Investigations on the Relationship Between the Autonomic Nervous System and the Triggering of Malignant Hyperthermia: A State-of-the-Science Review

Early research in malignant hyperthermia (MH) focused on the autonomic nervous system (ANS) as a primary trigger of the syndrome. This hypothesis was based on the initial signs and symptoms of MH such as tachycardia, cardiac arrhythmias, hypertension, and signs of increased metabolism in patients who developed MH. Supporting these early links between MH and the ANS were case reports from anesthesia providers who reported that patients who subsequently developed MH after a nontriggering previous anesthetic had appeared unusually stressed prior to the surgical procedure in which they triggered. There is no disagreement in the scientific community that a primary disorder in MH lies in the inability to control myoplasmic calcium levels in skeletal muscles. However, considering the variability in genetic and clinical presentation, the timing of intraoperative triggering, and the unexplained phenomenon of nonanesthetic triggering, the identification of cofactors in MH triggering remains paramount. A careful review of existing research supports the hypothesis that the autonomic nervous system plays a significant role as a cofactor in the triggering and progression of an MH episode. If a differentiation can be made and a link can be demonstrated between abnormalities in receptor sensitivity for or release, reuptake, or metabolism of catecholamines in malignant hyperthermia susceptible individuals, we may be able to use these as additional markers/predictors of disease.

Download Full-text

PAROXYSMAL HYPERTENSION SIMULATING PHEOCHROMOCYTOMA

PEDIATRICS ◽

10.1542/peds.8.5.664 ◽

1951 ◽

Vol 8 (5) ◽

pp. 664-671

Author(s):

NATALIE ARONSON ◽

GERTRUDE S. STERN ◽

SIDNEY Q. COHLAN

Keyword(s):

Blood Pressure ◽

Nervous System ◽

Autonomic Nervous System ◽

Signs And Symptoms ◽

Exploratory Laparotomy ◽

Excessive Sweating ◽

Autonomic Nervous ◽

Therapeutic Value ◽

Paroxysmal Hypertension

An eight year old child with intermittent attacks of hypertension and vomiting has been described, The blood pressure fell dramatically in response to Benzodioxane®, suggesting the presence of a pheochromocytoma, but this tumor was not found after an extensive exploratory laparotomy. The episodes of hypertension and vomiting together with the associated findings in this child of crying without tears, frequent blotching of the skin and excessive sweating and salivating are considered to be indications of an unusually labile autonomic nervous system. These latter characteristics were present in a younger sibling who also had an extremely labile blood pressure but who did not exhibit periodic attacks of hypertension and vomiting. A variety of agents were studied for their effects on the patient's signs and symptoms but none of these were demonstrated to have any therapeutic value.

Download Full-text

Clinical Assessment Scales in Autonomic Nervous System Disorders

Journal of the Korean Neurological Association ◽

10.17340/jkna.2021.2.21 ◽

2021 ◽

Vol 39 (2 Suppl) ◽

pp. 60-76

Author(s):

Eun Bin Cho ◽

Ki-Jong Park

Keyword(s):

Nervous System ◽

Autonomic Nervous System ◽

Scoring Systems ◽

Signs And Symptoms ◽

Self Report ◽

Symptom Scale ◽

Autonomic Symptom ◽

Autonomic Nervous ◽

Autonomic Nervous System Disorders ◽

Assessment Scales

The autonomic nervous system plays an important role in maintaining homeostasis mediated by the parasympathetic, sympathetic and enteric systems. Autonomic failure adversely affects body function and may increase morbidity and mortality. Therefore, the scoring systems, such as Ewing’s classification and Composite Autonomic Scoring Scale (CASS), were developed to detect and quantify autonomic deficits, primarily focusing on the cardiovascular reflex system. Autonomic disorders manifest with a myriad of symptoms resulting from the dysfunction of the gastrointestinal, genitourinary, secretomotor, pupillomotor systems as well as cardiovascular system. Several self-report questionnaires, such as Composite Autonomic Symptom Scale (COMPASS), Scale for Outcomes in Parkinson’s disease for Autonomic Symptoms (SCOPA-AUT), Survey of Autonomic Symptom (SAS), were also used to support to detect various signs and symptoms of autonomic dysfunction in clinical settings. In this review, we introduce clinically useful assessment scales in autonomic nervous system disorders.

