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Koutsouraki E, Theodoros K, Eleni G, Marianna K, Areti N, Ariadni K, Dimitrios M. Autonomic nervous system disorders in multiple sclerosis. J Neurol 2023:10.1007/s00415-023-11725-y. [PMID: 37084150 DOI: 10.1007/s00415-023-11725-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
Multiple sclerosis (MS) is a chronic progressive demyelinating disease of the central nervous system (CNS), which also affects the autonomic nervous system (ANS). Manifestations of MS in the ANS include urological, sexual, gastrointestinal, cardiovascular, and thermoregulatory disorders as well as increased fatigue. These problems are common yet are often underestimated due to the non-specificity of the symptoms and the limited evaluation of the ANS in the usual clinical practice. Most of these symptoms seem to be related to localized lesions in the CNS. However, the mechanisms by which these disorders are caused in MS have not been fully investigated, thus preventing any focused etiological treatment. The most common disorders of the ANS in MS represent a challenge for clinicians due to the variability of the clinical picture and our minimal data on their diagnosis and treatment. Early diagnosis and initiation of individualized treatment regimens, often in need of multiple approaches, seem to yield the best results in managing ANS dysfunction in MS patients.
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Affiliation(s)
- Effrosyni Koutsouraki
- First Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | | | | | | | | | - Koukoulidou Ariadni
- Nursing School, International University of Greece, Sindos, Thessaloniki, Greece
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Crnošija L, Adamec I, Krbot Skorić M, Habek M. How to explore and explain autonomic changes in multiple sclerosis. Neurophysiol Clin 2023; 53:102854. [PMID: 36966707 DOI: 10.1016/j.neucli.2023.102854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open
Abstract
Autonomic dysfunction (AD) in people with MS (pwMS) is a frequent finding. This narrative review will present an overview of central neural mechanisms involved in the control of cardiovascular and thermoregulatory systems, and methods of autonomic nervous system testing will be discussed thereafter. Since the need for standardization of autonomic nervous system (ANS) testing, we will focus on the standard battery of tests (blood pressure and heart rate response to Valsalva maneuver and head-up tilt, and heart rate response to deep breathing test plus one of the tests for sudomotor function), which can detect ANS pathology in the majority of pwMS. The review will briefly discuss the other types of AD in pwMS and the use of appropriate tests. While performing ANS testing in pwMS one has to consider the multiple sclerosis phenotypes, disease duration, and its activity, the degree of clinical disability of patients included in the study, and the disease-modifying therapies taken, as these factors may have a great influence on the results of ANS testing. In other words, detailed patient characteristics presentation and patient stratification are beneficial when reporting results of ANS testing in pwMS.
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Gaemelke T, Frandsen JJ, Hvid LG, Dalgas U. Participant characteristics of existing exercise studies in persons with multiple sclerosis - A systematic review identifying literature gaps. Mult Scler Relat Disord 2022; 68:104198. [PMID: 36257149 DOI: 10.1016/j.msard.2022.104198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Exercise is a cornerstone in rehabilitation of persons with multiple sclerosis (pwMS), which is known to elicit beneficial effects on various symptoms and to have a potential disease-modifying effect. However, it remains to be elucidated if the existing MS exercise literature covers the full age and disability span of pwMS. OBJECTIVE To systematically review MS exercise studies and provide a detailed mapping of the demographic and clinical characteristics of the included pwMS. METHODS A systematic review of MS exercise studies were performed using MEDLINE and EMBASE. From the resulting MS exercise studies, mean sample characteristics were extracted. RESULTS 4576 records were identified, from which 202 studies were included. Of these, 166 studies (82.2%) enrolled pwMS aged 35-54 years, 10.9% enrolled pwMS <35 years, and 6.9% enrolled pwMS ≥55 years (only 1.5% enrolled pwMS ≥60 years). A total of 118 studies (58.4%) reported Expanded Disability Status Scale (EDSS), with 88.1% of included pwMS having an EDSS between 2.0 and 6.5, while only one study enrolled pwMS with an EDSS ≥7.0. Finally, 80% of the studies included pwMS having a disease duration of 5-14.5 years. CONCLUSION Exercise studies in pwMS included primarily middle-aged (35-54 years) pwMS having an EDSS of 2.0-6.5 and a disease duration of 5-14.5 years. Few exercise studies were identified in young and older pwMS, in pwMS with mild disability and severe disability, and in pwMS having shorter or longer disease durations. These findings highlight the need for further investigation of exercise in these specific subgroups of pwMS as benefits of exercise might not generalize across subpopulations.
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Affiliation(s)
- Tobias Gaemelke
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark.
| | - Jens Jakob Frandsen
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
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Sim D, Brothers MC, Slocik JM, Islam AE, Maruyama B, Grigsby CC, Naik RR, Kim SS. Biomarkers and Detection Platforms for Human Health and Performance Monitoring: A Review. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2104426. [PMID: 35023321 PMCID: PMC8895156 DOI: 10.1002/advs.202104426] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/19/2021] [Indexed: 05/04/2023]
Abstract
Human health and performance monitoring (HHPM) is imperative to provide information necessary for protecting, sustaining, evaluating, and improving personnel in various occupational sectors, such as industry, academy, sports, recreation, and military. While various commercially wearable sensors are on the market with their capability of "quantitative assessments" on human health, physical, and psychological states, their sensing is mostly based on physical traits, and thus lacks precision in HHPM. Minimally or noninvasive biomarkers detectable from the human body, such as body fluid (e.g., sweat, tear, urine, and interstitial fluid), exhaled breath, and skin surface, can provide abundant additional information to the HHPM. Detecting these biomarkers with novel or existing sensor technologies is emerging as critical human monitoring research. This review provides a broad perspective on the state of the art biosensor technologies for HHPM, including the list of biomarkers and their physiochemical/physical characteristics, fundamental sensing principles, and high-performance sensing transducers. Further, this paper expands to the additional scope on the key technical challenges in applying the current HHPM system to the real field.
