Effect of Bortezomib on the Autonomic Nervous System.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5101-5101
Author(s):  
Roberto Crocchiolo ◽  
Stefania Ferrari ◽  
Valeria Calbi ◽  
Magda Marcatti ◽  
Elena Guggiari ◽  
...  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Hypotension ◽  
Postural Hypotension ◽  
Response To Therapy ◽  
Disease Stage ◽  
Drug Discontinuation ◽  
Disease Response ◽  
Autonomic Nervous ◽  
Sum Score

Abstract Background Peripheral neuropathy is one of the most frequent adverse events associated to bortezomib therapy; among neuropathic syndromes, postural hypotension is described as well. However, information on disautonomic toxicity are limited and there are no studies addressed to this particular issue so far. Before starting this study we had observed a case of dramatic acute autonomic failure during bortezomib treatment in a patient with advanced multiple myeloma, who developed severe orthostatic hypotension, tachycardia and impairment to tolerate the sitting and orthostatic posture for several weeks. Methods We prospectively studied 12 consecutive patients, treated with bortezomib at our Institution between February 2005 and July 2006. Assessment included neurological examination, INCAT Disability scale, INCAT sensory sum score, MRC sum score, nerve conduction studies, and standard cardiovascular autonomic tests including Lying to standing, Deep breathing and Postural hypotension. These tests were conducted baseline and after each bortezomib 21-days cycle up to three consecutive cycles. Results Two pts showed a clinically evident autonomic involvement with orthostatic hypotension; a change to a pathological score in 2 out of 3 tests anticipated clinical disautonomic signs in 1 and 11 weeks respectively. Clinical impairment showed to be reversible in both cases. Four pts presented only 1 pathological test (without any clinical sign or symptom of postural hypotension) and 6 patient had normal results. There was no apparent correlation between autonomic impairment and disease response to therapy or patients baseline characteristics (disease stage, Ig class, previous anti-myeloma therapies, concomitant thalidomide or anti-hypertensive treatment); furthermore, none had evidence of amyloidosis. Conclusions Our prospective study confirms that autonomic dysfunction is a potential adverse effect of bortezomib. Autonomic, non invasive, cardiovascular testing may reveal subclinical involvement and precede clinical evidence of disautonomic neuropathy. Further studies in larger cohorts of patients are needed to clarify the interactions between proteasome inhibitor activity and autonomic nervous system, in order to assess the frequency, the ability of available test in early pre-clinical diagnosis and the potential of the reversibility of neuropathic signs after drug discontinuation.

Blood Pressure and Orthostatic Hypotension: Faints, Near-Faints, and Lightheadedness

2013 ◽  
Author(s):  
J. Eric Ahlskog
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Hypotension ◽  
Vessel Diameter ◽  
Upright Position ◽  
Grocery Store ◽  
The Body ◽  
Autonomic Nervous ◽  
Neurodegenerative Process

Case example: Mrs. H. feels lightheaded intermittently during the day. This happens exclusively when she is up and about. Sometimes she notes graying of vision with these episodes. The feeling is not spinning (i.e., not vertigo). She has fainted twice when standing in line at the grocery store. If she sits, she feels much better. It is worse in the morning but may recur any time of the day. She feels fine while lying in bed at night. Older adults often worry about high blood pressure (BP), yet the opposite problem, low BP, is common among those with DLB or PDD. This is because the Lewy neurodegenerative process impairs the autonomic nervous system. The specific condition that may afflict those with DLB or PDD is orthostatic hypotension. The term orthostatic implies the upright position (i.e., standing); hypotension translates into low BP. Thus, the low BP occurring in these Lewy disorders develops in the upright position; conversely, it is normal or even high when lying down. When standing or walking, the BP may drop so low that fainting occurs. Among people with orthostatic hypotension, the BP is normal when sitting, although in severe cases, even the sitting BP is low. Whereas most people with DLB or PDD do not experience symptoms of orthostatic hypotension, it is sufficiently frequent to deserve attention. It often goes undiagnosed, even when fainting occurs. Unrecognized orthostatic hypotension may limit activities and impair the person’s quality of life. The first half of this chapter provides further background, with focus on BP measurement and recognition of orthostatic hypotension. The last half addresses treatment. The normal autonomic nervous system senses the position of our body with respect to the pull of gravity. It is able to reflexively counter gravity’s downward pull on the blood volume when standing (gravity tends to draw blood toward our feet when standing). An important mechanism for countering gravity’s pull is the constriction of blood vessel diameter in the lower half of the body. These vessels reflexively constrict during standing, in effect forcing blood up to the brain. The autonomic nervous system mediates these and other reflexive changes to stabilize BP.

