Clinical Assessment Of The Autonomic Nervous System

This book describes newly developed methods of assessing the autonomic nervous system. Up-to-date information on microneurographic analysis of human cardiovascular and thermoregulatory function in humans, heart rate variability, and 131I-metaiodobenzylguanidine (MIBG) scintigraphy are provided. Microneurography, which was originally developed as a technique to analyze the afferent muscle spindle, came to be used to analyze sympathetic nerve activity in the mid-1980s. In the twenty-first century, this technique has become prevalent all over the world especially in investigating the pathophysiology of human cardiovascular function. It is also now used in researching human thermoregulatory function. Heart rate variability is another valuable tool in investigating the current status of human vagal function and in predicting future cardiovascular disease. MIBG is also used to assess cardiac noradrenergic function, especially decreases associated with Parkinson’s disease, Lewy body disease, and multisystem atrophy. Overviews of recent advances in these three important assessments are provided by leading experts.Clinical Assessment of the Autonomic Nervous System is a useful resource for neurologists and researchers of clinical neurophysiology.

This book presents the concepts underlying the measurement of parasympathetic and sympathetic (P&S) activity in the autonomic nervous system and the application of these measurements in the development of therapeutic guidelines for treating dysfunctions in these processes. It provides an overview of the anatomy, physiology, and biochemistry of the autonomic nervous system; details general clinical applications of P&S monitoring that are independent of specialty or disease; presents the pathophysiology of P&S dysfunction in specific disorders, expected test results, therapeutic options, and expected outcomes; and includes case studies and longitudinal studies that demonstrate the major concepts for the common diseases for which P&S monitoring is recommended. Clinical Autonomic Dysfunction enables clinicians to improve patient outcomes by identifying and treating clinical problems related to autonomic nervous system disorders.

Autonomic testing is used to define the role of the autonomic nervous system in diverse clinical and research settings. Because most of the autonomic nervous system is inaccessible to direct physiological testing, in the clinical setting the most widely used techniques entail the assessment of an end-organ response to a physiological provocation. The noninvasive measures of cardiovascular parasympathetic function involve the assessment of heart rate variability while the measures of cardiovascular sympathetic function assess the blood pressure response to physiological stimuli. Tilt-table testing, with or without pharmacological provocation, has become an important tool in the assessment of a predisposition to neurally mediated (vasovagal) syncope, the postural tachycardia syndrome, and orthostatic hypotension. Distal, postganglionic, sympathetic cholinergic (sudomotor) function may be evaluated by provoking axon reflex mediated sweating, e.g., the quantitative sudomotor axon reflex (QSART) or the quantitative direct and indirect axon reflex (QDIRT). The thermoregulatory sweat test provides a nonlocalizing measure of global pre- and postganglionic sudomotor function. Frequency domain analyses of heart rate and blood pressure variability, microneurography, and baroreflex assessment are currently research tools but may find a place in the clinical assessment of autonomic function in the future.

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The autonomic nervous system innervates every organ in the body. An understanding of autonomic function requires expertise in many basic disciplines that are beyond practical use to clinicians. In this fourth edition of The Autonomic Nervous System Professor Appenzeller has selected basic findings of clinical relevance and put them into perspective with autonomic dysfunction. New concepts of psychoneuroendocrinology and the discovery of numerous definitive and putative neurotransmitters centrally and in the periphery have led to a reappraisal of previous views and to the increasing complexity of autonomic nervous system regulation. There has been a steady increase in the size of this volume since it was first published in 1970. This reflects in part the change from an assessment of autonomic clinical deficits largely based on anecdotal accounts to objective measurements increasingly done with noninvasive methods of measuring autonomic function. The need for the application of basic knowledge of autonomic function to the clinical aspects of active lifestyles has brought together a host of specialists working in the areas of pain, sports medicine, and behavioral abnormalities.

-- A complete, authoritative look at the neurologic exam from the leading experts in modern neurology -- The first chapter describes the neurological history and exam -- and subsequent chapters review localization of disorders of the various nervous systems -- Features step-by-step instructions for each stage of the neurological examinations -- A detailed concluding chapter examines laboratory assessment of neurological disorders

The same authors who created the brilliantly successful Cranial Nerves > have joined together to produce this companion volume. Spectacular full colour illustrations by Linda Wilson-Pauwels, the preeminent medical illustrator, illuminate the relationships between the central and autonomic nervous systems. The accompanying text provides both principles of anatomy and correlations to clinical disorders.

This book approaches the basic features of autonomic dysfunction in a practical way, complemented by an examination of unique and didactic case reports. Unlike other books on autonomic disorders, its goal is to provide a brief, practical and ready to use resource for physicians faced with patients’ autonomic complaints. Autonomic dysfunctions are specific disorders that affect or are related to the autonomic nervous system. Despite being primarily a field of neurology, it also has important ties to cardiology, endocrinology, gastroenterology and many other medical specialties. Moreover, as the action of the autonomous system tends to be diffuse, affecting different systems and organs throughout the body, its disorders may present a complex and multifaceted background, complicating its diagnosis, clinical evaluation and management. Thus, it is important to gather all the relevant information about autonomic dysfunction in a handy and practical way, providing an accessible guide for professionals and practitioners across a wide range of specialties. The content presented in this book is divided into two main parts: In the first part, the general principles of autonomic dysfunction are discussed. Here the reader will find information on the anatomy, physiology and pharmacology of the nervous system, the classification of autonomic disorders, general evaluation of these disorders and the principles of their management. In the second part, clinical cases for the most important autonomic disorders are presented and discussed in detail, particularly in light of their special importance for differential diagnosis. Using a clinical case-based approach, Evaluation and Management of Autonomic Disorders offers readers – primarily but not exclusively general practitioners in the fields of neurology, internal medicine, family medicine and cardiology – rapid access to the information required for the evaluation and management of these complex patients.