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Background: Chronic fatigue syndrome (CFS) is a complex multisystem disease that affects around 1 million of the Indian population every year and is characterized by persistent fatigue. CFS is related to cardiovascular illness, and cardiovascular autonomic nervous system dysfunction is often seen. We investigated the state of cardiac autonomic function in CFS and associated it with their level of inflammatory markers and disease severity since there is not much research on the subject. Aims and Objectives: The objective of this study is to evaluate cardiac autonomic functions by using heart rate variability (HRV) in patients with CFS and in healthy controls. The study aimed to evaluate the correlation between HRV and inflammatory markers in patients with CFS and in healthy controls. Materials and Methods: Thirty controls and 30 diagnosed cases of CFS were used in the research. The short-term variability of heart rate was used to measure autonomic function. We measured tumor necrosis factor-alpha (TNF-α) and interleukin (IL-10) in 3 mL of overnight fasting serum. TNF-α and IL-10 were used to evaluate the severity of CFS. Results: Patients with CFS showed a substantial reduction in low frequency (LF) (P=0.00*), high frequency (HF) (P=0.00*), LF/HF ratio (P=0.00*), and time domain parameters of HRV, namely RMSSD (P=0.03*), SDNN (P=0.00*), NN50 (P=0.00*) and total power (P=0.00*). Patients with CFS had considerably higher levels of TNF-α. TNF-α and LF/HF ratio and RMSSD, NN50, and HF were shown to have a substantially favorable correlation. Conclusions: Our research indicates a substantial correlation between autonomic dysfunction and inflammatory activity, as well as the severity of CFS. Therefore, we suggest that HRV might be a useful technique for accurately screening CFS patients for autonomic disruption symptoms early on, which can significantly lower morbidity and death in the future.

Background: Common headache disorders, including tension-type migraines and cluster headaches, are related to malfunctions of the autonomic nervous system (ANS). Many autonomic signs of migraines aggravate the discomfort of the episode. Understanding the function and comorbidities of migraine patients depends on tests for assessing the cardiovascular autonomic responsiveness of the ANS. Aims and Objectives: The aim and objective of this study is to evaluate the use of cardiovascular reflex testing in adults with chronic migraine and healthy controls. Investigating inflammatory markers in individuals suffering from chronic migraines and controls. Materials and Methods: Thirty healthy controls and 30 people suffering from persistent migraines were part of the research. Cardiovascular reflex tests were performed. Inflammatory markers such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1, and IL-10 were also evaluated. SPSS edition 21 was used for the statistical analysis. For parameters with normal and atypical distributions, the Mann–Whitney test and the unpaired t-test, respectively, were used. Results: Among 30 subjects, testing for autonomic reactivity related to chronic migraines revealed significantly lower values than those for control. Patients with chronic migraines had far more inflammatory markers, including TNF-α, IL-1, and IL-10. Conclusions: Revealing autonomic dysfunction, the group with chronic migraines had a lower parasympathetic tone and sympathoexcitation than the healthy control group. Future studies should concentrate on ANS dysfunction as a biomarker for early warning signals for drug intake and migraine control.

Abstract Background Recurrent non-epileptic episodes resembling paroxysmal sympathetic hyperactivity (PSH) have been observed in adolescents with Juvenile Ceroid Lipofuscinosis (CLN3-disease) and a possible association to an autonomic dysfunction has been suggested. The objective of the present study was to investigate the dynamics of the autonomic activity up to, during, and in the time after individual attacks. We include all seven suitable CLN3 patients in Denmark ≥ 15 years of age. HRV parameters were assessed from continuous heart rate monitoring during seven consecutive days and a particular focus of HRV parameters was obtained in close temporal context to clinically recurrent PSH-like episodes. In addition, the likelihood of PSH was assessed by caregiver’s description and by video documentation. Results Respectively eight and five episodes were recorded in two patients (18 and 20 years of age). The episodes were all safely superior to the cut off values of the clinical assessment score to be considered PSH-like episodes. During all 13 episodes, HRV revealed a statistically significant decrease in root mean square of successive differences (RMSSD) and standard deviation of the Poincaré-Plot interval (SD1) in the minutes prior to the clinical onset of the episodes, both indicating a sudden decrease in parasympathetic activity in advance of the onset. The reduced activity remained low during the episodes, and 15–30 min following the attack cessation, the parasympathetic activity had returned to pre-attacks levels. The sympathetic HRV parameters were unchanged resulting in a sympathetic overactivity during the episodes. In a third participant (32 years of age), in whom severity of PSH-like episodes had been gradually reduced during the last years, five episodes were registered. A similar temporally related reduction of the parasympathetic activity was found, but because the sympathetic activity decreased as well, no sympathetic dominance developed, which most reasonable is the reason to the clinically reduced expression of the episodes. Conclusion The documented transient withdrawal of parasympathetic activity leading to a paroxysmal unbalanced sympathetic hyperactivity most probably accounts for the PSH-like episodes occurring in post-adolescent CLN3 patients. The findings shed new light on both aetiology and possible preventative and therapeutic measures.

Introduction: The thyroid gland and the hypothalamus are closely linked to the cardiovascular system through the Autonomic Nervous System (ANS). The actions of thyroid hormones target the cardiovascular system, affecting homeostasis, which includes contraction, rhythm, blood flow, and peripheral vascular resistance of the myocardium. To assess the function of the ANS that influences the cardiovascular system, Heart Rate Variability (HRV) is an important and increasingly used tool. Aim: To investigate cardiac autonomic changes as assessed by short-term HRV in Subclinical Hypothyroidism (SCH) and to determine whether there is any association between Thyroid Stimulating Hormone (TSH) levels and the Low Frequency/High Frequency (LF/HF) ratio as well as the Standard Deviation of NN intervals (SDNN). Materials and Methods: A cross-sectional analytical study was conducted at R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India from November 2022 to October 2023. Both males and females aged 18-55 years with newly diagnosed SCH (cases, n=50) and healthy individuals (controls, n=50) were included in the study. HRV was recorded using a Physiograph Polyrite-D instrument equipped with bioamplifiers, four channels, and accessories {Record Mangement System (RMS) latest software-version 1.2.5}. The study variables included anthropometric parameters, biochemical parameters (TSH), and HRV parameters such as SDNN and the LF/HF ratio. Relevant data were collected using standard statistical methods, including Statistical Package for Social Sciences (SPSS) version 20.0, unpaired Student’s t-test, and Pearson’s correlation coefficient. Results: The present study found a significant increase in the LF/HF ratio in SCH patients (1.28±0.75) compared to controls (0.90±0.32). There was a significantly lower SDNN value among cases (40.63±21.89) compared to controls (79.86±15.36). No significant changes were observed in Heart Rate (HR), Systolic Blood Pressure (SBP), or Diastolic Blood Pressure (DBP) between cases and controls. The LF/HF ratio and TSH value showed a positive correlation (r=0.09, p=0.57), while SDNN exhibited a negative correlation with TSH value (r=-0.08, p=0.58) among the cases, but neither correlation was statistically significant. Conclusion: The present study concludes that there is a significant change in the LF/HF ratio in newly diagnosed SCH patients. Therefore, the evaluation of short-term HRV can be utilised as a routine screening test for improved medical care.