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Affiliation(s)
- Daniel Sim
- Air Force Research Laboratory711th Human Performance WingWright‐Patterson Air Force BaseOH 45433USA
- Research Associateship Program (RAP)the National Academies of Sciences, Engineering and MedicineWashingtonDC20001USA
- Integrative Health & Performance Sciences DivisionUES Inc.DaytonOH45432USA
| | - Michael C. Brothers
- Air Force Research Laboratory711th Human Performance WingWright‐Patterson Air Force BaseOH 45433USA
- Integrative Health & Performance Sciences DivisionUES Inc.DaytonOH45432USA
| | - Joseph M. Slocik
- Air Force Research LaboratoryMaterials and Manufacturing DirectorateWright‐Patterson Air Force BaseOH 45433USA
| | - Ahmad E. Islam
- Air Force Research LaboratorySensors DirectorateWright‐Patterson Air Force BaseOH 45433USA
| | - Benji Maruyama
- Air Force Research LaboratoryMaterials and Manufacturing DirectorateWright‐Patterson Air Force BaseOH 45433USA
| | - Claude C. Grigsby
- Air Force Research Laboratory711th Human Performance WingWright‐Patterson Air Force BaseOH 45433USA
| | - Rajesh R. Naik
- Air Force Research Laboratory711th Human Performance WingWright‐Patterson Air Force BaseOH 45433USA
| | - Steve S. Kim
- Air Force Research Laboratory711th Human Performance WingWright‐Patterson Air Force BaseOH 45433USA
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Zhong B, Jiang K, Wang L, Shen G. Wearable Sweat Loss Measuring Devices: From the Role of Sweat Loss to Advanced Mechanisms and Designs. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2103257. [PMID: 34713981 PMCID: PMC8728835 DOI: 10.1002/advs.202103257] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/15/2021] [Indexed: 05/22/2023]
Abstract
Wearable sweat sensors have received significant research interest and have become popular as sweat contains considerable health information about physiological and psychological states. However, measured biomarker concentrations vary with sweat rates, which has a significant effect on the accuracy and reliability of sweat biosensors. Wearable sweat loss measuring devices (SLMDs) have recently been proposed to overcome the limitations of biomarker tracking and reduce inter- and intraindividual variability. In addition, they offer substantial potential for monitoring human body homeostasis, because sweat loss plays an indispensable role in thermoregulation and skin hydration. Previous studies have not carried out a comprehensive and systematic review of the principles, importance, and development of wearable SLMDs. This paper reviews wearable SLMDs with a new health perspective from the role of sweat loss to advanced mechanisms and designs. Two types of sweat and their measurement significance for practical applications are highlighted. Then, a comprehensive review of advances in different wearable SLMDs based on hygrometers, absorbent materials, and microfluidics is presented by describing their respective device architectures, present situations, and future directions. Finally, concluding remarks on opportunities for future application fields and challenges for future sweat sensing are presented.
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Affiliation(s)
- Bowen Zhong
- State Key Laboratory for Superlattices and Microstructures, Institution of Semiconductors, Chinese Academy of Sciences, Beijing, 100083, China
- Center of Materials Science and Optoelectronic Engineering, University of Chinese Academy of Sciences, Beijing, 100029, China
| | - Kai Jiang
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese PLA, Beijing, 100853, China
| | - Lili Wang
- State Key Laboratory for Superlattices and Microstructures, Institution of Semiconductors, Chinese Academy of Sciences, Beijing, 100083, China
- Center of Materials Science and Optoelectronic Engineering, University of Chinese Academy of Sciences, Beijing, 100029, China
| | - Guozhen Shen
- State Key Laboratory for Superlattices and Microstructures, Institution of Semiconductors, Chinese Academy of Sciences, Beijing, 100083, China
- Center of Materials Science and Optoelectronic Engineering, University of Chinese Academy of Sciences, Beijing, 100029, China
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Razi O, Tartibian B, Teixeira AM, Zamani N, Govindasamy K, Suzuki K, Laher I, Zouhal H. Thermal dysregulation in patients with multiple sclerosis during SARS-CoV-2 infection. The potential therapeutic role of exercise. Mult Scler Relat Disord 2022; 59:103557. [PMID: 35092946 PMCID: PMC8785368 DOI: 10.1016/j.msard.2022.103557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/16/2022] [Accepted: 01/22/2022] [Indexed: 12/15/2022]
Abstract
Thermoregulation is a homeostatic mechanism that is disrupted in some neurological diseases. Patients with multiple sclerosis (MS) are susceptible to increases in body temperature, especially with more severe neurological signs. This condition can become intolerable when these patients suffer febrile infections such as coronavirus disease-2019 (COVID-19). We review the mechanisms of hyperthermia in patients with MS, and they may encounter when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Finally, the thermoregulatory role and relevant adaptation to regular physical exercise are summarized.
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Affiliation(s)
- Omid Razi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Razi University, Kermanshah, Iran
| | - Bakhtyar Tartibian
- Department of Exercise Physiology, Faculty of Physical Education and Sports Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Ana Maria Teixeira
- University of Coimbra, Research Center for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
| | - Nastaran Zamani
- Department of Biology, Faculty of Science, Payame-Noor University, Tehran, Iran
| | - Karuppasamy Govindasamy
- Department of Physical Education & Sports Science, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan.
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Hassane Zouhal
- Univ Rennes, M2S (Laboratoire Mouvement, Sport, Santé) - EA 1274, Rennes F-35000, France; Institut International des Sciences du Sport (2I2S), Irodouer 35850, France.
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Adamec I, Krbot Skorić M, Habek M. Understanding and managing autonomic dysfunction in persons with multiple sclerosis. Expert Rev Neurother 2021; 21:1409-1417. [PMID: 34654355 DOI: 10.1080/14737175.2021.1994856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic demyelinating immune mediated disease of the central nervous system. Autonomic dysfunction (AD) is frequently present in persons with MS (pwMS) and increases with disease duration and progression. AREAS COVERED Cardiovascular, genitourinary, and sudomotor autonomic dysfunction in pwMS are reviewed and managing of these disorders is addressed. EXPERT OPINION AD in pwMS can manifest with a myriad of symptoms including cardiovascular, urogenital, and sweating disorders. These symptoms can significantly impact the quality of life of pwMS with poor tolerance of upright position, difficulties in sexual function, and low endurance of physical activity especially in warm environments. Health professionals involved in care of pwMS should possess basic knowledge of the function of the autonomic nervous system and be informed of the way disorders of the autonomic function may manifest in pwMS in order to provide the proper care.
