Supine-to-standing transcranial Doppler test in patients with multiple system atrophy

Xu, Wei-Hai; Wang, Han; Hu, Ying-Huan; Wang, Bo; Chen, Jie; Gao, Shan

doi:10.1016/j.parkreldis.2013.01.021

Cited by 6 publications

(7 citation statements)

References 26 publications

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“…In other cases, single-photon emission computed tomography (SPECT) also showed a localized high-perfusion area [12]. Transcranial Doppler ultrasound–electroencephalogram (TCD-EEG) is a promising technique [13]. Compared with ictal SPECT or functional MRI, it is inexpensive, portable, and advantageous in providing the temporal pattern of neurovascular coupling [14].…”

Section: Discussionmentioning

confidence: 99%

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Acquired epileptiform opercular syndrome evaluated with real-time transcranial Doppler ultrasound-video-electroencephalogram before and after treatment: a case report

Peng

Liang

et al. 2019

BMC Neurol

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Background Acquired epileptiform opercular syndrome (AEOS) with electrical status epilepticus during sleep (ESES) may be recurrent and intractable. The real-time transcranial Doppler ultrasound–sleep-deprived video electroencephalogram (TCD-SDvEEG) can be used to observe the relationships among hemodynamic, electrophysiological, and clinical factors in a patient during therapy. This study reported the case of a healthy 5-year-old boy with AEOS. Case presentation The patient had initial seizures during sleep at the age of 1 year, with the left mouth pouting, left eye blinking and drooling for several seconds, and, sometimes, the left upper-limb flexion and head version to the left, lasting for 1–2 min. The combined antiepileptic drug regimens, including valproate, lamotrigine, and clonazepam, failed in the present case. Therefore, the add-on high-dose methylprednisolone therapy was provided. Also, the serial TCD-SDvEEG was used to monitor the dynamic changes before and after add-on steroid treatment. The results showed less than 15% variation in the range of blood flow fluctuation with spikes during non-rapid eye movement sleep after treatment. This was similar to the outcomes in healthy children and also accorded with the clinical improvements such as seizure control, drooling control, and language ability melioration. However, 95% of spike-wave index (SWI) was still maintained. The improvements in cerebral hemodynamics and clinical manifestations were faster and earlier than the SWI progression. Conclusions The real-time TCD-SDvEEG was highly sensitive in detecting therapeutic changes. The findings might facilitate the understanding of the mechanisms underlying neurovascular coupling in patients with AEOS accompanied by ESES.

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Section: Discussionmentioning

confidence: 99%

“…The cerebral hemodynamic responses have been widely adopted to map brain function in humans [16]. Previous studies proved that seizures were associated with substantially increased cerebral blood flow [13]. However, the effects of interictal epileptiform discharges (IEDs) on brain function are unclear.…”

Section: Discussionmentioning

confidence: 99%

Acquired epileptiform opercular syndrome evaluated with real-time transcranial Doppler ultrasound-video-electroencephalogram before and after treatment: a case report

Peng

Liang

et al. 2019

BMC Neurol

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“…It has been reported that patients with GAD may display abnormal cerebral blood flow [2], however the mechanism is still unclear. Cardio-cerebrovascular modulation, which is related to responses of the autonomic nervous system, has the function of regulating cerebral blood flow [3–5]. Several studies, such as Alkin et al and Faravelli et al, have focused on cardio-cerebrovascular modulation in panic disorder and have found some significant results [6–8]; however the characteristics of cardio-cerebrovascular modulation in patients with GAD are largely unknown.…”

Section: Introductionmentioning

confidence: 99%

“…As an important regulatory factor of cardio-cerebral vascular modulation [3–5], impaired autonomic regulation may influence integrated cardio-cerebrovascular modulation in patients with GAD and affect the cerebral blood flow.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of cardio-Cerebrovascular modulation in patients with generalized anxiety disorder: an observational study

et al. 2017

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BackgroundGeneralized anxiety disorder (GAD) has been shown in previous studies to display abnormal cerebral blood flow velocity (CBFV); however, the characteristics of cardio-cerebrovascular modulation are unknown. We aimed to analyze cardio-cerebrovascular modulation using parameters from a supine-to-standing test.MethodsThere are 2 parts to this study; in Part 1, 125 participants with Hamilton Anxiety scale scores ≥14 were enrolled, and 33 age- and sex-matched medically and psychiatrically healthy volunteers were recruited as control participants. Patients were divided by score into mild, moderate, and severe anxiety groups. The cardio-cerebrovascular modulation using the parameters of dynamic changes of CBFV and heart rate in response to an orthostatic challenge were investigated. In Part 2, we followed up the severe GAD patients for 6 months and repeated the supine-to-standing test, and severe GAD patients were divided into recovery and non-recovery groups.ResultsIn part 1, the GAD group displayed more marked CBFV and heart rate changes than the healthy group, but there was no difference in the CBFV and heart rate changes from the supine to upright position in mild, moderate, and severe anxiety groups. In part 2, The recovery group demonstrated significant improvement in changes in the CBFV and heart rate values from the supine to the upright position after treatment compared with before treatment. In the non-recovery group, the CBFV and heart rate changes were significantly higher than the healthy group regardless of treatment.ConclusionsCardio-cerebrovascular modulation is compromised in patients with GAD, however, this impairment can be restored to normal after the disappearance of anxiety.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1428-6) contains supplementary material, which is available to authorized users.

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Transcranial Doppler in autonomic testing: standards and clinical applications

et al. 2017

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When cerebral blood flow falls below a critical limit, syncope occurs and, if prolonged, ischemia leads to neuronal death. The cerebral circulation has its own complex finely tuned autoregulatory mechanisms to ensure blood supply to the brain can meet the high metabolic demands of the underlying neuronal tissue. This involves the interplay between myogenic and metabolic mechanisms, input from noradrenergic and cholinergic neurons, and the release of vasoactive substrates, including adenosine from astrocytes and nitric oxide from the endothelium. Transcranial Doppler (TCD) is a non-invasive technique that provides real-time measurements of cerebral blood flow velocity. TCD can be very useful in the work-up of a patient with recurrent syncope. Cerebral autoregulatory mechanisms help defend the brain against hypoperfusion when perfusion pressure falls on standing. Syncope occurs when hypotension is severe, and susceptibility increases with hyperventilation, hypocapnia, and cerebral vasoconstriction. Here we review clinical standards for the acquisition and analysis of TCD signals in the autonomic laboratory and the multiple methods available to assess cerebral autoregulation. We also describe the control of cerebral blood flow in autonomic disorders and functional syndromes.

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Supine-to-standing transcranial Doppler test in patients with multiple system atrophy

Cited by 6 publications

References 26 publications

Acquired epileptiform opercular syndrome evaluated with real-time transcranial Doppler ultrasound-video-electroencephalogram before and after treatment: a case report

Acquired epileptiform opercular syndrome evaluated with real-time transcranial Doppler ultrasound-video-electroencephalogram before and after treatment: a case report

Characteristics of cardio-Cerebrovascular modulation in patients with generalized anxiety disorder: an observational study

Transcranial Doppler in autonomic testing: standards and clinical applications

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