Spinal cord injury (SCI) is a destructive neuropathological condition characterized by the temporary or permanent impairment of spinal cord function, resulting in motor, sensory, and autonomic dysfunctions. Based on the principles of evidence-based medicine, the development of clinical practice guidelines of integrated Chinese and western medicine rehabilitation for SCI can provide clinicians with a comprehensive and standardized framework for SCI treatment and rehabilitation. This scientific, standardized and unified practice guideline covers the technical scope, normative references documents, terms and definitions, SCI classifications and clinical diagnosis, rehabilitation assessment, rehabilitation diagnosis and treatment program and treatment of common complications, etc. Rehabilitation assessment of SCI mainly includes sensory examination, motor examination, motor or sensory function rating, quality of life assessment, functional assessment and psychological function assessment (stress assessment, cognitive function assessment, and emotional state assessment). Rehabilitation diagnosis and treatment program of SCI mainly includes early treatment principles, drug therapy, physical therapy (muscle strength training, balance and gait training, aerobic exercise, electrical stimulation and other therapies), occupational therapy (joint range of motion training, activities of daily living training, resting motor skill training, upper limb function training and wheelchair skills training), assistive devices, traditional Chinese medicine therapy, including single drug therapy (ligustrazine, salvia miltiorrhiza injection, roasted nux vomica, etc.) and compound therapy (salvia miltiorrhiza ligustrazine injection, Buyang Huanwu decoction, Huoxue Tongdu decoction, erxian decoction, Yiqi Huoxue decoction and self-formulated decoction, etc.), acupuncture therapy and other therapies (new drug therapy, cell therapy, neuromodulation technology and brain-spine interface technology). Common complications of SCI include autonomic hyperreflexia, deep vein thrombosis, heterotopic ossification, orthostatic hypotension, pressure ulcers and urinary tract infection. This guideline can provide guidance for all kinds of rehabilitation institutions at all levels as well as the department of orthopedics and traumatology of traditional Chinese medicine, department of orthopedics of integrated traditional Chinese and western medicine, acupuncture and moxibustion department, Tuina department and rehabilitation medicine department in the hospitals of traditional Chinese medicine or general hospitals in China to perform SCI clinical diagnosis, rehabilitation assessment, rehabilitation treatment and treatment of common complications, with good clinical applicability, safety and effectiveness.

Despite the improvement of pre-, intra- and postoperative care methods, the problem of the development of postoperative neurological complications following prolonged anesthesia remains. A mechanism of occurrence of these complications may be circadian rhythm disorders. This article presents a review of the literature data on the prevalence, pathophysiological mechanisms, and risk factors of postoperative autonomic and circadian disorders. Notably, circadian rhythm disorders in surgical patients are observed at several levels: disruption of the sleep and wakefulness cycle, decreased melatonin secretion, instability of cortisol levels and body temperature, and changes in the vegetative balance towards sympathetic regulation. These disorders contribute to the development of postoperative pain and cognitive and anxiety-depressive disorders, hinder effective rehabilitation, and may be associated with postoperative mortality.

Abstract The objective of the present study was to evaluate the risk factors and outcomes associated with hyponatremia in patients with Guillain-Barré syndrome (GBS). We retrospectively studied 80 consecutive patients with GBS who visited our hospital and compared clinical, laboratory, and electrophysiological findings of patients with and without hyponatremia. Disability was evaluated using the Hughes grading system. Of the 80 patients, 18 (23%) had hyponatremia. Hyponatremia was significantly associated with older age (P = 0.003), urinary retention (P

Abstract Background Osteoarthritis (OA) is a chronic degenerative joint disease causing limited mobility and pain, with no curative treatment available. Recent in vivo studies suggested autonomic alterations during OA progression in patients, yet clinical evidence is scarce. Therefore, autonomic tone was analyzed in OA patients via heart rate variability (HRV) measurements. Methods Time-domain (SDRR, RMSSD, pRR50) and frequency-domain (LF, HF, LF/HF) HRV indices were determined to quantify sympathetic and parasympathetic activities. In addition, perceived stress, WOMAC pain as well as serum catecholamines, cortisol and dehydroepiandrosterone-sulphate (DHEA-S) were analyzed. The impact of the grade of disease (GoD) was evaluated by linear regression analysis and correlations with clinical data were performed. Results GoD significantly impacted the autonomic tone in OA patients. All time-domain parameters reflected slightly decreased HRV in early OA patients and significantly reduced HRV in late OA patients. Moreover, frequency-domain analysis revealed decreased HF and LF power in all OA patients, reflecting diminished parasympathetic and sympathetic activities. However, LF/HF ratio was significantly higher in early OA patients compared to late OA patients and implied a clear sympathetic dominance. Furthermore, OA patients perceived significantly higher chronic stress and WOMAC pain levels compared to healthy controls. Serum cortisol and cortisol/DHEA-S ratio significantly increased with GoD and positively correlated with WOMAC pain. In contrast, serum catecholamines only trended to increase with GoD and pain level. Conclusions This prospective study provides compelling evidence of an autonomic dysfunction with indirect sympathetic dominance in early and late knee OA patients for the first time based on HRV analyses and further confirmed by serum stress hormone measurements. Increased sympathetic activity and chronic low-grade inflammation in OA as well as in its major comorbidities reinforce each other and might therefore create a vicious cycle. The observed autonomic alterations coupled with increased stress and pain levels highlight the potential of HRV as a prognostic marker. In addition, modulation of autonomic activity represents an attractive future therapeutic option. Graphical abstract

Paroxysmal sympathetic hyperactivity (PSH) is a state of autonomic dysfunction characterized by symptoms such as tachypnea, tachycardia, hypertension, hyperthermia, sweating, and dystonia. It can occur after traumatic brain injury, hypoxic-ischemic encephalopathy, and diseases such as stroke. Hypoxia, extensive axonal damage, and young age are believed to predispose to the development of PSH. These patients may be diagnosed with pulmonary embolism, septicemia, or epileptic seizures. Delays in diagnosis prolong hospital stay. Here, we present an 81-year-old man who developed PSH after a recurrent stroke and our management.

An epileptic fit does not only manifest as bizarre motor activity but can destabilize autonomic functions. Abnormal electrical discharge originating from the cerebral cortex can spreads to involve the autonomic system thus creating a dysfunction of the sympathetic and the parasympathetic which modulate the cardiorespiratory, digestive, genitourinary systems. The autonomic phenomenon can be encountered in simple partial, complex partial, generalised tonic-clonic, absence and generalized tonic seizures. Both the motor and the autonomic components may manifest simultaneously; at times the autonomic symptoms may precede or outlastthe motor components. Autonomic features affecting the cardiopulmonary function may be life-threatening and contributes to 8-17% of deaths in individuals with epilepsy. Hypoventilation, apnoea, atrial fibrillation, sinus arrhythmias, atrial and ventricular premature depolarisations, bundle branch block and asystole are known to manifest in the peri-ictal and also in interictal phases of epilepsy. Poor control, and polytherapy in the management of patients, render some epileptics more vulnerable toexcessive excitability of the autonomic nervous system. The aim of this communication, therefore, is to alert and remind healthcare givers on the autonomic phenomena of epileptic fits some of which may result in sudden unexpected death. Clinician should always take a holistic approach in the evaluation of epilepsy patients and watch out especially for cardiorespiratory variability during and in-between attacks.

Parkinson’s Disease (PD) patients are more prone to traumatic injury due to a short shuffling gait and skeletal muscle rigidity. Diabetes mellitus is a chronic metabolic syndrome that affects all vital systems, including the autonomic nervous system. Cardiac autonomic neuropathy affects the conducting system of the heart, producing cardiac arrhythmias and silent ischaemia. Here, the authors report a case of head injury with Extradural Haematoma (EDH) in a 81 year old geriatric male patient posted for EDH evacuation. Emergency craniotomy in this patient with pre-existing PD, diabetes mellitus, and new-onset atrial flutter presents a significant challenge in anaesthetic management. In addition to that, chronic alcoholism further necessitates the selection of appropriate anaesthetic techniques and vigilant perioperative management to prevent intraoperative cardiac arrhythmias, hypotension, heart failure, and pulmonary oedema.