scholarly journals Sensitivity of the Baroreceptors and the State of the Autonomic Nervous System in Patients with Chronic Impairment of Consciousness Due to Severe Brain Damage

2019 ◽  
Vol 15 (5) ◽  
pp. 61-73 ◽  
Author(s):  
V. N. Dorogovtsev ◽  
D. S. Yankevich ◽  
A. L. Parfenov ◽  
A. E. Skvortsov ◽  
A. V. Kotelnikova
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Hypotension ◽  
Brain Damage ◽  
Main Trend ◽  
Control Group ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Orthostatic Test ◽  
Autonomic Nervous ◽  
Group 1

Purpose of the study: to examine sensibility of baroreceptors and the autonomic nervous in the passive orthostatic test in patients with chronic impairment of consciousness due to severe brain damage and determine their role in the rehabilitation process.Materials and methods. The study included 30 patients with long-term impairment of consciousness due to severe brain damage (group 1), 10 of them being in the vegetative state (VS) and 20 being in the minimally conscious state (MCS). Craniocerebral trauma was the main cause of severe damage in that group (53% of patients). The comparison group included 24 patients with focal neurological symptoms caused predominantly — 79.2% of cases — by cerebrovascular disorders (group 2). The control group (group 3) consisted of 22 healthy volunteers of a comparable age. All measurements were done with the help of a Task Force Monitor 1030i (CNSystem, Austria) in the course of passive orthostatic test at 0°–30°–60°–0°. Changes in the power of low-frequency (LFS) and highfrequency spectrum (HFS) of heart rate variability and baroreceptors sensibility (BRS) were analyzed. Statistical analysis was carried out using Statistica-10 software. Significance of inter-group differences on unrelated samples was determined by the Mann–Whitney U-test. Differences between groups were considered significant at P 0.05.Results. Maximal background values of BRS were found in the control group. In group 1 and 2 patients, considerable decrease of that index was noted, which was proportional to the brain damage severity. Similar dynamics was observed for the indices of autonomic nervous system sensibility (LFS and HFS). The main trend of orthostatic changes of BRS, LFS, and HFS was characterized by progressive decrease of the indices with increase of the patients’ angle of tilting and their return to the baseline level after the patients were put back into the horizontal position. 4 patients of group 1 (14%) displayed signs of orthostatic disorders upon tilting to 30°: in 3 cases, orthostatic hypotension was observed, and in one case the postural orthostatic tachycardia syndrome (POTS) was diagnosed. Those patients differed by lower BRS and higher sympathetic system activity (LFS) vs. the same indices of other patients in that group.Conclusion. Patients with chronic impairment of consciousness during the post-comatose period after a severe brain damage display a significant decrease of baroreceptors sensibility and autonomic nervous system disorders manifesting in significantly lower activity of the sympathetic and parasympathetic systems. The prominence of such disorders is associated with brain damage severity. Their risk of developing orthostatic hypotension during tilting towards a vertical position is higher in patients who have lower baroreceptors sensibility, and this should be taken into account beginning the process of their verticalization.

scholarly journals The features of autonomic nervous system homeostasis and adaptive potential in children with syncope

2021 ◽  
pp. 5-14
Author(s):  
T.A. Kovalchuk ◽  
◽  
N.Yu. Luchyshyn ◽  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Hypotension ◽  
Vasovagal Syncope ◽  
Circulatory System ◽  
Study Groups ◽  
Adaptive Potential ◽  
Autonomic Nervous ◽  
Cardiogenic Syncope ◽  
Autonomic Support

