Heart rate variability (HRV) of patients with traumatic brain injury (TBI) during the post-insult sub-acute period

Keren, Ofer; Yupatov, S; Radai, Michal M.; El'ad-Yarum, Ruchama; Faraggi, David; Abboud, Shimon; Ring, Haim; Groswasser, Zeev

doi:10.1080/02699050400024946

Cited by 91 publications

(69 citation statements)

References 29 publications

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“…Despite this link, there does appear to be a greater chance of developing PAID if a focal lesion is present after TBI. Evidence is building that PAID results from a loss of inhibitory inputs to sympathetic feedback loops (resulting in tachycardia, hypertension, hyperpyrexia, tachypnea, or diaphoresis) and may also result in loss of GABAergic inhibition of cortical projections (resulting in dystonic posturing) [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine for the treatment of paroxysmal autonomic instability with dystonia

2007

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Section: Discussionmentioning

confidence: 99%

Dexmedetomidine for the treatment of paroxysmal autonomic instability with dystonia

2007

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“…19,21,58 However, these studies evaluated patients in the post-acute (chronic) phase of TBI (Ͼ30 days). Along these lines, patients in the chronic phase of subarachnoid hemorrhage demonstrated similar HF/LF ratios compared to control subjects, while HF/LF ratios were increased in the acute phase, as discussed before.…”

Section: Discussionmentioning

confidence: 99%

“…The balance between these two subsystems, the sympathovagal balance, generates the net effect of the autonomic nervous system, of which heart rate is one of the end products. 21 Heart rate variability reflects the balance between the sympathetic and the parasympathetic parts of the autonomic nervous system, therefore, heart rate variability analysis is extensively used to measure autonomic activity.…”

Section: Immune Paralysis In Patients With Tbimentioning

confidence: 99%

“…Many reports focus on the non-autonomic nervous system, such as motor deficits, 17,18 while others have evaluated the role of the autonomic nervous system after TBI. [19][20][21] The autonomic nervous system comprises a collection of afferent and efferent nerve fibers that regulate important vital functions in the body, including blood pressure and heart rate. 22,23 The autonomic nervous system is composed of two parts, the sympathetic and the parasympathetic (vagal) part.…”

Section: Immune Paralysis In Patients With Tbimentioning

confidence: 99%

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Increased vagal tone accounts for the observed immune paralysis in patients with traumatic brain injury

Kox¹,

Pompe²,

Pickkers³

et al. 2008

Neurology

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Traumatic brain injury (TBI) is a leading cause of death and disability, especially in the younger population. In the acute phase after TBI, patients are more vulnerable to infection, associated with a decreased immune response in vitro. The cause of this immune paralysis is poorly understood. Apart from other neurologic dysfunction, TBI also results in an increase in vagal activity. Recently, the vagus nerve has been demonstrated to exert an anti-inflammatory effect, termed the cholinergic anti-inflammatory pathway. The anti-inflammatory effects of the vagus nerve are mediated by the ␣7 nicotinic acetylcholine receptor present on macrophages and other cytokineproducing cells. From these observations, we hypothesize that the immune paralysis observed in patients with TBI may, at least in part, result from augmented vagal activity and subsequent sustained effects of the cholinergic anti-inflammatory pathway. This pathway may counteract systemic proinflammation caused by the release of endogenous compounds termed alarmins as a result of tissue trauma. However, sustained activity of this pathway may severely impair the body's ability to combat infection. Since the cholinergic anti-inflammatory pathway can be pharmacologically modulated in humans, it could represent a novel approach to prevent infections in patients with TBI. Neurology

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“…Clinically irregularities in HR are reported during the subacute period. 28,29 However, variability in HR is primarily found following severe TBI, in which intracranial hypertension is observed. 30 Therefore, given that the FPI was more within the mild range, we would not expect HR effects beyond the acute period.…”

mentioning

confidence: 99%

Temperature and Heart Rate Responses to Exercise following Mild Traumatic Brain Injury

Griesbach

Tio

Nair

et al. 2013

Journal of Neurotrauma

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We have previously reported that mild fluid percussion injury (FPI) is associated with a heightening of the hypothalamic-pituitary-adrenal axis response during the first post-injury weeks. This is the same time period when rehabilitative exercise has been strongly suggested to be ineffective. Here, we explored whether cardiac and temperature autonomic function may also be compromised during this early post-injury period. Following an FPI or sham injury, rats were exercised with forced (fRW) or voluntary (vRW) running wheels on post-injury days 0-4 and 7-11. Results indicated that overall activity levels were decreased and circadian rhythm was affected after FPI. Autonomic disruptions became evident when exercise was introduced, and these disruptions were dependent upon the characteristics of exercise. Elevations in heart rate (HR) and core body temperature (CBT) were observed as a response to vRW and fRW. FPI animals had more pronounced increases in HR as a result of vRW. Likewise, increases in HR were observed with fRW in all animals. A strong stress response has recently been associated with fRW exercise. FPI rats exposed to fRW were more responsive to experimental manipulations and had higher a CBT after the FRW session. The results suggest that subacute exercise, particularly if linked to a strong stress response, may be counterproductive. Here we show that cardiac and temperature autonomic function are compromised during the subacute period following a mild TBI.

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Heart rate variability (HRV) of patients with traumatic brain injury (TBI) during the post-insult sub-acute period

Abstract: HRV differed of patients with TBI and in the control group. Tendency to HRV normalization changes was detected during the first 3 months after the injury, which suggests recovery of the autonomic nervous system.

Cited by 91 publications

References 29 publications

Dexmedetomidine for the treatment of paroxysmal autonomic instability with dystonia

Dexmedetomidine for the treatment of paroxysmal autonomic instability with dystonia

Increased vagal tone accounts for the observed immune paralysis in patients with traumatic brain injury

Temperature and Heart Rate Responses to Exercise following Mild Traumatic Brain Injury

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