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Autonomic Disturbances (autonomic + disturbance)
Selected AbstractsUrinary catecholamine excretion in tetanusANAESTHESIA, Issue 4 2006C. L. Thwaites Summary Imperfect understanding of the pathophysiology of tetanus has limited therapeutic advances. Autonomic disturbance is a major cause of mortality and is believed to be associated with catecholamine release, predominantly norepinephrine. We measured epinephrine and norepinephrine concentrations in 24-h urine collections from tetanus and critically ill patients suffering from other severe diseases. In patients with severe tetanus, mean (SD) epinephrine was 164.18 (129.37) nmol.day,1 compared with 45.18 (37.74) nmol.day,1 in mild-moderate disease (p = 0.008). In the severe group, mean (SD) norepinephrine was 411.64 (208.5), and 121.00 (81.81) nmol.day,1 in moderately ill patients (p < 0.001). Compared with critically ill control patients, median epinephrine was 331.77 in tetanus patients and 89.70 nmol.day,1 in controls (p < 0.001). Median norepinephrine concentration was 788.02 nmol.day,1 in tetanus and 300.05 nmol.day,1 in control patients, p = 0.006. The study finds a novel result of increased epinephrine excretion in tetanus and confirms that catecholamine excretion in tetanus exceeds that in other critically ill patients. These results should be considered in designing more effective therapeutic strategies. [source] Neurological complications of psychiatric drugs: clinical features and management,HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue S1 2008Peter M. Haddad Abstract This paper reviews the main neurological complications of psychiatric drugs, in particular antipsychotics and antidepressants. Extrapyramidal syndromes include acute dystonia, parkinsonism, akathisia, tardive dyskinesia and tardive dystonia. Extrapyramidal symptoms (EPS) are less frequent with atypical than with conventional antipsychotics but remain common in clinical practice partly due to lack of screening by health professionals. Neuroleptic malignant syndrome (NMS) consists of severe muscle rigidity, pyrexia, change in conscious level and autonomic disturbance but partial forms also occur. NMS is particularly associated with the initiation and rapid increase in dose of high-potency antipsychotics but it has been reported with all the atypical antipsychotics and rarely with other drugs including antidepressants. Serotonin toxicity comprises altered mental state (agitation, excitement, confusion), neuromuscular hyperactivity (tremor, clonus, myoclonus, hyper-reflexia) and autonomic hyperactivity and occurs on a spectrum. Severe cases, termed serotonin syndrome, usually follow the co-prescription of drugs that increase serotonergic transmission by different pathways, for example a monoamine oxidase inhibitor (MAOI) and a selective serotonin reuptake inhibitor (SSRI). Most antipsychotics and antidepressants lower the seizure threshold and can cause seizures; the risk is greater with clozapine than with other atypical antipsychotics and greater with tricyclic antidepressants (TCAs) than with SSRIs. In randomised controlled trials in elderly patients with dementia atypical antipsychotics are associated with a higher risk of stroke and death than placebo. Cohort studies suggest that conventional drugs carry at least the same risk. Cessation of treatment with antipsychotics and antidepressants can lead to a wide range of discontinuation symptoms which include movement disorders and other neurological symptoms. Clinicians need to be familiar with strategies to reduce the risk of these adverse events and to manage them when they arise. Their occurrence needs to be balanced against the benefits of psychiatric drugs in terms of efficacy and improved quality of life in a range of disorders. Copyright © 2007 John Wiley & Sons, Ltd. [source] Psychopathology in treated Wilson's disease determined by means of CPRS expert and self-ratingsACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2000K. Portala Objective: To examine the occurrence and severity of psychopathological symptoms in patients with treated Wilson's disease (WD) and to evaluate the clinical utility of a self-assessment. Method: Twenty-six consecutive patients with confirmed WD were investigated using the Comprehensive Psychopathological Rating Scale (CPRS) and the CPRS Self-rating Scale. Results: The total CPRS scores ranged from 2.5 to 59.0 (mean 29.4±15.5). Most common symptoms were: autonomic disturbances, observed muscular tension, fatiguability, reduced sexual interest, lack of appropriate emotion, concentration difficulties, reduced sleep, aches and pains, hostile feelings, apparent sadness and failing memory. Agreement between interview-based ratings and self-ratings was low. Conclusion: The patients with treated WD have prominent psychopathology in the same range as