The aim of the study. To examine the frequency and spectrum of cognitive, anxiety-depressive, autonomic disorders and their interrelationship in patients with coronary heart disease (CHD) after COVID-19 infection. Materials and methods. The study involved 71 patients with CHD, stable angina pectoris FC II–III (age 69.0 [64.0; 76.0] years): group 1 (main) – 31 CHD patients after COVID-19; group 2 (comparison) – 40 CHD patients without COVID-19 history. Spectral and temporal HRV parameters were assessed using 24-hour Holter ECG monitoring, anxiety-depressive disorders (ADD) – using the HADS scale, cognitive status of patients – according to the MoCa scale. Results. CHD patients after COVID-19 had a higher frequency of ADD detection and a greater anxiety level (16 [10; 24] versus 10 [9; 13] points, p < 0.05), depression (14 [8; 20] versus 11 [10; 12] points, p < 0.05) as compared to patients without previous history of COVID-19. At the same time, the predominance of the anxiety component over the depressive one in patients of both groups has been revealed. In CHD patients after COVID-19, a decrease in the total MoCa scale score has been found as compared to patients without COVID-19: 24 [22; 26] versus 28 [26; 30] points, p < 0.05. There was an association between the total level of anxiety and depression and the severity of cognitive impairment (r = -0.36, p < 0.05). CHD patients exposed to COVID-19 showed an increased sympathetic and parasympathetic tone of the central nervous system within 24 hours, an increased LF/HF ratio during the active period, activation of slow-acting humoral regulation mechanisms amid increasing stress index and centralization index. In the group of patients with CHD after COVID-19, a wide range of correlations between the rate of ADD, cognitive disorders and HRV parameters has been found. Conclusions. Patients with coronary heart disease recovered from COVID-19 have shown an increase in the incidence and degree of ADD and cognitive disorder manifestations which was accompanied by autonomic dysfunction resulting in stress on the functional and adaptive state of the cardiovascular system. The association between ADD, autonomic and cognitive disorders in patients with coronary heart disease after COVID-19 has confirmed the common pathogenetic links of the disorders found.

Objective: To assess pain outcomes, stress levels and body awareness among patients with chronic pain and explore potential associations between these variables. Design: An explorative study. Methods: Patients with chronic pain in primary and specialist care were assessed regarding pain intensity using the Numerical Rating Scale (NRS; 0–10 point scale) and stress levels using the Stress and Crisis Inventory (SCI-93; 0–140). To assess body awareness, multidimensional assessment of interoceptive awareness (MAIA; 0–5), a widely used self-report measure of interoceptive bodily awareness was used. Results: Participants (n = 42) reported an average NRS of 4.4, elevated stress levels and low body awareness. Stress levels were moderately correlated with pain intensity (r = 0.53; p

Background: A critical illness such as severe coronavirus disease 2019 (COVID-19) activates autonomic, endocrine, and emotional stress responses. Whether the manifestations of excessive stress experience persist beyond full recovery into the intermediate post-COVID period (3–6 months after recovery) is not known and was the question we addressed in the current study. Methods: An analytical observational cross-sectional study compared the heart rate variability (HRV), 8 AM serum cortisol concentration, and the Depression, Anxiety, and Stress Scale–21 (DASS-21) scores between COVID-19 recovered participants and their age-matched control subjects (21 male participants, 30–70 years of age, in each group). Results: The median (Q1–Q3) of low frequency (LF), high frequency (HF), and total powers of HRV was significantly reduced in those who recovered from severe COVID-19, compared to control subjects (respectively LF power: 410.871 [245.10–861.94], 947.57 [536.11–1778.55], P = 0.011; HF power: 192.916 [87.66–564.43], 705.18 [248.67–1192.19] P = 0.013; Total power: 646.33 [308.72–1518.28], 1613.33 [956.14–4022.55] P = 0.015, Mann–Whitney U-test). Serum cortisol and DASS-21 scores were not different from the control group. Conclusions: Impaired cardiac autonomic function, evidenced by reduced HRV, was observed in the intermediate period following recovery from severe COVID-19. However, psychological stress and elevated serum cortisol were not noted. Our result that exposes the effect of COVID-19 on cardiac autonomic responsiveness is important as diminished HRV increases the vulnerability of COVID-19 survivors to diseases. These findings may also suggest a focus of therapy in them, as specific interventions are known to improve HRV and cardiac autonomic functioning.

Background: Autonomic function tests can be used by patients with chronic migraine and chronic tension-type headaches (TTH) as a non-invasive, sensitive, and reliable marker for evaluating heart function. Studies have demonstrated sympathetic and parasympathetic dysfunction. Patients with migraines experience sympathetic and parasympathetic nervous system hyperfunction, while tension headache sufferers experience the opposite. Aims and Objectives: Parasympathetic reactivity tests will be used in the current study to evaluate the cardiac autonomic functioning in patients with chronic migraine and chronic TTH in the adult age group. Materials and Methods: Two groups of headache patients were enrolled: Those with chronic migraine (n=25) and those with chronic TTH (n=25). To conduct statistical analyses, SPSS version 21 was used. For parameters with normal and abnormal distributions, the unpaired t-test and Mann–Whitney U-test, respectively, were employed. Results: Out of 25 subjects, parasympathetic reactivity tests such as Valsalva ratio (1.38±0.10 vs. 1.49±0.19, P=0.022*) and expiratory-inspiratory ratio (1.18±0.03 vs. 1.25±0.77, P=0.000*) in chronic migraine were significantly decreased as compared to chronic TTH. Lying to standing 30:15 ratio (1.15±0.08 vs. 1.19±0.10, P=0.090) and delta heart rate (14.56±1.39 vs. 14.96±1.43, P=0.320) was decreased in chronic migraine as compared to chronic TTH but was not significant. Conclusions: In contrast to the chronic TTH group, the chronic migraine group’s total parasympathetic tone was reduced. We therefore draw the conclusion from the findings that regular monitoring of the parasympathetic reactivity can be very helpful in predicting cardiovascular risk for these patients in addition to advising the treatment practices for chronic migraine and chronic TTH, which include regular exercise and medication.

The aim of the study: to assess changes in myocardial electrical activity and heart rate variability (HRV) in patients with coronary artery disease (CAD) depending on the stage of iron deficiency (ID) and identify their relationship with ferrokinetic parameters. Materials and methods. In total, 90 patients with CAD, stable angina II–III FC were examined (men – 35, women – 55, age – 69 (61; 72) years). The patients were divided into 4 groups: the 1st group (n = 16) consisted of patients with concomitant ID anemia (IDA) of mild and moderate severity, the 2nd (n = 15) – with latent ID, the 3rd (n = 14) – with functional ID, the 4th (n = 45) – patients with CAD without iron metabolism disorders. The HRV features during 24 hours, daytime and nighttime as well as their relationships with ferrokinetic and hematological parameters were analyzed. The data analysis was performed using Statistica 13.0. Results. CAD patients with concomitant IDA demonstrated a tendency to have a higher average daytime heart rate value (U = 14.0; p ≈ 0.08), a longer duration of tachycardia (U = 20.0; p ≈ 0.06), and a significantly greater number (2.4 times) of ventricular extrasystoles (VE) (U = 7.0; p < 0.05) compared to patients without iron metabolism disorders. There were no statistically significant differences in heart rate, episodes of tachycardia, and the number of arrhythmic events in CAD patients with different stages of ID. During the temporal analysis of HRV indicators, patients with different stages of concomitant ID demonstrated a decrease in overall HRV due to SDNN-index, rMSSD (%) and HRVT triangular index both in active and passive periods as compared to patients without iron metabolism disorders. Spectral analysis of HRV has revealed reduced parasympathetic activity of the autonomic nervous system due to HF indicator in patients of the 1st–3rd groups. The presence of concomitant IDA was characterized by maximum changes in HRV indicators and the predominance of central mechanisms of HRV regulation over autonomic ones, which was confirmed by a significant increase in the centralization index (IC) and stress index (SI). For CAD patients with concomitant IDA and latent ID, a number of relationships between ferrokinetic and HRV parameters was found. There were no statistically significant correlations between indicators of iron metabolism and HRV in patients with CAD and functional ID. Conclusions. The decrease in iron stores in the body due to its tissue and transport reserves is accompanied by changes in the myocardial electrical activity, a progressive reduction in heart rate variability, autonomic dysfunction towards a suppression of the parasympathetic domain activity, confirming the relevant correlations with the ferrokinetic parameters.

Abstract Dysregulation of the autonomic nervous system is an important long-term consequence of spinal cord injury (SCI). Yet, there is a scarcity of teaching resources about this topic for preclinical medical students. Given the association of SCI sequelae with emergency complications and mortality, it is imperative to equip medical students with the ability to recognize them. We designed a “Meet the Patient” (MTP) session with the primary goal to enhance student learning about SCI sequelae by interacting with patients and listening to real-life stories. The session primarily focused on recognizing triggers and symptoms of autonomic dysreflexia (AD) and discussing the loss of bowel and bladder control, while providing opportunities to learn more about living with SCI from patients’ real-life experiences. During the MTP session, patients living with SCI discussed their experience with AD, neurogenic bowel and bladder, and spasticity, among other SCI sequelae. We evaluated the outcomes of the MTP session by assessing numerical performance in questions related to the session (post-session quiz and final exam) and students’ satisfaction (post-session survey) in two subsequent academic years. The numerical performance in SCI-questions was high for both academic years (and higher than national average for the final exam question), indicating adequate acquisition of knowledge. Satisfaction with the session was high, with most students indicating that the session helped them consolidate their knowledge about the topic.