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Affiliation(s)
- Ivan Adamec
- Department of Neurology, University Hospital Center Zagreb, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Magdalena Krbot Skorić
- Department of Neurology, University Hospital Center Zagreb, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.,Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Mario Habek
- Department of Neurology, University Hospital Center Zagreb, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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Peripheral nervous system in multiple sclerosis-understanding the involvement via autonomic nervous system. Neurol Sci 2021; 42:2731-2736. [PMID: 34036450 DOI: 10.1007/s10072-021-05309-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
AIM The aim of this review is to summarize the clinical and paraclinical findings that demonstrate that multiple sclerosis (MS) affects the peripheral nervous system (PNS) as well as the central nervous system (CNS). Methods: Narrative review. RESULTS MS is traditionally defined as a chronic demyelinating immune-mediated disease of the CNS. However, there is emerging evidence that MS is a disease that does not solely affect the CNS but can manifest with PNS involvement as well. Several pathology studies have reported on signs of demyelination in the PNS, as well as on structural and functional involvement of the PNS in persons with MS (pwMS). From the functional aspect, several studies have shown autonomic nervous system (ANS) involvement in the form of sudomotor dysfunction measured with quantitative sudomotor axon reflex test (QSART) in different stages of MS, adding to the growing body of evidence that indicate PNS involvement in MS. In this review the clinical, pathological, neurophysiological, and imaging findings that demonstrate that MS affects the PNS as well as the CNS are summarized, with the emphasis on the ANS abnormalities. CONCLUSION Further large-scale research is needed in order to fully understand the frequency and importance of PNS affection in MS.
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Chaseling GK, Filingeri D, Allen D, Barnett M, Vucic S, Davis SL, Jay O. Blunted sweating does not alter the rise in core temperature in people with multiple sclerosis exercising in the heat. Am J Physiol Regul Integr Comp Physiol 2020; 320:R258-R267. [PMID: 33296279 DOI: 10.1152/ajpregu.00090.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The purpose of this study is to determine whether thermoregulatory capacity is altered by multiple sclerosis (MS) during exercise in the heat. Sixteen MS participants (EDSS: 2.9 ± 0.9; 47 ± 8 yr; 77.6 ± 14.0 kg) and 14 healthy control (CON) participants (43 ± 11 yr; 78.6 ± 17.0 kg) cycled at a heat production of 4 W·kg-1 for 60 min at 30°C, 30% relative humidity (RH) (Warm). A subset of eight MS (EDSS: 2.6 ± 0.5; 44 ± 8 yr; 82.3 ± 18.2 kg) and 8 CON (44 ± 12 yr; 81.2 ± 21.1 kg) also exercised at 35°C, 30% RH (Hot). Rectal temperature (Tre), mean skin (Tsk) temperature, and local sweat rate (LSR) on the upper back (LSRback) and forearm (LSRarm) were measured. All CON, and only 9 of 16 and 7 of 8 MS participants completed 60 min of exercise in Warm and Hot trials, respectively. All MS participants who were unable to complete exercise stopped with a ΔTre between 0.2 and 0.5°C. The time to reach a ΔTre of 0.2°C was similar (MS: 28 ± 15 min, CON: 32 ± 18 min; P = 0.51). For MS participants, completing 60-min of exercise in Warm, ΔTre (P = 0.13), ΔTsk (P = 0.45), LSRback (P = 0.69), and LSRarm (P = 0.54) was similar to CON, but ΔTb (body temperature) (MS: 0.16 ± 0.13°C, CON: 0.07 ± 0.06°C; P = 0.02) and onset time (MS: 16 ± 10 min, CON: 8 ± 5 min; P = 0.02) for sweating were greater in MS. Similarly, in Hot, ΔTre (P = 0.52), ΔTsk (P = 0.06), LSRback (P = 0.59), and LSRarm (P = 0.08) were similar, but ΔTb (MS: 0.19 ± 0.16°C, CON: 0.06 ± 0.04°C; P = 0.04) and onset time (MS: 13 ± 7 min, CON: 6 ± 3 min; P = 0.02) for sweating were greater in MS. Even at 35°C, a delayed sweating onset did not alter heat loss to sufficiently affect exercise-induced rises in core temperature. Heat intolerance with MS does not seem attributable to thermoregulatory impairments.
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Affiliation(s)
- Georgia K Chaseling
- Thermal Ergonomics Laboratory, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Davide Filingeri
- Thermal Ergonomics Laboratory, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Thermosense Lab, Environmental Ergonomics Research Centre, Loughborough University, Leicestershire, United Kingdom
| | - Dustin Allen
- Department of Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas.,Department of Health Sciences, Boston University, Boston, Massachusetts
| | - Michael Barnett
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Steve Vucic
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney Clinical School, Westmead, New South Wales, Australia
| | - Scott L Davis
- Department of Applied Physiology and Wellness, Southern Methodist University, Dallas, Texas.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Sander C, Braun N, Modes F, Schlake HP, Eling P, Hildebrandt H. Can biofeedback-based training alleviate fatigue and vigilance performance in fatigued MS patients? Neuropsychol Rehabil 2020; 32:131-147. [PMID: 32851896 DOI: 10.1080/09602011.2020.1808023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
MS related fatigue might be related to autonomous nervous system (ANS) dysfunctions or to inflammation related vagal (hyper-) activation. Consequently, influencing ANS status may lead to relieve of fatigue. We used two opposite biofeedback interventions to either increase sympathetic ("self-alert training", SAT) or parasympathetic activation ("progressive muscle relaxation", PMR). We recorded fatigue status of patients before and after a challenging vigilance task, their behavioural performance on this task, their skin conductance response (SCR), and parameters indicating parasympathetic activity concerning heart rate variability (HRV). We repeated these recordings after the biofeedback training sessions. Patients of the SAT group were able to learn to increase their SCR voluntarily. Patients of the PMR group showed increasing parameters indicating parasympathetic modulation of the HRV. The vigilance task increased their feeling of fatigue. However, there was no effect of biofeedback training on either fatigue status or performance on the vigilance task. Our results show that MS patients can learn to change voluntarily their ANS activity using biofeedback instructions based on SCR and this can be used in future studies to test the postulated link between ANS and fatigue. However, in this experimental intervention we were unable to document a relation between ANS activity and fatigue.Trial registration: ClinicalTrials.gov identifier: NCT03268187.
