The sympathetic skin response in peripheral autonomic failure — evaluation in pure autonomic failure, pure cholinergic dysautonomia and dopamine-beta-hydroxylase deficiency

Magnifico, Fabiola; Misra, Vidhi; Murray, N.M.F.; Mathias, C. J.

doi:10.1007/bf02281117

Cited by 40 publications

(16 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other studies have used electrodermal or sweating responses to evaluate sympathetic sudomotor "tone" [21,35,36]. Sympathoneural sweating responses depend on release of acetylcholine, not norepinephrine, from the nerve terminals [37].…”

Section: Discussionmentioning

confidence: 99%

Noninvasive detection of sympathetic neurocirculatory failure

Goldstein

Tack

2000

Clinical Autonomic Research

View full text Add to dashboard Cite

In sympathetic neurocirculatory failure (SNF), reflexive sympathetically mediated cardiovascular stimulation does not compensate for decreased cardiac filling. This explains orthostatic hypotension in chronic primary autonomic failure (CPAF). During phase 2 of the Valsalva maneuver (phase 2_L), blood pressure increases from its peak. During phase 4, blood pressure normally "overshoots" the baseline. Because these changes depend on sympathetically mediated cardiovascular stimulation, a progressive decrease in pressure during phase 2 and absence of the overshoot in phase 4 may indicate SNF. Moreover, because beat-to-beat blood pressure can be measured noninvasively using a photoplethysmographic or tonometric device, evaluating reflexive pressure responses might enable noninvasive diagnosis of SNF. This study assessed the relative frequencies of abnormal phase 2_L and phase 4 blood pressure in patients with CPAF and orthostatic hypotension and whether noninvasive measurement of beat-to-beat blood pressure can be used to diagnose SNF in patients. Twenty patients with chronic primary autonomic failure and orthostatic hypotension and 50 comparison patients, including several with CPAF but lacking orthostatic hypotension, underwent arterial pressure monitoring during performance of the Valsalva maneuver. Of the 20 patients with CPAF and orthostatic hypotension, all had an abnormal phase 2_L or phase 4 pressure response (sensitivity 100%), whereas only 3 of the 50 comparison patients had an abnormal response in either phase (specificity 94%). Seventeen patients with CPAF and orthostatic hypotension had abnormal responses in both phases (sensitivity 85%), but none of the comparison patients had such findings in both phases (specificity 100%). Of 13 patients in whom beat-to-beat blood pressure was recorded simultaneously invasively and noninvasively, all had abnormal blood pressure responses during phase 2_L and phase 4, whereas none of 29 comparison patients had such symptoms. Detection of abnormal blood pressure responses during phase 2_L or phase 4 of the Valsalva maneuver is a highly sensitive test for SNF. Abnormal pressure during these phases appears to identify SNF specifically. Noninvasive measurements can detect both of these abnormalities.

show abstract

Section: Discussionmentioning

confidence: 99%

Noninvasive detection of sympathetic neurocirculatory failure

Goldstein

Tack

2000

Clinical Autonomic Research

View full text Add to dashboard Cite

show abstract

“…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 .…”

mentioning

confidence: 99%

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

2001

Self Cite

View full text Add to dashboard Cite

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...

show abstract

“…From a sense of disembodiment or insubstantiality, the delusional belief is formed. Interestingly, like the Tranel patients, who had reduced SCR in the absence of any impostor beliefs, there is a condition that results in a deterioration of autonomic response across all sensory modalities but which does not result in the patient forming delusional beliefs about their existential status-pure autonomic failure (Magnifico et al 1998;Heims et al 2004;Mabuchi et al 2010; see also Coltheart 2007).…”

Section: Misplaced Being: Unpacking Feelings Of Familiarity and Unfammentioning

confidence: 95%

Beliefs, experiences and misplaced being: an interactionist account of delusional misidentification

Young

2010

Phenom Cogn Sci

View full text Add to dashboard Cite

This paper contrasts an interactionist account of delusional misidentification with more traditional one-and two-stage models. Unlike the unidirectional nature of these more traditional models, in which the aetiology of the disorder is said to "progress" from a neurological disruption via an anomalous experience to a delusional belief, the interactionist account posits the interaction of top-down and bottom-up processes to better explain the maintenance of the delusional belief. In addition, it places a greater emphasis on the patient's underlying phenomenal experience in accounting for the specificity of the delusional content. The role played by patient phenomenology is examined in light of Ratcliffe's recent phenomenological account. Similarities and differences are discussed. The paper concludes that a purely phenomenological account is unable to differentiate between non-delusional patient groups, who have what appear to be equivalent phenomenal experiences to patients suffering from delusional misidentification but without the delusional belief, and delusional groups, something the interactionist model is able to do.

show abstract

The sympathetic skin response in peripheral autonomic failure — evaluation in pure autonomic failure, pure cholinergic dysautonomia and dopamine-beta-hydroxylase deficiency

Cited by 40 publications

References 16 publications

Noninvasive detection of sympathetic neurocirculatory failure

Noninvasive detection of sympathetic neurocirculatory failure

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

Beliefs, experiences and misplaced being: an interactionist account of delusional misidentification

Contact Info

Product

Resources

About