Introduction. An imbalance in the autonomic nervous system regulation, known as dysautonomia, is one of the most common clinical syndromes that accompany several diseases. The balance between sympathetic and parasympathetic influences on the body can rapidly change during dynamic processes, especially in cases of infectious and acute diseases, where autonomic regulation plays an active role in shaping the immune response. In children with respiratory diseases, the influence of the vagus nerve (n.vagus) on the frequency and depth of breathing is also important but remains relatively understudied. Assessment of vegetative balance in pediatrics is carried out using various methods depending on the child's age and condition, with commonly used approaches including questionnaires, calculation of the Kerdo autonomic index, and orthostatic testing. The aim. To compare the diagnostic capabilities of different methods for assessment of the autonomic nervous system state in school-age children on the model of acute bronchitis. Materials and methods. The paper presents data from a study that assessed the state of the autonomic nervous system in 52 school-age children (12-16 years old) divided into two groups: 30 children with acute bronchitis in the convalescent period and 22 clinically healthy individuals. Three different methods were used: the A.M. Wayne scale, the Kerdo index, and the orthostatic test. Results. The survey based on Wayne's questionnaire did not reveal a significant difference between the groups of healthy children and those affected by bronchitis. Dynamic tests proved to be more suitable for assessing acute pathology, such as Kerdo's autonomic index and the orthostatic test. The autonomic Kerdo index in children with bronchitis was significantly higher (14.2±2.38 points) than in healthy children (6.4±3.18 points, p

The aim of this systematic review with meta-analysis was to determine differences in cardiovascular autonomic parameters between patients with myasthenia gravis (MG) and healthy controls (HCs). Two reviewers searched four electronic databases, namely PubMed, Web of Science, EMBASE, and SCOPUS, from database inception to 7 July 2023 for studies investigating cardiovascular autonomic parameters in MG vs. HCs. A random-effects meta-analysis was performed to compute Hedges’ g ± 95% confidence intervals (CI). Out of a total of 2200 records, 8 observational studies with a sample size of 301 patients with MG and 454 HCs were included in the systematic review. Meta-analysis revealed lower values of expiration/inspiration ratio (g = −0.45, I2 = 74.7), baroreflex sensitivity (g = −0.56, 95%CI −0.80, −0.33; I2 = 0.3), percentage of adjacent NN intervals differing by more than 50 ms (g = −1.2, I2 = 82.8), square root of the mean of squared differences between successive beat intervals (g = −1.94, I2 = 95.1), mean of the standard deviations of all NN intervals (g = −0.83, 95%CI −1.37, −0.28; I2 = 55.5), and high frequency of HRV during tilt (g = −0.75, 95%CI −0.11, −0.39; I2 = 0). MG patients vs. HCs had higher systolic blood pressure (g = 0.39; I2 = 56.1), sympathovagal balance at rest/during tilt (LF/HF-RRIsupine, g = 0.44; I2 = 0; LF/HF-RRItilt, g = 0.86; I2 = 0; LF/HFtilt, g = 0.40; I2 = 0). As a group, MG patients have altered cardiac autonomic function, including decreased parasympathetic function, lower baroreflex sensitivity, and higher sympathovagal balance at rest and during orthostatic challenges.

Stroke is a major cause of functional disability and is increasing in frequency. Therefore, stroke prognosis must be both accurate and timely. Among other biomarkers, heart rate variability (HRV) is investigated in terms of prognostic accuracy within stroke patients. The literature research of two databases (MEDLINE and Scopus) is performed to trace all relevant studies published within the last decade addressing the potential utility of HRV for stroke prognosis. Only the full-text articles published in English are included. In total, forty-five articles have been traced and are included in the present review. The prognostic value of biomarkers of autonomic dysfunction (AD) in terms of mortality, neurological deterioration, and functional outcome appears to be within the range of known clinical variables, highlighting their utility as prognostic tools. Moreover, they may provide additional information regarding poststroke infections, depression, and cardiac adverse events. AD biomarkers have demonstrated their utility not only in the setting of acute ischemic stroke but also in transient ischemic attack, intracerebral hemorrhage, and traumatic brain injury, thus representing a promising prognostic tool whose clinical application may greatly facilitate individualized stroke care.

Abstract Background Ongoing symptoms or the development of new symptoms following a SARS-CoV-2 diagnosis has caused a complex clinical problem known as “long COVID” (LC). This has introduced further pressure on global healthcare systems as there appears to be a need for ongoing clinical management of these patients. LC personifies heterogeneous symptoms at varying frequencies. The most complex symptoms appear to be driven by the neurology and neuropsychiatry spheres. Methods A systematic protocol was developed, peer reviewed, and published in PROSPERO. The systematic review included publications from the 1st of December 2019–30th June 2021 published in English. Multiple electronic databases were used. The dataset has been analyzed using a random-effects model and a subgroup analysis based on geographical location. Prevalence and 95% confidence intervals (CIs) were established based on the data identified. Results Of the 302 studies, 49 met the inclusion criteria, although 36 studies were included in the meta-analysis. The 36 studies had a collective sample size of 11,598 LC patients. 18 of the 36 studies were designed as cohorts and the remainder were cross-sectional. Symptoms of mental health, gastrointestinal, cardiopulmonary, neurological, and pain were reported. Conclusions The quality that differentiates this meta-analysis is that they are cohort and cross-sectional studies with follow-up. It is evident that there is limited knowledge available of LC and current clinical management strategies may be suboptimal as a result. Clinical practice improvements will require more comprehensive clinical research, enabling effective evidence-based approaches to better support patients.

ABSTRACT Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laboratory criteria, with other organic and psychiatric conditions being ruled out. CASE REPORT: A 39-year-old female patient, who is institutionalized and completely dependent, has a medical history of recurrent urinary infections and colonization by carbapenem-resistant Klebsiella pneumoniae. Her regular medication regimen included sertraline, valproic acid, quetiapine, risperidone, lorazepam, diazepam, haloperidol, baclofen, and fentanyl. The patient began experiencing dyspnea. Upon physical examination, she exhibited hypotension and a diminished vesicular murmur at the right base during pulmonary auscultation. Initially, after hospitalization, she developed high febrile peaks associated with hemodynamic instability, prompting the initiation of antibiotic treatment. Despite this, her fever persisted without an increase in blood inflammatory parameters, and she developed purulent sputum, necessitating antibiotherapy escalation. The seventh day of hospitalization showed no improvement in symptoms, suggesting NNMS as a differential diagnosis. All antipsychotic and sedative drugs, as well as antibiotherapy, were discontinued, after which the patient showed significant clinical improvement. CONCLUSION: Antipsychotic agents are commonly employed to manage behavioral changes linked to various disorders. However, their severe side effects necessitate a high degree of vigilance, the cessation of all medications, and the implementation of supportive care measures. A prompt and accurate diagnosis of NMS is crucial to alleviating the severe, prolonged morbidity and potential mortality associated with this syndrome.

