Electrodiagnostic assessment of the autonomic nervous system: A consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology

Cheshire, William P.; Freeman, Roy; Gibbons, Christopher H.; Cortelli, Pietro; Wenning, Gregor K.; Hilz, Max J.; Spies, Judith M.; Lipp, Axel; Sandroni, Paola; Wada, Naoki; Mano, Akiko; Kim, Hyun Ah; Kimpinski, Kurt; Iodice, Valeria; Idiáquez, Juan; Thaisetthawatkul, Pariwat; Coon, Elizabeth A.; Low, Phillip A.; Singer, Wolfgang

doi:10.1016/j.clinph.2020.11.024

Cited by 96 publications

(93 citation statements)

References 170 publications

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“…We then conducted a detailed medical record review of identified cases to derive demographic information (age, sex), COVID-19 infection details (date, symptoms, date of confirmatory testing), symptoms compatible with autonomic dysfunction (type, onset, duration), and findings on neurological examination. After review of all available clinical information and results of autonomic function testing, the most appropriate autonomic diagnosis was determined [12,13].…”

Section: Clinical Variablesmentioning

confidence: 99%

Autonomic dysfunction following COVID-19 infection: an early experience

et al. 2021

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Purpose Post-COVID-19 syndrome is a poorly understood aspect of the current pandemic, with clinical features that overlap with symptoms of autonomic/small fiber dysfunction. An early systematic analysis of autonomic dysfunction following COVID-19 is lacking and may provide initial insights into the spectrum of this condition. Methods We conducted a retrospective review of all patients with confirmed history of COVID-19 infection referred for autonomic testing for symptoms concerning for para-/postinfectious autonomic dysfunction at Mayo Clinic Rochester or Jacksonville between March 2020 and January 2021. Results We identified 27 patients fulfilling the search criteria. Symptoms developed between 0 and 122 days following the acute infection and included lightheadedness (93%), orthostatic headache (22%), syncope (11%), hyperhidrosis (11%), and burning pain (11%). Sudomotor function was abnormal in 36%, cardiovagal function in 27%, and cardiovascular adrenergic function in 7%. The most common clinical scenario was orthostatic symptoms without tachycardia or hypotension (41%); 22% of patients fulfilled the criteria for postural tachycardia syndrome (POTS), and 11% had borderline findings to support orthostatic intolerance. One patient each was diagnosed with autoimmune autonomic ganglionopathy, inappropriate sinus tachycardia, vasodepressor syncope, cough/vasovagal syncope, exacerbation of preexisting orthostatic hypotension, exacerbation of sensory and autonomic neuropathy, and exacerbation of small fiber neuropathy. Conclusion Abnormalities on autonomic testing were seen in the majority of patients but were mild in most cases. The most common finding was orthostatic intolerance, often without objective hemodynamic abnormalities on testing. Unmasking/exacerbation of preexisting conditions was seen. The temporal association between infection and autonomic symptoms implies a causal relationship, which however cannot be proven by this study.

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Section: Clinical Variablesmentioning

confidence: 99%

Autonomic dysfunction following COVID-19 infection: an early experience

et al. 2021

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“…Indeed, alterations to SCL in AN were observed to be correlated with psychological factors (including anxiety and metacognitive dysfunction) (Léonard et al, 1998 ; Palomba et al, 2017 ). Given that sympathetic skin response has been demonstrated to be emotionally activated (Cheshire et al, 2020 ), the use of SCL to provide insight into thermoregulatory autonomic function is therefore limited.…”

Section: Discussionmentioning

confidence: 99%

Autonomic Nervous System Function in Anorexia Nervosa: A Systematic Review

et al. 2021

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Background: Autonomic nervous system (ANS) dysfunction has been suggested to contribute to the high prevalence of cardiovascular complications in individuals with anorexia nervosa (AN), yet has not been thoroughly investigated. The current review aimed to synthesize the evidence of basal ANS function in individuals with a current diagnosis of AN and those with a previous diagnosis who had achieved weight restoration, as compared to controls.Methods: A systematic review of nine databases was conducted and studies that were published in a peer-review journal, in English, that included at least one assessment of ANS function in individuals with a current or previous diagnosis of AN were selected. Forty-six studies were included with a total of 811 participants with a current diagnosis of AN and 123 participants with a previous diagnosis of AN.Results: ANS function was assessed through heart rate variability (n = 27), orthostatic challenge, blood pressure variability or baroreflex sensitivity (n = 11), adrenergic activity (n = 14), skin conductance level (n = 4), and pupillometry (n = 1). Individuals with AN demonstrated increased parasympathetic activity and decreased sympathetic activity, suggestive of autonomic dysregulation. Following weight restoration, autonomic function trended toward, or was equivalent to, control levels.Discussion: Autonomic dysregulation is indicated through a range of assessments in individuals with AN. Future investigations should utilize a variety of assessments together in order to conclusively establish the nature of autonomic dysfunction in AN, and following extended weight restoration. Moreover, investigation into the co-occurrence of ANS function and cardiovascular risk is required.

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“…Epidermal nerve fiber (ENF) densities were ascertained in a 3-mm punch biopsy of skin taken from the lateral thigh and calf and placed in paraformaldehyde-lysine-periodic acid fixative and compared to age-matched controls using normative data [ 5 , 6 ]. Autonomic evaluation included beat-to-beat blood pressure acquisition for testing of cardiovagal (parasympathetic) function, adrenergic (sympathetic) function of heart rate (HR) and systolic blood pressure (SBP) during rapid respiration, Valsalva maneuver and 5-min 70° head up tilting (HUT) using autonomic laboratory components (WR Medical Electronics, MN) were performed according to standard guidelines [ 7 ]. 18 Fluorodeoxyglucose (FDG) positron emission tomography (PET) fused to 3-Tesla non-contrast brain magnetic resonance imaging (MRI) with 3D rendering was performed using volumetric software.…”

Section: Methodsmentioning

confidence: 99%

Post-acute sequelae of SARS-CoV-2 infection (PASC): peripheral, autonomic, and central nervous system features in a child

Younger

2021

Neurol Sci

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Electrodiagnostic assessment of the autonomic nervous system: A consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology

Cited by 96 publications

References 170 publications

Autonomic dysfunction following COVID-19 infection: an early experience

Autonomic dysfunction following COVID-19 infection: an early experience

Autonomic Nervous System Function in Anorexia Nervosa: A Systematic Review

Post-acute sequelae of SARS-CoV-2 infection (PASC): peripheral, autonomic, and central nervous system features in a child

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