Download Full-text

Family conflict, autonomic nervous system functioning, and child adaptation: State of the science and future directions

Development and Psychopathology ◽

10.1017/s0954579411000034 ◽

2011 ◽

Vol 23 (2) ◽

pp. 703-721 ◽

Cited By ~ 101

Author(s):

Mona El-Sheikh ◽

Stephen A. Erath

Keyword(s):

Nervous System ◽

Autonomic Nervous System ◽

Family Conflict ◽

Future Research ◽

Risk And Resilience ◽

Autonomic Nervous ◽

Wide Range ◽

Psychological Maladjustment ◽

System Functioning ◽

State Of The Science

AbstractThe family is one of the primary contexts of child development. Marital and parent–child conflict (family conflict) are common and predict a wide range of negative behavioral and emotional outcomes in children. Thus, an important task for developmental researchers is to identify the processes through which family conflict contributes to children's psychological maladjustment, as well as vulnerability and protective factors in the context of family conflict. In the current paper, we aim to advance a conceptual model that focuses on indices of children's autonomic nervous system (ANS) functioning that increase vulnerability or provide protection against psychological maladjustment in the context of family conflict. In doing so, we provide a selective review that reflects the state of the science linking family conflict, children's ANS activity, and child psychological adjustment, and offer directions and guidance for future research. Our hope is to accelerate research at the intersection of family conflict and ANS functioning to advance understanding of risk and resilience among children.

Download Full-text

Autonomic Involvement in Subacute and Chronic Immune-Mediated Neuropathies

Autoimmune Diseases ◽

10.1155/2013/549465 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Anna Mazzeo ◽

Claudia Stancanelli ◽

Rita Di Leo ◽

Giuseppe Vita

Keyword(s):

Nervous System ◽

Autonomic Nervous System ◽

Autonomic Function ◽

Signs And Symptoms ◽

Autonomic Functions ◽

Autonomic Nervous ◽

Immune Mediated ◽

Chronic Course

Autonomic function can be impaired in many disorders in which sympathetic, parasympathetic, and enteric arms of the autonomic nervous system are affected. Signs and symptoms of autonomic involvement are related to impairment of cardiovascular, gastrointestinal, urogenital, thermoregulatory, sudomotor, and pupillomotor autonomic functions. Availability of noninvasive, sensitive, and reproducible tests can help to recognize these disorders and to better understand specific mechanisms of some, potentially treatable, immune-mediated autonomic neuropathies. This paper describes autonomic involvement in immune-mediated neuropathies with a subacute or chronic course.

Download Full-text

Temporary Diplopia After Gow-Gates Injection: Case Report and Review

Anesthesia Progress ◽

10.2344/15-00020.1 ◽

2016 ◽

Vol 63 (3) ◽

pp. 139-146 ◽

Cited By ~ 1

Author(s):

Bernadette Alvear Fa ◽

Steven R. Speaker ◽

Alan W. Budenz

Keyword(s):

Nervous System ◽

Case Report ◽

Autonomic Nervous System ◽

Intravenous Injection ◽

Local Anesthetic ◽

Case Reports ◽

Anesthetic Techniques ◽

Double Vision ◽

Current Case ◽

Autonomic Nervous

Complications associated with various local anesthetic techniques have been recorded in case reports and reviews. This current case reports a transient incident of blurred, double vision (diplopia) following a Gow-Gates mandibular block injection. There is descriptive discussion on possibilities associated with intra-arterial injection, intravenous injection, diffusion through tissue planes, and the autonomic nervous system pathway to lend credence suggesting the etiology of the complication. For practitioners, recognizing when a complication arises from anesthesia delivery and managing the patient in an appropriate manner is essential to an overall agreeable outcome.

Download Full-text

Behavioral and Autonomic Responses in Treating Children with High-Functioning Autism Spectrum Disorder: Clinical and Phenomenological Insights from Two Case Reports

Brain Sciences ◽

10.3390/brainsci10060382 ◽

2020 ◽

Vol 10 (6) ◽

pp. 382

Author(s):

Lucia Billeci ◽

Ettore Caterino ◽

Alessandro Tonacci ◽

Maria Luisa Gava

Keyword(s):

Autism Spectrum Disorder ◽

Nervous System ◽

Autonomic Nervous System ◽

Case Reports ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Autonomic Response ◽

System Response ◽

High Functioning ◽

Autonomic Nervous

In this study, we aimed to evaluate the process applied in subjects with Autism Spectrum Disorder (ASD) to elaborate and communicate their experiences of daily life activities, as well as to assess the autonomic nervous system response that subtend such a process. This procedure was evaluated for the first time in two eight-year-old girls with high-functioning ASDs. The subjects performed six months of training, based on the cognitive–motivational–individualized (c.m.i.®) approach, which mainly consisted in building domestic procedures and re-elaborating acquired experiences through drawing or the use of icons made by the children. Together with behavioral observations, the response of the autonomic nervous system during such re-elaboration was recorded. A change in communicative and interactive competences was observed, moving from a condition of spontaneity to one in which the girls were engaged in relating their experiences to a parent. Autonomic response highlighted how, in communicating their own experiences, they achieved a state of cognitive activation, which enabled a greater communicative and emotional connection with the interlocutor. This is a proof-of-concept study on the application of the c.m.i.®, which needs to be extensively validated in the clinical setting.

Download Full-text