Ocular autonomic function in progressive autonomic failure

Clark, Charles V.; Ewing, D J

doi:10.1007/bf00157061

Cited by 12 publications

(8 citation statements)

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“…Pupillary Function in Individuals With Pure Autonomic Failure and Multiple System Atrophy.— In individuals with PAF, a bilateral Horner syndrome is usually present 24,25 . The pupils of patients with PAF have been shown to dilate in response to extremely low doses of phenylephrine (ie, 0.5%) indicating a high degree of adrenergic receptor supersensitivity 26 . By contrast, in patients with MSA, the pupils are often completely normal, with normal responses to light 25…”

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confidence: 99%

Migraine: A Chronic Sympathetic Nervous System Disorder

2004

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The major finding of the present study is that migraine is a disorder of chronic sympathetic dysfunction, sharing many diagnostic and clinical characteristics with pure autonomic failure and multiple system atrophy. However, the sympathetic nervous system dysfunction in migraine differs from pure autonomic failure and multiple system atrophy in that occurs in an anatomically intact system. It is proposed that the sympathetic dysfunction in migraine relates to an imbalance of sympathetic co-transmitters. Specifically, it is suggested that a migraine attack is characterized by a relative depletion of sympathetic norepinephrine stores in conjunction with an increase in the release of other sympathetic cotransmitters such as dopamine, prostaglandins, adenosine triphosphate, and adenosine. An enhanced understanding of the sympathetic dysfunction in migraine may help to more effectively diagnose, prevent, and/or treat migraine and other types of headache.

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confidence: 99%

Migraine: A Chronic Sympathetic Nervous System Disorder

2004

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“…Additionally, subjects with PAF do not generate heart rate and blood pressure increases during effortful exercise or mental arithmetic (stressor tasks) 6 and do not increase circulating catecholamines during physical or emotional challenge 6 . These subjects have absent sympathetic skin conductance responses to emotive and orienting stimuli 9 , and have diminished pupilliary reflexes 10 . Through histological evidence, PAF has been associated with Lewy bodies in peripheral autonomic ganglia 11 , but its cause is unknown 6 .…”

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Neuroanatomical basis for first- and second-order representations of bodily states

2001

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articles Emotional, cognitive and physical behaviors mediated by the central nervous system are integrated with peripheral changes in bodily states. Moreover, physiological changes in bodily state directly influence emotional expression 1,2 and cognitive functions such as decision-making 3 and memory 4 . At a broader level, emotions may be subsumed within homeostatic mechanisms that underlie survival of the organism 2,5 . In a theoretical model 5 based on neurological observations, prime emphasis is given to the cerebral representation of bodily states as a substrate for emotions and conscious awareness. Fundamental components of the model are first-order autoregulatory mappings and second-order re-mappings of bodily states consequent upon behavioral experience. The dorsal pons is proposed to support first-order mapping of bodily state, because of its involvement in homeostatic regulation mediated via afferent information from the body. The model also proposes that somatosensory areas, the somatosensory cortices and insula, contribute to this primary representation of bodily states. In contrast, cingulate and medial parietal cortices are critical components in second-order mappings of experience-dependent changes in body states.Here we tested specific predictions arising from these theoretical considerations. We compared the state-dependent regional brain activity in healthy human subjects with activity in subjects with pure autonomic failure (PAF) 6 . PAF is an idiopathic disorder acquired in middle age that only affects the peripheral autonomic nervous system. Subjects with PAF cannot modulate their bodily state via the autonomic nervous system because of peripheral autonomic denervation, but have no other neurological deficit (sensory or motor). Consequently, there is no integrated central feedback of information concerning autonomic changes that are normal accompaniments of ongoing behavior 6 . Peripheral autonomic denervation results in a failure of neurogenic control of circulation, the cardinal feature of which is orthostatic (postural) hypotension due to an inability to activate sympathetic pathways to engender vasoconstriction during gravitational challenges [6][7][8] . Additionally, subjects with PAF do not generate heart rate and blood pressure increases during effortful exercise or mental arithmetic (stressor tasks) 6 and do not increase circulating catecholamines during physical or emotional challenge 6 . These subjects have absent sympathetic skin conductance responses to emotive and orienting stimuli 9 , and have diminished pupilliary reflexes 10 . Through histological evidence, PAF has been associated with Lewy bodies in peripheral autonomic ganglia 11 , but its cause is unknown 6 . PAF is distinguished from central neurodegenerative causes of autonomic failure (such as multiple system atrophy or Parkinson's disease with autonomic failure) by normal life expectancy 6,7 , and by the absence of clinical and hormonal 12 indicators of central neurological degeneration. Similarly, gross and pervasive...

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“…PAF, with reduced or absent peripheral autonomic function represents a useful lesion model for such investigation. Absence of peripheral autonomic arousal is accompanied by disabled peripheral autonomic regulation attendant to task performance (e.g., cardiovascular [26], pupillary [27], and dermal conductance responses [28]). …”

Section: Pure Autonomic Failure As Lesion Model For Probing Autonomicmentioning

confidence: 99%