Background Parkinson's disease (PD) is frequently accompanied with anxiety, depression, sleep disorders, autonomic dysfunction, cognitive impairment, and other non-motor symptoms, among which autonomic dysfunction and cognitive impairment severely impair the quality of life. The relationship between autonomic dysfunction and cognitive impairment in PD is still controversial. Objective To analyze the characteristic of autonomic dysfunction and its correlation with cognitive impairment in PD patients. Methods A total of 156 patients with idiopathic PD admitted to Henan Provincial People's Hospital between September 2018 and November 2020 were enrolled. General data of patients, including age, sex, duration of disease, age of onset and years of education, were collected. According to the prevalence and duration of autonomic dysfunction, they were divided into autonomic dysfunction group (AutD group, n=107) and non-autonomic dysfunction group (NAutD group, n=49) . The part Ⅲ of the Unified Parkinson's Disease Rating Scale (UPDRS-Ⅲ) was used to assess motor symptoms. The Hoehn-Yahr (H-Y) scale was used to assess the severity of PD. The non-motor symptoms were assessed by the Non-motor Symptoms Scale (NMSS) . The Hamilton Anxiety Scale (HAMA) and Hamilton Rating Scale for Depression 24-item (HAMD-24) were used to evaluate anxiety and depression symptoms, respectively. The 39-item Parkinson's Disease Questionnaire (PDQ-39) was used to evaluate PD-specific health related quality of life. Autonomic function was evaluated by Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) . Cognitive function was evaluated by Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) . Spearman correlation analysis was used to explore the correlation between autonomic function (assessed using the SCOPA-AUT score) and cognitive function (assessed using the MMSE score and MoCA score) . Results Among the 156 patients, 83 were male and 73 were female, with a mean age of (63.9±0.7) years. AutD group had greater mean age (t=-4.391, P

The aim of the study: to investigate the effect of concomitant anemia on the features of cardiac remodeling and electrical disorders in patients with coronary artery disease (CAD). Materials and methods. In total, 89 patients with CAD, stable angina II–III FC were examined (men – 34, women – 55, age – 69 (61; 72) years). All patients were divided into 2 groups: the main group (n = 44) consisted of patients with CAD and anemia, the comparison group (n = 45) – patients with CAD without iron-deficiency anemia. The results of echocardioscopy and 24-hour ECG (Holter) monitoring were analyzed. Results. Left ventricular (LV) end-diastolic and end-systolic volume were higher in the main group by 24.7 % (U = 60.0; P < 0.05) and 25.9 % (U = 53.5, P < 0.05), respectively; end-diastolic and end-systolic left ventricular index also were higher in the main group by 20.2 % (U = 99.5; P < 0.05) and 34.8 % (U = 98.5; P < 0.05), respectively. There was no statistically significant difference in the types of LV geometry; however, the left ventricular mass index was significantly higher by 12.0 % in patients of the main group (U = 315.5; P < 0.05). The patients of both groups mostly showed diastolic dysfunction type 1, however, in the main group, there was a tendency to increase the number of patients with diastolic dysfunction type 2 and type 3. In patients of the main group, in the active period, there was a decrease in SDNNi by 31.85 % (U = 216; P < 0.05), VLF by 53.79 % (U = 176; P < 0.05); increase in LF by 60.56 % (U = 53; P < 0.05) and SI by 2.14 times (U = 43.5; P < 0.05). The presence of anemia in patients with CAD caused a twofold increase in the risk of autonomic dysfunction (BP = 2.045; 95 % CI 1.084–3.861; P < 0.05), 1.5 times increase in tachycardia episodes (BP = 1.510; 95 % CI 1.047–2.178; P < 0.05) and 2.2 times increase in myocardial ischemia (BP = 2.173; 95 % CI 1.047–4.512; P < 0.05). Conclusions. Concomitant anemia in patients with coronary artery disease adversely affects the structural and geometric properties of the heart, leads to an overall suppression of heart rate variability, increases the sympathetic tone of the autonomic nervous system in daytime period and the stress index, as well as raises the risk of autonomic dysfunction, tachycardia and myocardial ischemia.

Since its regulatory approval over a half-century ago, botulinum toxin has evolved from one of the most potent neurotoxins known to becoming routinely adopted in clinical practice. Botulinum toxin, a highly potent neurotoxin produced by Clostridium botulinum, can cause botulism illness, characterized by widespread muscle weakness due to inhibition of acetylcholine transmission at neuromuscular junctions. The observation of botulinum toxin’s anticholinergic properties led to the investigation of its potential benefits for conditions with an underlying etiology of cholinergic transmission, including autonomic nervous system dysfunction. These conditions range from disorders of the integument to gastrointestinal and urinary systems. Several formulations of botulinum toxin have been developed and tested over time, significantly increasing the availability of this treatment for appropriate clinical use. Despite the accelerated and expanded use of botulinum toxin, there lacks an updated comprehensive review on its therapeutic use, particularly to treat autonomic dysfunction. This narrative review provides an overview of the effect of botulinum toxin in the treatment of autonomic dysfunction and summarizes the different formulations and dosages most widely studied, while highlighting reported outcomes and the occurrence of any adverse events.

Introduction: Parkinson's disease is an idiopathic, slow progressive neurodegenerative condition with the loss of dopaminergic neurons in the substantia nigra compacta of the midbrain. Due to cardiovascular dysautonomia and impaired baroreflex function in Parkinson's disease, the development of orthostatic hypotension is most common, along with increased blood pressure variability, supine hypertension, nocturnal hypertension, etc. Orthostatic hypotension in Parkinson's disease increases the risk of developing coronary heart disease, myocardial infarction, and the risk of overall, and cardiovascular mortality. Case report: Orthostatic hypotension in Parkinson's disease is associated with an increased risk of gait disturbances, loss of balance, falls resulting in injuries and limb fractures, and mortality. In this paper, we presented a patient who had previously been treated for arterial hypertension, with the current clinical presentation of symptomatic orthostatic hypotension in Parkinson's disease. After neurological evaluation and the implementation of pharmacological and non-pharmacological therapy for orthostatic hypotension, gradual improvement and stabilization of blood pressure values are achieved, along with a reduction in orthostatic hypotension symptoms and a decrease in subjective discomfort. Conclusion: In the presence of orthostatic hypotension in Parkinson's disease, in addition to pharmacological therapy, nonpharmacological treatment measures are very important for stabilizing blood pressure values and reducing the symptoms of orthostatic hypotension.

Aim:The assessment of heart rate variability (HRV) has been considered as an important non-invasive method to evaluate cardiac autonomic function. Concerning recent evidence on the relationship between impaired autonomic dysfunction and sarcoidosis, we aimed to investigate the effect of pulmonary sarcoidosis on cardiac autonomic dysfunction.Materials and Methods:This prospective study comprised of 36 participants, including 18 patients diagnosed with pulmonary sarcoidosis and 18 age-matched healthy volunteers. All participants underwent echocardiographic examination, 12-channel electrocardiography and 24-h Holter monitoring. HRV parameters were determined and compared between the groups.Results:In time domain analyses, RMSDD values significantly decreased in the patient group compared to the control group (p=0.043). The low-frequency power in frequency domain analyses between sarcoidosis patients and controls demonstrated a statistically significant difference (p=0.045). In the correlation analysis, PR duration was negatively correlated with all-time domain and frequency domain parameters as SDNN, SDANN and high-frequency values, which had a statistically significant difference (p=0.009, p=0.003, p=0.047 respectively). Corrected QT (QTc) duration was negatively correlated with all-time domain and frequency domain parameters as well. The low-frequency/high-frequency ratio was positively correlated with QTc duration.Conclusion:The patients with pulmonary sarcoidosis displayed a decrease in all HRV values reflecting diminished parasympathetic tone or blunted cardiac response to vagal modulation. This may cause cardiac outcomes such as atrioventricular conduction abnormalities, proarrhythmic tendency, ventricular arrhythmias and sudden death.

Abstract Background and Aims An autonomic nervous disorder is an important characteristic of cardiac amyloidosis; however, the prevalence of autonomic dysfunction in wild‐type transthyretin amyloidosis (ATTRwt) has not been established. Analysis of the R‐R interval coefficient of variation (CVR‐R) is a noninvasive method to measure parasympathetic activity. We aimed to assess autonomic dysfunction of ATTRwt and determine the utility of CVR‐R for the detection of ATTRwt in other cardiac diseases. Methods This is a single‐center, retrospective, case‐control study. Fifty patients with heart failure (HF) were studied. The etiologies of HF were as follows: ATTRwt, n = 10; previous myocardial infarction (MI), n = 20; and left ventricular hypertrophy (LVH) due to other disease processes (e.g., aortic stenosis), n = 20. We measured the CVR‐R at rest (CVR‐Rrest), CVR‐R with deep breaths (CVR‐Rbreath), and the change rate (CVR‐Rdiff rate). The relative change formula is as follows: CVR‐Rdiff rate = (CVR‐Rbreath − CVR‐Rrest)/CVR‐Rrest× 100 (%). Results There was no difference in the CVR‐Rrest levels among the three groups. The CVR‐Rdiff rate levels in the ATTRwt group were significantly lower (ATTRwt: −8.77 [−43.8 to 10.9]; LVH: 67.4 [38.7 to 89.4]; MI: 83.7 [60.4 to 142.9]). Based on the receiver operative characteristic curve analysis to identify ATTRwt in HF, the best cut‐off value for the CVR‐Rdiff rate was 19.7 (area under the curve: 0.848). Conclusion Our data suggested autonomic dysfunction in patients with ATTRwt. Measurement of the CVR‐R in HF patients may be a convenient support tool for the detection of ATTRwt.