The investigation of the nature of syncope shows that it is caused by failure of compensatory reflex mechanisms of the autonomic nervous system. Therefore, the determination of specific parameters of autonomic nervous system homeostasis and adaptive potential improves the approach to determining the clinical predictors of the syncope and facilitate its early diagnosis. Purpose — to determine the nature and compare of autonomic dysregulation and functional changes of in children with syncope of different genesis, to identify the circumstances for the formation of insufficient autonomic regulation. Materials and methods. The enrolled subjects were 125 children with syncope, aged 8–17 years, and 41 controls. Children were divided into three groups for analysis: 81 — with vasovagal syncope, 25 — with syncope due to orthostatic hypotension, 19 — with cardiogenic syncope. All children underwent a clinical and functional examination of the cardiovascular system to identify features of autonomic homeostasis. Results. Autonomic imbalance with a predominance of sympathetic autonomic regulation was detected in children of all study groups. The results of functional tests and quantitative integrative indicators showed significantly increased autonomic reactivity with depletion of adaptive potential in all study groups (p<0.05). Children with vasovagal syncope had excessive levels more often (p<0.05), and children with syncope due to orthostatic hypotension had insufficient levels of autonomic support (p<0.05). Violations of cardiorespiratory inter systemic connections were found in children with vasovagal and cardiogenic syncope significantly more often, compared to the control group (p <0.05). Correlations were found between the parameters of the initial autonomic balance, autonomic support of the circulatory system, and the manifestations of syncope in children. Conclusions. The correlation between pathological types of autonomic response and the frequency and duration of syncopal episode indicates a pathogenetic relationship between the state of autonomic support and the ability of the circulatory system to respond to triggers. Therefore, indicators of the autonomic homeostasis and adaptive potential can be applied for predicting the occurrence of syncopal episodes and monitoring of effective management of syncope in children. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: children, syncope, autonomic nervous system homeostasis, adaptive potential.

scholarly journals Neglected cause of recurrent syncope: a case report of neurogenic orthostatic hypotension

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Robert J H Miller ◽  
Derek S Chew ◽  
Satish R Raj
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Hypotension ◽  
Correct Diagnosis ◽  
Valsalva Manoeuvre ◽  
System Failure ◽  
Neurogenic Orthostatic Hypotension ◽  
Physician Visits ◽  
Autonomic Nervous ◽  
History Of

Abstract Background Syncope commonly results in emergency room and physician visits, leading to hospitalization and invasive investigations. Up to 24% of these presentations may be caused by neurogenic orthostatic hypotension (nOH), which continues to be an under-recognized clinical entity. We review an approach to diagnosing nOH. Case summary An 85-year-old man with a history of Parkinson’s disease was referred for a history of recurrent syncope, which had resulted in extensive cardiac investigation. Collateral history revealed that the events were orthostatic in nature, but with variable time to onset of symptoms. The patient was found to have significant postural drop in blood pressure without compensatory tachycardia. Cardiovascular autonomic function testing was performed, which confirmed significant autonomic nervous system failure, including a marked hypotensive response on tilt-table testing and a lack of vasoconstriction during Valsalva manoeuvre. The patient was diagnosed with nOH and initiated on midodrine with subjective improvement in the frequency of syncope. Discussion Autonomic nervous system failure, with nOH, is a common cause of recurrent syncope, particularly in older patients. Attention to detail during the medical history, including precipitating factors and the presence of prodromal symptoms prior to syncope, is critical for making the correct diagnosis. Measuring orthostatic vital signs correctly in patients with syncope provides valuable information, is cost-effective, and critical to diagnose nOH.

scholarly journals Regional Gray Matter Volume Changes in Parkinson’s Disease with Orthostatic Hypotension