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Affiliation(s)
- Carina Sander
- Institute of Psychology, University of Oldenburg, Oldenburg, Germany.,Median Klinik Wilhelmshaven, Wilhelmshaven, Germany
| | - Niclas Braun
- Department and Polyclinic for Psychiatry and Psychotherapy, Universitätsklinikum Bonn AöR, Bonn, Germany
| | - Fenja Modes
- Institute of Psychology, University of Oldenburg, Oldenburg, Germany
| | | | - Paul Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Helmut Hildebrandt
- Institute of Psychology, University of Oldenburg, Oldenburg, Germany.,Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
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Kwon S, Kim YS, Kim J, Kim BJ, Min JH. Clinical and MRI correlates of autonomic dysfunction in neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2020; 43:102215. [PMID: 32474288 DOI: 10.1016/j.msard.2020.102215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND The aim of this study was to investigate the relationship of autonomic dysfunction and clinical findings in patients with neuromyelitis optica spectrum disorder (NMOSD). METHODS For the assessment of autonomic dysfunction, heart rate variability (HRV) and blood pressure (BP) measurement to deep breathing, Valsalva maneuver or head tilt-table test, with quantitative sudomotor axon reflex test (QSART) were used and interpreted in the form of the composite autonomic scoring scale (CASS). Clinical and radiological correlates with autonomic profiles were analyzed. RESULTS A total of 27 patients (mean age, 44.4 ± 12.26 years; female: male=22:5) were enrolled in this study and 74.1% of them showed autonomic dysfunction, involving the adrenergic, cardiovagal, or sudomotor domains. Eighteen patients were during remission, in whom, demographics and MRI findings were associated with an index or a total score of CASS. The presence of cervical cord lesion showed the association with cardiovagal index (B = 0.750, S.E. 0.242, 95% CI 0.237-1.263, p = 0.007), male gender with sudomotor index (B = 1.600, S.E. 0.653, 95% CI 0.199-3.001, p = 0.028) and the involvement of brain and/or spinal cord with a total CASS score (B = 1.500, S.E. 0.655, 95% CI 0.096-2.904, p = 0.038). In multivariable analysis, delayed pressure recovery time showed a significant positive association with EDSS score (B = 0.103, S.E. 0.031, 95% CI 0.037-0.168, p = 0.004). DISCUSSION Cardiovascular and sudomotor autonomic dysfunction are common in NMOSD. Several clinical and MRI characteristics of patients may warrant the investigation of autonomic dysfunction and its proper management.
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Affiliation(s)
- Soonwook Kwon
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ye Sel Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juhyeon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Neurology, College of Medicine, Gyeongsang University Hospital, Republic of Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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12
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Allen DR, Huang MU, Morris NB, Chaseling GK, Frohman EM, Jay O, Davis SL. Impaired Thermoregulatory Function during Dynamic Exercise in Multiple Sclerosis. Med Sci Sports Exerc 2019; 51:395-404. [PMID: 30779715 DOI: 10.1249/mss.0000000000001821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Impairments in sudomotor function during passive whole-body heating have been reported in multiple sclerosis (MS), a demyelinating disease of the CNS that disrupts autonomic function. However, the capability of the thermoregulatory system to control body temperature during exercise has never been assessed in MS. Thus, the aim of the present study was to test the hypothesis that thermoregulatory function is impaired in MS patients compared with healthy controls (CON) exercising at similar rates of metabolic heat production. METHODS Sweating and skin blood flow responses were compared between 12 individuals diagnosed with relapsing-remitting MS (9 females, 3 males) and 12 sex-, age-, mass-, and BSA-matched CON during a single bout of cycling exercise (rate of metabolic heat production: ∼4.5 W·kg) for 60 min in a climate-controlled room (25°C, 30% RH). RESULTS Individuals with MS exhibited an attenuated increase in cumulative whole-body sweat loss after 30 min (MS, 72 ± 51 g; CON, 104 ± 37 g; P = 0.04) and 60 min (MS, 209 ± 94 g; CON, 285 ± 62 g; P = 0.02), as well as lower sweating thermosensitivity (MS, 0.49 ± 0.26 mg·cm·min·°C; CON, 0.86 ± 0.30 mg·cm·min·°C; P = 0.049). Despite evidence for thermoregulatory dysfunction, there were no differences between MS and CON in esophageal or rectal temperatures at 30- or 60-min time points (P > 0.05). Cutaneous vasculature responses were also not different in MS compared with CON (P > 0.05). CONCLUSION Taken together, MS blunts sweating responses during exercise while cutaneous vasculature responses are preserved. Altered mechanisms of body temperature regulation in persons with MS may lead to temporary worsening of disease symptoms and limit exercise tolerance under more thermally challenging conditions.
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Affiliation(s)
- Dustin R Allen
- Applied Physiology and Wellness, Southern Methodist University, Dallas, TX.,Department of Health Sciences, Boston University, Boston, MA
| | - M U Huang
- Applied Physiology and Wellness, Southern Methodist University, Dallas, TX
| | - Nathan B Morris
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, AUSTRALIA
| | - Georgia K Chaseling
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, AUSTRALIA
| | - Elliot M Frohman
- Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, AUSTRALIA.,Charles Perkins Centre, The University of Sydney, Camperdown, NSW, AUSTRALIA
| | - Scott L Davis
- Applied Physiology and Wellness, Southern Methodist University, Dallas, TX.,Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
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13
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Abstract
Wilhelm Uhthoff, known for his contributions to both neurology and neuro-ophthalmology, was a German ophthalmologist who specialized in neurologic disorders. The eponym "Uhthoff's phenomenon" was first used to describe the reversible, transient blurring of vision in patients with multiple sclerosis during exercise. Subsequently, it was discovered that this neurologic sign not only was triggered by physical exertion but also by other homeostatic disruptions such as hot baths, menstruation, and high external temperatures. Here, we take a look at the life and career of Wilhelm Uhthoff and discuss the basis behind this phenomenon.