ABSTRACT BACKGROUND: Coronary artery disease is an important cause of morbidity and mortality. The impact of ventricular arrhythmias with impaired cardiac vagal activity is one of the most recently studied prognostic factors. However, there are no studies evaluating the phenomenon of heart rate turbulence (HRT) during physical exertion. OBJECTIVE: To study the behavior of HRT during exercise testing, among individuals after myocardial infarction. DESIGN AND SETTING: Feasibility study conducted in a university hospital among individuals 4-6 weeks after myocardial infarction. METHODS: All subjects underwent 24-hour Holter monitoring and ergometric stress testing. We considered that abnormal HRT was present if the turbulence onset was ≥ 0% or turbulence slope was ≤ 2.5 mm/relative risk interval. RESULTS: All 32 subjects were asymptomatic. Their median age was 58 years (interquartile range 12.8) and 70% were male. Abnormal HRT was associated with ventricular dysfunction in this population. We found no differences regarding the behavior of HRT, in relation to age, gender, smoking, systemic arterial hypertension, diabetes mellitus or dyslipidemia. Ergometric stress testing detected premature ventricular beats (PVB) in approximately 44% of the examinations, and these occurred both during the active phase of effort and in the recovery period. The low occurrence of several isolated PVB in beta-blocked subjects made it difficult to perform statistical analysis to correlate HRT between ergometric and Holter testing. CONCLUSION: The data obtained in this study do not support performing HRT through ergometric stress testing among patients who remain on beta-blockers post-myocardial infarction, for the purpose of assessing cardiac vagal activity.

Summary: Parkinson's disease (PD) is a neurodegenerative disease characterized pathologically by the formation of Lewy bodies comprised mainly of α-synuclein. Assessment of skin synuclein has the potential as an excellent diagnostic method with high sensitivity, specificity, and reproducibility that is also convenient and acceptable to patients. In this review, we summarize findings regarding the characteristics of cutaneous nerve p-α-syn or α-syn deposits and their correlations with clinical phenotypes in PD patients with and without orthostatic hypotension and LRRK2, GBA, and SNCA gene mutations. This review can serve as a reference for the diagnosis and classification of PD based on α-syn deposit patterns and to deeply explore its pathogenesis. Funding statement: The work was partly supported by the National Natural Science Key Foundation of China (No. 81830040 and No 82130042) and the Program of Excellent Talents in Medical Science of Jiangsu Province (No. JCRCA2016006) .

High prevalence of autonomic dysfunction syndrome in schoolchildren was found, the specifics of its clinical presentation with identification of the most salient symptoms are given. The purpose of the work was to find the occurrence of NS (nervous system) functional disorders in various age groups, with gender differences noted, among schoolchildren of secondary schools in Almaty. The NS dysfunction was assessed using questionnaires in 1827 schoolchildren (966 girls –52.87%, 861 boys –47.12%) 7–17 years old, attending the secondary schools in Almaty. As a result, we found numerous NS functional disorders among 56,8% of adolescents. Manifestations of vegetative instability were expressed as headaches in 44.5% of children, drowsiness in 53.8% of cases, complaints of fatigue and weakness in 56.8% of children. Complaints of sleep disturbance were recorded in 32% of schoolchil-dren, a greater number of complaints of syncope were received in the tenth grade from girls - 22%. Cardialgia, as a manifestation of NDC and adaptive-adaptive mechanisms of the body, occurred in 20.4% of cases.

Dumping syndrome has long been associated with gastric surgery. The authors experienced an adult patient presenting with dumping syndrome after meningitis without any previous surgical procedures on the stomach and small bowel. Dysfunction of the autonomic nervous system after infective meningitis may originate from postinfectious sequelae or an immunologic mechanism. A comprehensive study and proper management of autonomic symptoms of patients with a central nervous system infection are needed.

Background: Off springs with a parental history of type 2 diabetes mellitus are genetically susceptible to develop diabetes. In some recent reports it has been shown that these vulnerable population exhibit altered autonomic activity even before the manifestations of disease. Autonomic dysfunction might be the initial cardiac pathology in subclinical type2 diabetes. Till now very few studies have been done to find out the early outcomes of this genetic transmission. Keeping in view of the above facts, the current study was carried out to find out the association between autonomic dysfunction and parental history of diabetes. Aim and Objectives: This study was aimed to quantify and compare the difference (if any) of heart rate recovery in response to 3minute step test between the young non diabetic children of non-diabetic and diabetic parents. Materials and Methods: Fifty-one non diabetic students were divided into two groups. One group comprised of students with parental history of type2 diabetes mellitus and another group with students without parental history of diabetes. Each student was subjected to 3minute Master step test. Recordings of heart rate were made before and after exercise. Heart arte recovery (HRR) in 1 minute (HRR1) as well as in 2, 3 and 4 minute (HRR2,HRR3, HRR4) were recorded and analyzed. Results: The resting (basal) as well as 1stminute heart rate recovery (HRR1) was not significantly different between the two groups. Likewise, the 2nd minute HRR (HRR2), 3rd minute HRR (HRR3) and 4th minute HRR (HRR4) respectively were also not significantly different between the two groups. Conclusion: This study concludes that there is no difference in the heart rate recovery in response to the exercise stress test between the young non diabetic children of non-diabetic and diabetic parents. Therefore, parental history of diabetes does not have any impact on the cardiovascular autonomic activity before the disease manifestation.

Introduction: Studies have reported that off springs of hypertensive parents are more likely to develop hypertension. Affection of target organ starts even before the diagnosis of hypertension. Autonomic dysfunction may be the initial cardiac effects in the pathogenesis of hypertension. Till now very few studies have been done to find the early outcomes in the cardiac autonomic functions in the normotensive siblings of hypertensive patients. Heart rate recovery after exercise is a useful marker for cardiac autonomic function. Since the etio-pathogenesis of hypertension is expected to affect the autonomic cardiovascular parameters even before the prehypertensive stage, the following study was carried out to analyze the heart rate recovery, in the descendent non- hypertensive young adults with and without parental history of hypertension. Aim and objective: This research study was aimed to study the quantify and compare the difference (if any) of heart rate recovery in response to 3minute step test between non hypertensive children of non- hypertensive and hypertensive parents within an age group of 18-22 years. Material &Methods: A total of 63 normotensive students were divided into one hypertensive parents(HP) group containing students with parental history of hypertension) and one non hypertensive parents group (NHP) having students without parental history of hypertension). Each student was subjected to 3 minute Master step test. Recordings of heart rate were made before and after exercise. Heart rate recovery index (HRRI) of 1minute (HRRI1), as well as in 2, 3 and 4 minute (HRRI2, HRRI3, HRRI4) were calculated and analyzed. Results: The resting (basal) heart rate as well as 1st minute heart rate recovery index (HRRI1) was not significantly different in the two groups. Likewise, the 2nd minute (HRRI2), 3rd minute (HRRI3), and 4th minute HRRI (HRR4) respectively were also not significantly different between the two groups. Conclusion: This study concluded that there is no significant difference in heart rate recovery among non-hypertensive young adults, with and without parental history of hypertension.

Studies in 82 patients were aimed at optimizing the diagnosis and treatment of vestibular dysfunctions with vegetative-vascular disorders during degenerative changes in the cervical spine.The main symptoms of vestibulopathy were dizziness as well as their provoking and related causes. Obtained objective state data of the vestibular analyzer using the integrative index of ataxia, the state of autonomic characteristics, data of the psychoemotional and cognitive sphere. The author's method of treating such conditions using a complex of vegetotropic, vascular, nootropic drugs, as well as intranasal electrophoresis, was used. Positive results were obtained for this type of therapy for vestibulopathy and autonomic vascular disorders.