in patients with moderate to severe depressive disorders. A specific symptom profile has been identified. If confirmed, the identification of the typical symptom profile might be of great importance. The patients with WD tend to underestimate the presence of psychopathological symptoms. [source] Hemicrania Continua Responsive to Intravenous Methyl PrednisoloneHEADACHE, Issue 4 2009Sanjay Prakash DM Hemicrania continua (HC) is a strictly unilateral, continuous primary headache disorder with periodic exacerbations, usually accompanied by cranial autonomic disturbances. Exquisite and persistent effect of indomethacin is a fundamental property of HC. We report 2 patients of HC in which attacks were successfully eliminated by repeated infusion of methyl prednisolone. [source] Dysautonomia in human T-cell lymphotrophic virus type I-associated myelopathy/tropical spastic paraparesisANNALS OF NEUROLOGY, Issue 5 2001Alexandre H. Alamy MD The frequency and importance of dysautonomia in human T-cell lymphotrophic virus type I,associated myelopathy/tropical spastic paraparesis (HAM/TSP) have not been fully investigated. We describe the characteristics of dysautonomia in such patients in a case-control study. Our results indicate that autonomic disturbances are more frequent in HAM/TSP than has been previously suggested, with a predominance of sympathetic nervous system dysfunction. In some of these patients, the symptoms may be severe enough to warrant specific treatment. [source] Devices for Noninvasive Transcranial Electrostimulation of the Brain Endorphinergic System: Application for Improvement of Human Psycho-Physiological StatusARTIFICIAL ORGANS, Issue 3 2002Valery P. Lebedev Abstract: It is well known that deficit of endorphins plays an important role in disturbances of human psycho-physiological status. Previously, we revealed that brain endorphinergic structures have quasiresonance characteristics. On the basis of these data, a method of activation of the brain endorphinergic structures by means of noninvasive and rather selective transcranial electrostimulation (TES) as a kind of functional electrical stimulation (FES) was elaborated. New models of TES devices (TRANSAIR) were developed for indoor and outdoor usage. To increase the efficacy of TES, the frequency modulation according to normal distribution in the limits of the quasiresonance characteristics was put into operation. The blind and placebo-controlled (passive and active placebo) study was produced to estimate the TES effects on stress events and accompanied psycho-physiological and autonomic disturbances of different intensities on volunteers and patients in the following groups: everyday stress and fatigue; stress in regular military service and in field conditions; stress in the relatives of those lost in mass disaster; posttraumatic stress (thermal burns); and affective disorders in a postabstinence period. Some subjective verbal and nonverbal tests and objective tests (including heart rate variability) were used for estimation of the initial level of psycho-physiological status, which changes after TES sessions. It was demonstrated that fatigue, stress, and other accompanied psycho-physiological disturbances were significantly improved or abolished after 2,5 TES sessions. The TES effects were more pronounced in cases of heavier disturbances. In conclusion, activation of the brain endorphinergic structures by TES is an effective homeostatic method of FES that sufficiently improves quality of life. [source] Clinical aspects of neuromuscular transmission disordersACTA NEUROLOGICA SCANDINAVICA, Issue 2006Amelia Evoli Autoimmune disorders of neuromuscular transmission are caused by antibodies (abs) directed against membrane proteins at the motor end-plate. Myasthenia gravis (MG) is due, in most cases, to abs against the nicotinic acetylcholine receptor (AChR). Anti-AChR-positive MG actually includes different disease entities: weakness can be confined to extrinsic ocular muscles or can be generalized; patients with generalized MG (G-MG) can be subdivided on the basis of age of onset, HLA association and thymic pathology. About 15% of G-MG patients are anti-AChR-negative; in a proportion of these cases serum abs against the muscle- specific kinase (MuSK) are found. Anti-MuSK-positive MG is characterized by predominant involvement of bulbar muscles and very low frequency of thymic pathology. The Lambert-Eaton myasthenic syndrome (LEMS) is caused by abs against voltage-gated calcium channels at nerve terminal. LEMS is characterized by muscle weakness and autonomic disturbances and it is paraneoplastic in over 50% of the cases. In neuromyotonia and cramp-fasciculation syndrome, that are thought to be due to anti-voltage-gated potassium channel abs, signs of peripheral nerve hyperexcitability can be associated with CNS features. [source] | ||||||||||||||||||||||