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Affiliation(s)
| | - Mattia Rosso
- Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, MA, USA
| | - Jonathan D Santoro
- Department of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA/Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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14
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Baker LB. Physiology of sweat gland function: The roles of sweating and sweat composition in human health. Temperature (Austin) 2019; 6:211-259. [PMID: 31608304 PMCID: PMC6773238 DOI: 10.1080/23328940.2019.1632145] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 12/21/2022] Open
Abstract
The purpose of this comprehensive review is to: 1) review the physiology of sweat gland function and mechanisms determining the amount and composition of sweat excreted onto the skin surface; 2) provide an overview of the well-established thermoregulatory functions and adaptive responses of the sweat gland; and 3) discuss the state of evidence for potential non-thermoregulatory roles of sweat in the maintenance and/or perturbation of human health. The role of sweating to eliminate waste products and toxicants seems to be minor compared with other avenues of excretion via the kidneys and gastrointestinal tract; as eccrine glands do not adapt to increase excretion rates either via concentrating sweat or increasing overall sweating rate. Studies suggesting a larger role of sweat glands in clearing waste products or toxicants from the body may be an artifact of methodological issues rather than evidence for selective transport. Furthermore, unlike the renal system, it seems that sweat glands do not conserve water loss or concentrate sweat fluid through vasopressin-mediated water reabsorption. Individuals with high NaCl concentrations in sweat (e.g. cystic fibrosis) have an increased risk of NaCl imbalances during prolonged periods of heavy sweating; however, sweat-induced deficiencies appear to be of minimal risk for trace minerals and vitamins. Additional research is needed to elucidate the potential role of eccrine sweating in skin hydration and microbial defense. Finally, the utility of sweat composition as a biomarker for human physiology is currently limited; as more research is needed to determine potential relations between sweat and blood solute concentrations.
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Affiliation(s)
- Lindsay B Baker
- Gatorade Sports Science Institute, PepsiCo R&D Physiology and Life Sciences, Barrington, IL, USA
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15
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Sander C, Modes F, Schlake HP, Eling P, Hildebrandt H. Capturing fatigue parameters: The impact of vagal processing in multiple sclerosis related cognitive fatigue. Mult Scler Relat Disord 2019; 32:13-18. [PMID: 31005825 DOI: 10.1016/j.msard.2019.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/21/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Causes of fatigue in Multiple Sclerosis remain elusive. Recently, we developed a model linking cognitive fatigue to inflammatory processes based on a neuroinflammatory reflex-arc instantiated by the vagus nerve. The relation between experienced autonomic dysfunctions, based on vagal processing, and cognitive fatigue is well-known, but an examination of the association of objectively measured vagal activity and cognitive fatigue is missing. An attempt was made to collect behavioral and physiological evidence that can be associated with experienced autonomic dysfunctions and fatigue in Multiple Sclerosis patients. METHODS Behavioral performance (response bias) and autonomic functioning (Heart rate variability and Skin conductance level) during an acoustic vigilance task were investigated in 53 Multiple Sclerosis patients. We assessed trait fatigue (independent from task), and time-on-task related increase of fatigue. Regression analysis was used to predict the fatigue status with physiological and behavioral scores. RESULTS Response bias, indicating a reduced responsiveness, and high and very low frequency components of Heart rate variability, indicating an increased parasympathetic activity, contribute to the regression of trait fatigue. Reduced Heart rate variability (SDNN) and increased parasympathetic activity (pNN50) remained in the regression model predicting time-on-task fatigue. CONCLUSION Cognitive fatigue in MS is related to parasympathetic activity and reduced responsiveness, supporting our model representing fatigue as inflammatory processes in the brain. Standardized subjective and objective autonomous dysfunction measures might be considered as additional assessments in MS.
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Affiliation(s)
- Carina Sander
- Institute of Psychology, Carl von Ossietzy University of Oldenburg, Department VI - Medicine and Health Sciences, Ammerländer Heerstr. 114-11826129, Oldenburg, Germany; Median Klinik Wilhelmshaven, Department of Neurology, Bremer Straße 2, 26382 Wilhelmshaven, Germany.
| | - Fenja Modes
- Institute of Psychology, Carl von Ossietzy University of Oldenburg, Department VI - Medicine and Health Sciences, Ammerländer Heerstr. 114-11826129, Oldenburg, Germany.
| | - Hans-Peter Schlake
- Median Klinik Wilhelmshaven, Department of Neurology, Bremer Straße 2, 26382 Wilhelmshaven, Germany.
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Montessorilaan 3, 6525 HR, Nijmegen, Netherlands.
| | - Helmut Hildebrandt
- Institute of Psychology, Carl von Ossietzy University of Oldenburg, Department VI - Medicine and Health Sciences, Ammerländer Heerstr. 114-11826129, Oldenburg, Germany; Klinikum Bremen-Ost, Department of Neurology, Züricher Str. 40, 28325 Bremen, Germany.
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16
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Habek M. Immune and autonomic nervous system interactions in multiple sclerosis: clinical implications. Clin Auton Res 2019; 29:267-275. [PMID: 30963343 DOI: 10.1007/s10286-019-00605-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/28/2019] [Indexed: 12/25/2022]
Abstract
Multiple sclerosis is characterized by a wide spectrum of clinical manifestations, among which dysfunction of the autonomic nervous system represents an important cause of multiple sclerosis-related disability. The aim of this review is to provide an overview of autonomic dysfunction in people with multiple sclerosis, and to discuss the interactions between the immune and autonomic nervous systems and the effects of these interactions on various aspects of multiple sclerosis. Autonomic dysfunction in people with multiple sclerosis can be demonstrated clinically and on a molecular level. Clinically, it can be demonstrated by measuring autonomic symptoms with the Composite Autonomic Symptom Score (COMPASS-31), and neurophysiologically, with different autonomic nervous system tests. Both symptomatic and objectively determined autonomic dysfunction can be associated with increased risk of multiple sclerosis disease activity. Further supporting these clinical observations are molecular changes in immune cells. Changes in the sympathetic autonomic system, such as different expression of dopaminergic and adrenergic receptors on immune cells, or modulation of the cholinergic anti-inflammatory pathway over different subunits of the nicotinic acetylcholine receptor in the peripheral immune system, may mediate different effects on multiple sclerosis disease activity.
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Affiliation(s)
- Mario Habek
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia. .,School of Medicine, University of Zagreb, Zagreb, Croatia.