Background: Postural tachycardia syndrome (POTS) is a form of autonomic dysregulation. There is increasing evidence that the etiology may be immune-mediated in a subgroup of patients. Patients with POTS often experience an exacerbation of their symptoms associated with (viral) infections and often fear the same symptom aggravation after vaccination. In this report we describe the tolerability of messenger ribonucleic acid (mRNA) vaccines against coronavirus disease 19 (COVID-19) and the consequences of a COVID-19 infection on POTS symptoms in our cohort of patients with neuropathic POTS. Methods: We conducted a standardized, checklist-based interview with 23 patients and recorded the acute side effects of mRNA vaccination, acute symptoms of COVID-19 infection as well as the effects of vaccination and COVID-19 infection on POTS symptoms. Results: Of all included patients, 20 patients received two mRNA vaccines without having had a previous COVID-19 infection, and five patients in total had suffered a COVID-19 infection. Of these, three had COVID-19 without and two after being vaccinated. No increased frequency of side effects after both doses of mRNA vaccines was observed. Six patients reported a mild and short-term aggravation of their POTS symptoms beyond the duration of acute vaccine side effects. All five patients who suffered a COVID-19 infection subsequently reported a pronounced and persistent exacerbation of POTS symptoms. Conclusions: Our observations suggest that mRNA vaccines are not associated with a higher frequency of acute side effects in patients with POTS. Symptom exacerbation as a consequence of mRNA vaccination seems to be less frequent and of shorter duration compared to patients who suffered a COVID-19 infection.

Abstract A 46‐year‐old male had 11‐year history of cryptic autonomic dysfunction. He developed a fatal autonomic failure with diffuse hypoxic brain injury. Histology examination of medulla oblongata and the celiac ganglion revealed many α‐synuclein immunoreactive Lewy bodies confirming the diagnosis of premanifesting Parkinson's disease (PD). PNS involvement in PD is underappreciated.

Abstract Background Heart rate variability (HRV) is an objective, non-invasive tool to assessing autonomic dysfunction in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). People with CFS/ME tend to have lower HRV; however, in the literature there are only a few previous studies (most of them inconclusive) on their association with illness-related complaints. To address this issue, we assessed the value of different diurnal HRV parameters as potential biomarker in CFS/ME and also investigated the relationship between these HRV indices and self-reported symptoms in individuals with CFS/ME. Methods In this case–control study, 45 female patients who met the 1994 CDC/Fukuda definition for CFS/ME and 25 age- and gender-matched healthy controls underwent HRV recording-resting state tests. The intervals between consecutive heartbeats (RR) were continuously recorded over three 5-min periods. Time- and frequency-domain analyses were applied to estimate HRV variables. Demographic and clinical features, and self-reported symptom measures were also recorded. Results CFS/ME patients showed significantly higher scores in all symptom questionnaires (p

Abstract Neuropathy should be considered as a possible etiological factor in patients with severe gastrointestinal symptoms, without signs of disease on routine investigations. Examinations of the autonomic and peripheral nervous systems may be helpful to select the patients who should be investigated with full‐thickness intestinal biopsy, and to give appropriate care.

Attention deficit/hyperactivity disorder (ADHD) is one of the most frequently seen mental disorders in children with an increasing risk for other mental disorders. ADHD represents a primary biological dysfunction of the central nervous system, such as dysregulation of frontal-subcortical-cerebellar catecholaminergic circuits and imbalances in the dopaminergic system. However, autonomic nervous system, comprised of two primary branches - sympathetic and parasympathetic nervous systems that are normally in dynamic balance, plays an essential role in the regulation of body functions. Although it is generally assumed that the autonomic regulation is impaired during ADHD the information related to this dysregulation is limited. One of the options to observe changes of autonomic balance in ADHD is pupillary light reflex (PLR). Pupillometric evaluation can be used for the assessment of functioning of both autonomic nervous system branches and certain parameters of pupil responsivity can be helpful as a tool for medical diagnostic and treatment. In conclusion, these findings suggest the pupillometry as a non-invasive method that can indicate abnormalities in the complex central autonomic network regulating PLR.

Background: Almost all organs and systems in the body are affected by Human Immunodeficiency Virus (HIV) infection. Autonomic nervous system involvement and cardiac autonomic dysfunction is known to affect severely the quality of life in HIV patients due to fatal consequences in later stages of the disease. Aim and Objectives: Assessment of cardiac autonomic dysfunction on HIV infection/Acquired Immunodeficiency Disease Syndrome (AIDS) patients and to correlate the degree of dysfunction with Cluster of Differentiation 4 (CD4) count. Material and Methods: Fifty one human HIV sero-positive patients with 20 HIV sero-positive patients without AIDS and 31 with AIDS and 51 controls were studied for cardiac autonomic dysfunction in a tertiary care medical college hospital. The assessment of cardiac autonomic function was done by series of autonomic function tests. The number of abnormal test results correlated with CD4 count. Results: In patients with HIV, abnormal cardiac autonomic functions were observed in 5.6% of patients without AIDS and 37.5% of patients with AIDS. Significant differences between HIV patients and controls was observed for systolic blood pressure response to standing (p

It is nowadays recognized that Parkinson’s disease (PD) involves a variety of non-motor manifestations, which sometimes seriously affect the quality of life in these patients. This study explored the prevalence of digestive symptoms in a group of 86 PD patients from the South-eastern Romania (56% male, mean age 70.6) who had been diagnosed with Parkinson’s disease according to the United Kingdom Brain Bank criteria; patient-reported digestive symptoms were assessed using the Scale for Outcomes in Parkinson’s Disease for Autonomic Symptoms (SCOPA-AUT). The overall prevalence of digestive symptoms in the studied group was impressive (98,8%). Defecatory dysfunction (75.6%), ranks first followed by swallowing difficulties/choking (68.6%) and constipation (66.3%); 60.4% of study subjects experienced digestive symptoms “regularly” or even “often”. The proportion of patients having more than 3 digestive symptoms increased almost progressively with disease duration; nevertheless, there was no statistically significant correlation between disease duration and the number or frequency of digestive symptoms.

General anxiety disorder (GAD) is a condition characterized by extreme, persistent, and uncontrollable worry lasting for more than six months. In addition to cognitive and behavioral symptoms, individuals with GAD also commonly exhibit physical signs and autonomic nervous system symptoms. Heart rate turbulence (HRT) is the assessment of sinus rhythm cycle fluctuation occurring in the presence of ventricular premature contraction (VPC), and is a parameter used to show autonomic dysfunction. There are no studies in the literature investigating the association between GAD and HRT. The aim of the present study was to determine the association between HRT and anxiety symptom levels. The study included 72 consecutive patients. The patients were fitted with Holter devices for 24-hr rhythm monitoring and asked to complete the Hospital Anxiety and Depression Scale (HADS) to assess their anxiety symptom levels. The study participants were grouped based on the severity of their anxiety symptoms as low (group 1) and high (group 2). Of the 72 participants, 26 had high anxiety levels and 46 had low anxiety levels. There was a significant difference between the two groups in HRT parameters. Patients in the high-anxiety group had significantly higher turbulence onset (TO) and significantly lower turbulence slope (TS) when compared with the low-anxiety group. Anxiety score was positively correlated with TO (r=0.296, p=0.01) and negatively correlated with TS (r=-0.304, p=0.009). In the present study, we found that patients with high anxiety levels showed greater abnormality in HRT parameters, indicating autonomic dysfunction. [Med-Science 2019; 8(1.000): 143-7]