2021 ◽  
Vol 11 (3) ◽  
pp. 294
Author(s):  
Jung Bin Kim ◽  
Hayom Kim ◽  
Chan-Nyung Lee ◽  
Kun-Woo Park ◽  
Byung-Jo Kim
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Hypotension ◽  
Gray Matter ◽  
Temporal Cortex ◽  
Inferior Temporal Cortex ◽  
Volume Changes ◽  
Autonomic Nervous System Dysfunction ◽  
Autonomic Nervous ◽  
The Right

Neurodegenerative change in the central nervous system has been suggested as one of the pathophysiological mechanisms of autonomic nervous system dysfunction in Parkinson’s disease (PD). We analyzed gray matter (GM) volume changes and clinical parameters in patients with PD to investigate any involvement in the brain structures responsible for autonomic control in patients with PD having orthostatic hypotension (OH). Voxel-based morphometry was applied to compare regional GM volumes between PD patients with and without OH. Multivariate logistic regression analysis using a hierarchical model was carried out to identify clinical factors independently contributing to the regional GM volume changes in PD patients with OH. The Sobel test was used to analyze mediation effects between the independent contributing factors to the GM volume changes. PD patients with OH had more severe autonomic dysfunction and reduction in volume in the right inferior temporal cortex than those without OH. The right inferior temporal volume was positively correlated with the Qualitative Scoring MMSE Pentagon Test (QSPT) score, reflecting visuospatial/visuoperceptual function, and negatively correlated with the Composite Autonomic Severity Score (CASS). The CASS and QSPT scores were found to be factors independently contributing to regional volume changes in the right inferior temporal cortex. The QSPT score was identified as a mediator in which regional GM volume predicts the CASS. Our findings suggest that a decrease in the visuospatial/visuoperceptual process may be involved in the presentation of autonomic nervous system dysfunction in PD patients.

Cardiovascular Reflexes and Autonomic Neuropathy

1978 ◽  
Vol 55 (4) ◽  
pp. 321-327 ◽  
Author(s):  
D. J. Ewing
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Autonomic Neuropathy ◽  
Autonomic Dysfunction ◽  
Postural Hypotension ◽  
Systemic Disease ◽  
Cardiovascular Reflexes ◽  
Diabetic Patients ◽  
Pharmacological Agents ◽  
Autonomic Nervous

Clinical features of autonomic neuropathy include postural hypotension, sweating abnormalities, disturbance of body temperature regulation, gastric fullness and nausea, intermittent nocturnal diarrhoea, constipation, bladder problems and impotence. In diabetic patients, gustatory sweating and hypoglycaemic unawareness also sometimes occur (Johnson & Spalding, 1974). The onset of symptoms is usually insidious and permanent, but may occasionally be acute and reversible (Young, Asbury, Corbett & Adams, 1975). Autonomic dysfunction can arise from three main causes: first, those where the damage to the autonomic nervous system is isolated, as in primary postural hypotension (Bannister, Sever & Gross, 1977) and familial dysautonomia (Brunt & McKusick, 1970); secondly, those caused by toxic or pharmacological agents which interfere with autonomic reflexes; thirdly, those associated with systemic disease, of which diabetes mellitus is the most common. Other diseases which may cause autonomic dysfunction include amyloidosis, porphyria, tetanus, polyneuritis, tabes dorsalis, parkinsonism, chronic renal failure and alcoholism, and occasionally autonomic neuropathy has been associated with carcinoma of the bronchus or the pancreas (Johnson & Spalding, 1974). Although it is possible to localize lesions within the autonomic nervous system to afferent or efferent sympathetic or parasympathetic pathways (Johnson & Spalding, 1974; Moskowitz, 1977), many of the available tests are complex and invasive and often lack adequate control measurements (Young et al., 1975). Because of the patchy nature of autonomic neuropathy, current interest has centred around the search for bedside tests that are ‘global’, reproducible and non-invasive. This review summarizes the present state of knowledge of simple tests of cardiovascular reflex function in the clinical evaluation of autonomic neuropathy, particularly in diabetic subjects.

scholarly journals Prevalence of resting bradycardia, resting hypotension and orthostatic hypotension in chronic spinal cord injury patients