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17
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Krbot Skorić M, Crnošija L, Adamec I, Barun B, Gabelić T, Smoljo T, Stanić I, Pavičić T, Pavlović I, Drulović J, Pekmezović T, Habek M. Autonomic symptom burden is an independent contributor to multiple sclerosis related fatigue. Clin Auton Res 2018; 29:321-328. [PMID: 30209702 DOI: 10.1007/s10286-018-0563-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/30/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate a possible association between autonomic dysfunction and fatigue in people with multiple sclerosis. METHODS In 70 people with multiple sclerosis early in the disease course (51 females, mean age 33.8 ± 9.1), quantitative sudomotor axon reflex tests, cardiovascular reflex tests (heart rate and blood pressure responses to the Valsalva maneuver and heart rate response to deep breathing), and the tilt table test were performed. Participants completed the Composite Autonomic Symptom Score 31, the Modified Fatigue Impact Scale, and the Epworth Sleepiness Scale, as well as the Beck Depression Inventory. Cutoff scores of ≥ 38 or ≥ 45 on the Modified Fatigue Impact Scale were used to stratify patients into a fatigued subgroup (N = 17 or N = 9, respectively). RESULTS We found clear associations between fatigue and scores in subjective tests of the autonomic nervous system: fatigued patients scored significantly worse on Composite Autonomic Symptom Score 31, and there was a strong correlation between the Modified Fatigue Impact Scale and the Composite Autonomic Symptom Score 31 (rs = 0.607, p < 0.001). On the other hand, we found only modest associations between fatigue and scores in objective tests of the autonomic nervous system: there was a clear trend for lower sweating outputs at all measured sites, which reached statistical significance for the distal leg and foot. We found weak correlations between the Modified Fatigue Impact Scale and the Valsalva ratio (rs = - 0.306, p = 0.011), as well as between the Modified Fatigue Impact Scale and quantitative sudomotor axon reflex tests of the forearm, proximal, and distal lower leg (rs = - 0.379, p = 0.003; rs = - 0.356, p = 0.005; and rs = - 0.345, p = 0.006, respectively). A multiple regression model showed that the Composite Autonomic Symptom Score 31, Beck Depression Inventory, and Epworth Sleepiness Scale were independent predictors of fatigue (p = 0.005, p = 0.019, and p = 0.010, respectively). CONCLUSION These results suggest that-even early in the course of the disease-people with multiple sclerosis suffer from objective and subjective impairments of the autonomic nervous system. The results also point to an association between autonomic nervous system impairment and multiple sclerosis related fatigue.
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Affiliation(s)
- Magdalena Krbot Skorić
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Luka Crnošija
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Ivan Adamec
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Barbara Barun
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tereza Gabelić
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Ivan Stanić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tin Pavičić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivan Pavlović
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Jelena Drulović
- Clinic of Neurology, CCS, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezović
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mario Habek
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
- School of Medicine, University of Zagreb, Zagreb, Croatia.
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18
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Adamec I, Crnošija L, Junaković A, Krbot Skorić M, Habek M. Progressive multiple sclerosis patients have a higher burden of autonomic dysfunction compared to relapsing remitting phenotype. Clin Neurophysiol 2018; 129:1588-1594. [PMID: 29885648 DOI: 10.1016/j.clinph.2018.05.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To determine autonomic dysfunction (AD) differences in patients with relapsing remitting multiple sclerosis (pwRRMS) and progressive MS (pwPMS). METHODS Composite autonomic scoring scale (CASS) and heart rate variability (HRV) were performed in 40 pwRRMS and 30 pwPMS. RESULTS pwPMS had a significantly higher sudomotor index and total CASS score compared to pwRRMS (p < 0.001 and p < 0.001, respectively). Disease duration positively correlated with sudomotor index and total CASS (rs = 0.409, p < 0.001 and rs = 0.472, p < 0.001, respectively), while the Expanded Disability Status Scale (EDSS) positively correlated with sudomotor index and total CASS (rs = 0.411, p < 0.001 and rs = 0.402, p = 0.001, respectively) in all patients. Type of multiple sclerosis (pwRRMS or pwPMS) corrected for age, sex and disease duration, was a statistically significant predictor of CASS value (B = 1.215, p = 0.019). Compared to pwRRMS, pwPMS had a significantly lower standard deviation of NN intervals (SDNN), low frequency (LF), and high frequency (HF), during both the supine and tilt-up phases (all p-values <0.006). pwPMS had a significantly lower LF/HF (p = 0.008) during tilt-up. CONCLUSION There is a significant difference in autonomic function in pwRRMS and pwPMS; with pwPMS having a higher burden of AD, which is particularly evident for sweating dysfunction. SIGNIFICANCE Further research is needed to establish whether parasympathetic and sudomotor dysfunction may serve as markers of progressive MS.
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Affiliation(s)
- Ivan Adamec
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Luka Crnošija
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Anamari Junaković
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Magdalena Krbot Skorić
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Mario Habek
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
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19
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Post Junctional Sudomotor and Cutaneous Vascular Responses in Noninjured Skin Following Heat Acclimation in Burn Survivors. J Burn Care Res 2018; 38:e284-e292. [PMID: 27359190 DOI: 10.1097/bcr.0000000000000372] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thermal tolerance is improved in burn survivors following 7 days of exercise heat acclimation. It is unknown whether post junctional sudomotor and/or cutaneous vascular adaptations in noninjured skin contribute to this improvement. Thirty-three burn survivors were stratified into moderately (17-40% BSA grafted, n = 19) and highly (>40% BSA grafted, n = 14) skin-grafted groups. Nine nonburned subjects served as controls. All subjects underwent a 7-day heat acclimation protocol, which improved thermal tolerance in all groups. Before and after this heat acclimation protocol, post junctional cutaneous vascular responses were assessed by administering increasing doses of sodium nitroprusside (SNP) and methacholine (MCh) using intradermal microdialysis in noninjured skin. MCh infusion was also used to assess post junctional responses in sudomotor function in noninjured skin. Cutaneous vascular responses to SNP and MCh were not different between pre- and post heat acclimation in either group of burn survivors (both P > .05). The maximal sweating rate to MCh increased post acclimation in the control group (0.41 ± 0.20 to 0.54 ± 0.21 mg·min·cm; P = .016) but was unchanged in both groups of burn survivors (both P > .05). The number of sweat glands activated during the highest dose of MCh was elevated in the >40% BSA-grafted group (49 ± 16 to 56 ± 18 glands·cm; P = .005) but was unchanged in control subjects and the <40% BSA-grafted group (both P > .05). Given that post junctional administration of MCh and SNP did not alter sweating or skin blood flow from noninjured skin of burn survivors, improved thermal tolerance in these individuals following heat acclimation is more likely a result of either an increased sweating efficiency or an increased neural drive for sweating.