Background: Evidence is accruing to suggest that microbiota-gut-brain signalling plays a regulatory role in cardiorespiratory physiology. Chronic intermittent hypoxia (CIH), modelling human sleep apnoea, affects gut microbiota composition and elicits cardiorespiratory morbidity. We investigated if treatment with prebiotics ameliorates cardiorespiratory dysfunction in CIH-exposed rats. Methods: Adult male rats were exposed to CIH (96 cycles/day, 6.0% O2 at nadir) for 14 consecutive days with and without prebiotic supplementation (fructo- and galacto-oligosaccharides) beginning two weeks prior to gas exposures. Findings: CIH increased apnoea index and caused hypertension. CIH exposure had modest effects on the gut microbiota, decreasing the relative abundance of Lactobacilli species, but had no effect on microbial functional characteristics. Faecal short-chain fatty acid (SCFA) concentrations, plasma and brainstem pro-inflammatory cytokine concentrations and brainstem neurochemistry were unaffected by exposure to CIH. Prebiotic administration modulated gut microbiota composition and diversity, altering gut-metabolic (GMMs) and gut-brain (GBMs) modules and increased faecal acetic and propionic acid concentrations, but did not prevent adverse CIH-induced cardiorespiratory phenotypes. Interpretation: CIH-induced cardiorespiratory dysfunction is not dependant upon changes in microbial functional characteristics and decreased faecal SCFA concentrations. Prebiotic-related modulation of microbial function and resultant increases in faecal SCFAs were not sufficient to prevent CIH-induced apnoea and hypertension in our model. Our results do not exclude the potential for microbiota-gut-brain axis involvement in OSA-related cardiorespiratory morbidity, but they demonstrate that in a relatively mild model of CIH, sufficient to evoke classic cardiorespiratory dysfunction, such changes are not obligatory for the development of morbidity, but may become relevant in the elaboration and maintenance of cardiorespiratory morbidity with progressive disease. Funding: Department of Physiology and APC Microbiome Ireland, University College Cork, Ireland. APC Microbiome Ireland is funded by Science Foundation Ireland, through the Government's National Development Plan.

Abstract Background The clinical effect of copper accumulation on the heart of patients suffering from Wilson’s disease (WD) is not completely understood. We aimed to determine if patients with WD show signs of cardiac involvement, structural heart disease or autonomic dysfunction. In this prospective trial, we studied 61 patients (mean age 44.3 ± 15.2 years, 51% males) with WD and compared them to 61 age- and gender-matched healthy controls. All subjects underwent clinical examination, blood tests, echocardiography and 24 h electrocardiographic (ECG) recording. Results Left- and right ventricular systolic function did not differ significantly between WD patients and controls. However, 5 of the 61 patients had a reduced left ventricular ejection fraction (LVEF). Furthermore, diastolic dysfunction was more prevalent in WD patients (9 of 61 vs. 0 of 61, p = 0.001). The severity of WD based on the Unified Wilson’s Disease Rating Scale was significantly correlated to NT-pro BNP (r = 0.34, P = 0.013). Patients with an exacerbation of WD in medical history had higher troponin levels compared to those without (11.3 ± 4.7 vs 4.6 ± 1.2). The autonomic function assessed by triangular index (TI) and SDNN-index was significantly reduced in WD patients compared to controls in most in almost every age category (p-value TI and SDNN: age 20–29, p

Neurodegenerative diseases belong to the group of progressive disease entities leading to pathological changes in nerve cells. Loss of nerve cells causes numerous motor and non-motor disorders, which include autonomic nervous system (AUN) disorders. The aim of the study is to review the available literature on the most frequently occurring disorders of the autonomic nervous system occurring in neurodegenerative diseases and methods of their diagnosis. For this purpose, databases such as MedLine, PubMed, Cochrane Library and Polish Medical Bibliography were searched. Articles in Polish and English were selected. The paper presents the methods most commonly used to assess the autonomic nervous system, cardiovascular disorders. Accounted for methods that, thanks to their ease of implementation, have found wide clinical application. Non-invasive methods include, among others: analysis of heart rate variability, 24-hour blood pressure monitoring, tilt test and deep slow breathing test. In addition to the above-mentioned studies and tests, the literature also includes questionnaires for assessing dysautonomy. The most commonly used is the Lowa Autonomous Symptom Questionnaire. Studies published so far confirm the need to use AUN assessment in neurodegenerative diseases. Diagnosis and treatment of nervous system dysautonomics is important from the point of view of a holistic therapeutic approach.

Background: Multiple sclerosis (MS) is a chronic demyelinating disease of the nervous system. In its course, there are many motor and non-motor disorders, including the autonomic system disorders. They are characterized by an increase or decrease in the activity of the autonomic nervous system. The course of the disease is most often multi-phase, there are periods of remission and exacerbation. The aim of the study is to assess cardiovascular parameters and heart rate variability in response to orthostatic stimuli in a patient with multiple sclerosis. Material and Method: A 48-year-old woman suffering from multiple sclerosis for 10 years (a form of secondary progressive disease) participated in the study. A study was carried out for cardiovascular response and heart rate variability in response to orthostatic stimuli. For this purpose, the Task Force Monitor system was used, which is a non-invasive method that allows the assessment of hemodynamic parameters such as heart rate, systolic blood pressure, diastolic blood pressure, and peripheral vascular resistance. Spectral heart rate variability (HRV) analysis was also used to assess the function of the autonomic nervous system. The evaluated parameters were: low-frequency component (LF), high-frequency (HF) and sympathetic-parasympathetic balance factor (LF / HF). Results: In the rest position, an autonomic balance shift was observed towards sympathetic domination. After performing the tilt test, the patient had an after pionization drop in blood pressure (orthostatic hypotension) as well as vascular resistance. Conclusions: The analysis of the case study shows that in multiple sclerosis there may be disorders of the autonomic nervous system manifested by abnormal regulation of arterial pressure in a vertical position.

Severe or persistent stress can cause emotional disturbances, which worsens the human condition. Psychological counselling is of paramount importance, however, some people may not have access to a psychologist or psychotherapist in a stressful situation and one has to resort to the medical therapy. 85 patients (mean age 26.5 ± 3.5 years) under professional stress (primary school teachers, nurses) diagnosed with “tension headaches, autonomic dysfunction” were included in the observational study. Patients were explained the causes of the disease, given recommendations on lifestyle and prescribed Valocordin at the dosage of 15 drops 3 times a day for 3 weeks. All patients showed improvement; none of the patients reported difficulty remembering, attention failure, problems talking. 88.3% of patients showed positive effect after 6 months, 61.1% of patients after 9 months and 49.9% of patients after 12 months. Despite disagreements in the medical professional environment, Valocordin remains one of the most popular drugs in patients under stress. The short-term use of Valocordin at therapeutic doses under stress conditions effectively helps to cope with insomnia, increased anxiety, relieves nervous tension and autonomic dysfunction.

Abstract Complex neurodevelopmental disorders need multi-disciplinary treatment approaches for optimal care. The clinical effectiveness of treatments is limited in patients with rare genetic syndromes with multisystem morbidity. Emotional and behavioural dysregulation is common across many neurodevelopmental disorders. It can manifest in children across multiple diagnostic groups, including those on the autism spectrum and in rare genetic syndromes such as Rett Syndrome (RTT). There is, however a remarkable scarcity in the literature on the impact of the autonomic component on emotional and behavioural regulation in these disorders, and on the longer-term outcomes on disorder burden. RTT is a debilitating and often life-threatening disorder involving multiple overlapping physiological systems. Autonomic dysregulation otherwise known as dysautonomia is a cardinal feature of RTT characterised by an imbalance between the sympathetic and parasympathetic arms of the autonomic nervous system. Unlocking the autonomic component of emotional and behavioural dysregulation would be central in reducing the impairment seen in patients with RTT. In this vein, Emotional, Behavioural and Autonomic Dysregulation (EBAD) would be a useful construct to target for treatment which could mitigate burden and improve the quality of life of patients. RTT can be considered as a congenital dysautonomia and because EBAD can give rise to impairments occurring in multiple overlapping physiological systems, understanding these physiological responses arising out of EBAD would be a critical part to consider when planning treatment strategies and improving clinical outcomes in these patients. Biometric guided pharmacological and bio-feedback therapy for the behavioural and emotional aspects of the disorder offers an attracting perspective to manage EBAD in these patients. This can also allow for the stratification of patients into clinical trials and could ultimately help streamline the patient care pathway for optimal outcomes. The objectives of this review are to emphasise the key issues relating to the management of EBAD in patients with RTT, appraise clinical trials done in RTT from the perspective of autonomic physiology and to discuss the potential of EBAD as a target for clinical trials.