings show that bladder, bowel and sexual dysfunction are all prominent in patients with PD. Amelioration of pelvic organ dysfunction, particularly bowel dysfunction which most affects the quality of life, therefore should be a primary target in the treatment of patients with PD.

s from The Japanese Journal: The Autonomic Nervous System #1 Heart rate variability in menopausal state. Analysis with short-time measurements at rest and after work load Yuka Goto, Hiroyuki Okuda, Yuko Nakamura, Mikiya Nakatsuka Kurashiki Daiichi Hospital Outpatient Kampo Clinic for Women, Okayama 710-0826, Japan Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan The aim of this study was to compare heart rate variability (HRV) between women in pre-menopausal state and women in postmenopausal state, and to determine whether difference in age and estrogen-level could account for any difference in HRV between the two groups. 264 subjectswere analyzedwithoutmaking adjustments for age. In this study the post-menopausal state was characterized by amenorrhea of more than 12 months, an E2 value of 20 pg/ml in the blood, and an FSH blood level higher than 40 mlU/ml. We have found that in the post-menopausal state the value of VLF, LF, HF at rest, HR and LF/HF ratio atmaximum load, and VLF and LF after exercise, were significantly lower than in the pre-menopausal state. Subsequently, 36 subjects were analyzed after adjusting for age. The resultswere almost the same before and after adjustment for age. In conclusion, women in post-menopausal state, showed less fluctuation of autonomic nervous activity represented by HRV than women in pre-menopausal state. (The Autonomic Nervous System, 50: 293-299, 2013). doi:10.1016/j.autneu.2014.09.005 #2 Gastric emptying and colonic transit in patients with Parkinson's disease. Effects of Rikkunshi-to on gastrointestinal dysfunction Hirokazu Doi, Ryuji Sakakibara, Masahiko Kishi, Yohei Tsuyuzaki, Fuyuki Tateno, Shigekazu Hiraia, Tohru Masaka, Mitsutoshi Sato Pharmaceutical Unit, Sakura Medical Center, Toho University, Chiba 285-8741, Japan Neurology, Internal Medicine, Sakura Medical Center, Toho University, Chiba 285-8741, Japan Chemical Pharmacology, Pharmaceutical Sciences, Toho University, Chiba 274-8510, Japan Gastric motility impairment and constipation are common complications of Parkinson's disease. Degeneration of enteric nerves and ganglia is considered to be part of the pathogenesis of those autonomic dysfunctions. In this study, we evaluated the correlation between gastric emptying and colonic transit time in 56 Parkinson's disease patients. In addition, we investigated the effect of Rikkunshi-to, an extract of the dietary herbs commonly used for dyspepsia, in 9 patients. Gastric emptyingwas examined by the 13C-acetate breath test [the peak time of the 13C percentage-dose-excess curve (Tmax-13C)]. Colonic transit time (CTT) was examined after ingestion of a radio-opaque marker. In Parkinson's disease patients, Tmax-13C and CTT were markedly delayed when compared with the data from a normal group published in previous reports. Although therewas not significant correlation between Tmax-13C and CTT among these patients, the frequency of highly delayed gastric emptying (Tmax-13C ≧ 75 min) tended to be larger in patients with delayed CTT (CTT N 39 h). Rikkunshi-to was administered at the dose of 15 g/day to 9 patients, of whom 8 had delayed CTT and 4 had delayed gastric emptying. Tmax-13C and CTTweremeasured before and after the treatment. After three months of treatment, 7 of the 8 patients with delayed CTT had an improvement; the Tmax-13C test was improved in all the 4 patients with delayed gastric emptying. These results suggest that Rikkunshi-has beneficial effects in Parkinson's disease patientswith constipation and/orwith delayed gastric emptying. (The Autonomic Nervous System, 50: 300-305, 2013). doi:10.1016/j.autneu.2014.09.006 #3 Effects of pain caused by orthodontic tooth movement on autonomic nervous system Jun Oba, Naoto Hara, Yasue Kotegawa, Yukiko Miyazawa, Kazuo Mukuno, Hiroo Oda, Kazuichi Yoshida Department of Orthodontics, Kanagawa Dental University Yokohama Dental and Medical Clinic, Kanagawa 221-0835, Japan Department of Ophthalmology, Kanagawa Dental University, Yokohama Dental and Medical Clinic, Kanagawa 221-0835, Japan Department of Orthodontics, Kanagawa Dental University Hospital, Kanagawa 238-8580, Japan Department of Anesthesiology, Graduate School of Kanagawa Dental University, Kanagawa 238-8580, Japan In order to investigate the effects of pain caused by orthodontic tooth movement on the autonomic nervous system, we selected three healthy men and three healthy women (mean age: 30.3 ± 8.4 years) and inserted separating elastic strips between the upper right first molar and the adjacent tooth to induce pain due to the tooth movement, and we conducted our testing after 3, 6, 9 and 24 h. The degree of pain was Autonomic Neuroscience: Basic and Clinical 186 (2014) 95–98