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20
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Davis SL, Jay O, Wilson TE. Thermoregulatory dysfunction in multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2018; 157:701-714. [PMID: 30459034 DOI: 10.1016/b978-0-444-64074-1.00042-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Multiple sclerosis (MS) is a progressive neurologic disorder that disrupts axonal myelin in the central nervous system. Demyelination produces alterations in saltatory conduction, slowed conduction velocity, and a predisposition to conduction block. An estimated 60-80% of MS patients experience temporary worsening of clinical signs and neurologic symptoms with heat exposure (Uhthoff's phenomenon). This heat intolerance in MS is related to the detrimental effects of increased temperature on action potential propagation in demyelinated axons, resulting in conduction slowing and/or block. Additionally, MS may produce impaired neural control of autonomic and endocrine functions. Isolating and interpreting mechanisms responsible for autonomic dysfunction due to MS can be difficult as it may involve sensory impairments, altered neural integration within the central nervous system, impaired effector responses, or combinations of all of these factors. MS lesions occur in areas of the brain responsible for the control and regulation of body temperature and thermoregulatory effector responses, resulting in impaired neural control of sudomotor pathways or neural-induced changes in eccrine sweat glands, as evidenced by observations of reduced sweating responses in MS patients. Although not comprehensive, some evidence exists concerning treatments (cooling, precooling, and pharmacologic) for the MS patient to preserve function and decrease symptom worsening during heat stress. This review focuses on four main themes influencing current understanding of thermoregulatory dysfunction in MS: (1) heat intolerance; (2) central regulation of body temperature; (3) thermoregulatory effector responses; and (4) countermeasures to improve or maintain function during thermal stress.
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Affiliation(s)
- Scott L Davis
- Department of Applied Physiology and Wellness, Southern Methodist University, Dallas, TX, United States.
| | - Ollie Jay
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Thad E Wilson
- Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, United States
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21
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Abstract
In humans, sweating is the most powerful autonomic thermoeffector. The evaporation of sweat provides by far the greatest potential for heat loss and it represents the only means of heat loss when air temperature exceeds skin temperature. Sweat production results from the integration of afferent neural information from peripheral and central thermoreceptors which leads to an increase in skin sympathetic nerve activity. At the neuroglandular junction, acetylcholine is released and binds to muscarinic receptors which stimulate the secretion of a primary fluid by the secretory coil of eccrine glands. The primary fluid subsequently travels through a duct where ions are reabsorbed. The end result is the expulsion of hypotonic sweat on to the skin surface. Sweating increases in proportion with the intensity of the thermal challenge in an attempt of the body to attain heat balance and maintain a stable internal body temperature. The control of sweating can be modified by biophysical factors, heat acclimation, dehydration, and nonthermal factors. The purpose of this article is to review the role of sweating as a heat loss thermoeffector in humans.
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22
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Allen DR, Huang M, Parupia IM, Dubelko AR, Frohman EM, Davis SL. Impaired sweating responses to a passive whole body heat stress in individuals with multiple sclerosis. J Neurophysiol 2017; 118:7-14. [PMID: 28275061 DOI: 10.1152/jn.00897.2016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/02/2017] [Accepted: 03/07/2017] [Indexed: 01/11/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system (CNS), disrupting autonomic function. The aim of this study was to test the hypothesis that individuals with MS have blunted control of thermoregulatory reflex increases in sweat rate (SR) and cutaneous vasodilation compared with controls during a passive whole body heat stress (WBH). Eighteen individuals with relapsing-remitting MS and 18 healthy controls (Con) participated in the study. Core temperature (Tcore), skin temperature, heart rate, arterial blood pressure (10-min intervals), skin blood flow (laser-Doppler flux, LDF), and SR were continuously measured during normothermic baseline (34°C water perfusing a tube-lined suit) and WBH (increased Tcore 0.8°C via 48°C water perfusing the suit). Following WBH, local heaters were warmed to 42°C, inducing peak cutaneous vasodilation at the site of LDF collection. Cutaneous vascular conductance (CVC) was calculated as the ratio of LDF to mean arterial pressure and expressed as a percentage of peak achieved during local heating. Individuals with MS had attenuated SR responses to WBH (ΔSR from baseline: Con, 0.65 ± 0.27; MS, 0.42 ± 0.17 mg·cm-2·min-1, P = 0.003), whereas Δ%CVC42C from baseline was similar between groups (Con, 42 ± 16%; MS, 38 ± 12%, P = 0.39). SR responses were blunted as a function of Tcore in MS (interaction: group × Tcore, P = 0.03), of which differences were evident at ΔTcore 0.7°C and 0.8°C (P < 0.05). No interaction was observed in Δ%CVC42C Taken together, the findings show MS blunts sweating responses, whereas control of the cutaneous vasculature is preserved, in response to WBH.NEW & NOTEWORTHY This study is the first to assess the reflex control of the thermoregulatory system in individuals living with multiple sclerosis (MS). The novel findings are twofold. First, attenuated increases in sweat rate in subjects with MS compared with healthy controls were observed in response to a moderate increase (0.8°C) in core temperature via passive whole body heat stress. Second, it appears the reflex control of the cutaneous vasculature is preserved in MS.
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Affiliation(s)
- Dustin R Allen
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and
| | - Mu Huang
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and
| | - Iqra M Parupia
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and
| | - Ariana R Dubelko
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and
| | - Elliot M Frohman
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Scott L Davis
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and .,Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
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23
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Madeira LG, Passos RL, Souza JFD, Rezende NA, Rodrigues LOC. Autonomic thermoregulatory dysfunction in neurofibromatosis type 1. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:796-802. [PMID: 27759804 DOI: 10.1590/0004-282x20160122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/20/2016] [Indexed: 11/22/2022]
Abstract
Objective Neurofibromatosis type 1 (NF1) causes neural and cutaneous disorders and reduced exercise capacity. Exercise/heat exposure increasing internal temperature must be compensated by eccrine sweat function and warmed skin vasodilation. We suspected NF1 could adversely affect eccrine sweat function and/or vascular thermoregulatory responses (VTR). Methods The eccrine sweat function and VTR of 25 NF1 volunteers (14 males, 11 females; 16-57 years old) were compared with 23 non-NF1 controls matched by sex, age, height and weight (CG). Sweating was induced by 1) pilocarpine 1% iontophoresis (PILO); and 2) by passive heating (HEAT) via the lower third of the legs being immersed in 42°C water for one hour. Previously established eccrine sweat function and VTR protocols were used. Results The NF1 group showed: a) lower sweat rate than the CG group during PILO; b) a smaller diastolic pressure decrease; and c) higher tympanic temperatures than controls during HEAT (p < 0.05). Conclusion Reduced sweating and vascular thermoregulatory responses suggest autonomic dysfunction in NF1 individuals.