2017 ◽  
Vol 4 (5) ◽  
pp. 1319
Author(s):  
Kuldeep Kumar Ashta ◽  
Ravi Kumar
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Hypotension ◽  
Incomplete Spinal Cord Injury ◽  
Cross Sectional ◽  
Autonomic Nervous ◽  
Cord Injury ◽  
Complete Spinal Cord Injury

Background: Spinal cord injury (SCI) is a devastating event which usually leads to the impairment of autonomic nervous system and also causes many acute and chronic complications. There are very few clinical tests to assess the proper functioning of the autonomic nervous system. So, it is hypothesized to access the presence of resting bradycardia, resting hypotension and orthostatic hypotension and to use them as indirect indicators for the autonomic dysfunction in chronic spine cord injury (SCI) patients.Methods: The study was an analytic cross-sectional study, to assess the prevalence of resting bradycardia, resting hypotension and orthostatic hypotension in the spinal cord injury patients.Results: This study was conducted on 87 SCI patients, out of which 58 were paraplegics (21 having complete spinal cord injury, 37 with incomplete spinal cord injury) and 29 tetraplegics (13 with complete spinal cord injury, 16 with incomplete spinal cord injury). Orthostatic hypotension (67% vs 48.65%), resting hypotension (38.09% versus 29.7%) and resting bradycardia (33.33% versus 27.03%) were more amongst paraplegics patients with complete spinal cord injury as compared to paraplegics with incomplete spinal cord injury patients. All tetraplegic patients with complete spinal cord injury had resting bradycardia. Orthostatic hypotension, resting hypotension was found to be greater in tetraplegic patients with complete spinal cord injury.Conclusions: Complications due to autonomic impairment pose day to day difficulties in life of chronic SCI patients hampering their quality of life. So, the assessment of autonomic functions must be a part of clinical evaluation of individuals with SCI and efforts must be made to tackle these complications in the best possible way.

scholarly journals Improving Diuretic Response in Heart Failure by Implementing a Patient-Tailored Variability and Chronotherapy-Guided Algorithm

2021 ◽  
Vol 8 ◽  
Author(s):  
Ariel Kenig ◽  
Yotam Kolben ◽  
Rabea Asleh ◽  
Offer Amir ◽  
Yaron Ilan
Keyword(s):  
Heart Failure ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Learning Algorithm ◽  
Public Health Problem ◽  
Adverse Outcomes ◽  
Response To Therapy ◽  
Major Public Health Problem ◽  
Diuretic Resistance ◽  
Autonomic Nervous

Heart failure is a major public health problem, which is associated with significant mortality, morbidity, and healthcare expenditures. A substantial amount of the morbidity is attributed to volume overload, for which loop diuretics are a mandatory treatment. However, the variability in response to diuretics and development of diuretic resistance adversely affect the clinical outcomes. Morevoer, there exists a marked intra- and inter-patient variability in response to diuretics that affects the clinical course and related adverse outcomes. In the present article, we review the mechanisms underlying the development of diuretic resistance. The role of the autonomic nervous system and chronobiology in the pathogenesis of congestive heart failure and response to therapy are also discussed. Establishing a novel model for overcoming diuretic resistance is presented based on a patient-tailored variability and chronotherapy-guided machine learning algorithm that comprises clinical, laboratory, and sensor-derived inputs, including inputs from pulmonary artery measurements. Inter- and intra-patient signatures of variabilities, alterations of biological clock, and autonomic nervous system responses are embedded into the algorithm; thus, it may enable a tailored dose regimen in a continuous manner that accommodates the highly dynamic complex system.

Assessment of autonomic nervous system with tilt test in a case of idiopathic orthostatic hypotension

1992 ◽  
Vol 37 (1) ◽  
pp. 66
Author(s):  
Atsonobu Nomura ◽  
Hirokazu Saitoh ◽  
Takeshi Ino ◽  
Hiroyuki Sasaki ◽  
Hirotsugu Atarashi ◽  
...  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Hypotension ◽  
Tilt Test ◽  
Autonomic Nervous ◽  
Idiopathic Orthostatic Hypotension
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