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Affiliation(s)
- Luciana G Madeira
- Universidade Federal de Minas Gerais, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Programa de Pós Graduação em Ciências do Esporte, Belo Horizonte MG, Brasil
| | - Renata Lf Passos
- Universidade Federal de Minas Gerais, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Programa de Pós Graduação em Ciências do Esporte, Belo Horizonte MG, Brasil
| | - Juliana F de Souza
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Centro de Referência em Neurofibromatoses, Belo Horizonte MG, Brasil
| | - Nilton A Rezende
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Centro de Referência em Neurofibromatoses, Belo Horizonte MG, Brasil
| | - Luiz O C Rodrigues
- Universidade Federal de Minas Gerais, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Programa de Pós Graduação em Ciências do Esporte, Belo Horizonte MG, Brasil.,Universidade Federal de Minas Gerais, Hospital das Clínicas, Centro de Referência em Neurofibromatoses, Belo Horizonte MG, Brasil
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24
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Wong BJ, Hollowed CG. Current concepts of active vasodilation in human skin. Temperature (Austin) 2016; 4:41-59. [PMID: 28349094 PMCID: PMC5356216 DOI: 10.1080/23328940.2016.1200203] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 10/30/2022] Open
Abstract
In humans, an increase in internal core temperature elicits large increases in skin blood flow and sweating. The increase in skin blood flow serves to transfer heat via convection from the body core to the skin surface while sweating results in evaporative cooling of the skin. Cutaneous vasodilation and sudomotor activity are controlled by a sympathetic cholinergic active vasodilator system that is hypothesized to operate through a co-transmission mechanism. To date, mechanisms of cutaneous active vasodilation remain equivocal despite many years of research by several productive laboratory groups. The purpose of this review is to highlight recent advancements in the field of cutaneous active vasodilation framed in the context of some of the historical findings that laid the groundwork for our current understanding of cutaneous active vasodilation.
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Affiliation(s)
- Brett J. Wong
- Department of Kinesiology & Health, Georgia State University, Atlanta, GA, USA
| | - Casey G. Hollowed
- Department of Kinesiology & Health, Georgia State University, Atlanta, GA, USA
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25
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Autonomic dysfunction in multiple sclerosis is better detected by heart rate variability and is not correlated with central autonomic network damage. J Neurol Sci 2016; 367:133-7. [PMID: 27423576 DOI: 10.1016/j.jns.2016.05.049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND MS-associated autonomic dysfunction (AD) in multiple sclerosis (MS) is poorly understood and the best method for its detection unestablished. We compared classical Ewing battery and newer methods as heart rate variability (HRV) and spontaneous baroreflex sensibility (BRS) to detect AD in MS and related them to central autonomic network (CAN) lesions. METHODS We enrolled 20 relapsing-remitting MS patients, median age of 36 (interquartile range 32-46) years, disease duration of 5.5 (2.2-6.8) years, Expanded Disability Status Scale (EDSS) score of 1.0 (1.0-1.5) and 20 age- and gender-matched healthy controls. We assessed Ewing battery and spontaneous HRV and BRS. CAN involvement was evaluated by magnetic resonance imaging. RESULTS HRV showed both parasympathetic and sympathetic significant impairment in MS (p<0.05). From Ewing battery only isometric test was significantly decreased in MS (p=0.006). Disease duration and severity, lesion burden and CAN involvement were not correlated with laboratorial parameters. CONCLUSIONS Our MS cohort had both sympathetic and parasympathetic dysfunction independently from disease duration, neurological deficits and lesion burden or CAN involvement. HRV analysis maybe more useful than classical Ewing battery to screen AD.
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Pritchett RC, Al-Nawaiseh AM, Pritchett KK, Nethery V, Bishop PA, Green JM. Sweat gland density and response during high-intensity exercise in athletes with spinal cord injuries. Biol Sport 2015; 32:249-54. [PMID: 26424929 PMCID: PMC4577563 DOI: 10.5604/20831862.1163370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/17/2014] [Accepted: 01/08/2015] [Indexed: 11/13/2022] Open
Abstract
Sweat production is crucial for thermoregulation. However, sweating can be problematic for individuals with spinal cord injuries (SCI), as they display a blunting of sudomotor and vasomotor responses below the level of the injury. Sweat gland density and eccrine gland metabolism in SCI are not well understood. Consequently, this study examined sweat lactate (S-LA) (reflective of sweat gland metabolism), active sweat gland density (SGD), and sweat output per gland (S/G) in 7 SCI athletes and 8 able-bodied (AB) controls matched for arm ergometry VO2peak. A sweat collection device was positioned on the upper scapular and medial calf of each subject just prior to the beginning of the trial, with iodine sweat gland density patches positioned on the upper scapular and medial calf. Participants were tested on a ramp protocol (7 min per stage, 20 W increase per stage) in a common exercise environment (21±1°C, 45-65% relative humidity). An independent t-test revealed lower (p<0.05) SGD (upper scapular) for SCI (22.3 ±14.8 glands · cm(-2)) vs. AB. (41.0 ± 8.1 glands · cm(-2)). However, there was no significant difference for S/G between groups. S-LA was significantly greater (p<0.05) during the second exercise stage for SCI (11.5±10.9 mmol · l(-1)) vs. AB (26.8±11.07 mmol · l(-1)). These findings suggest that SCI athletes had less active sweat glands compared to the AB group, but the sweat response was similar (SLA, S/G) between AB and SCI athletes. The results suggest similar interglandular metabolic activity irrespective of overall sweat rate.
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Affiliation(s)
- R C Pritchett
- Department of Nutrition, Exercise and Health Science, Central Washington University, Ellensburg, WA, USA
| | - A M Al-Nawaiseh
- Department of Sport Rehabilitation, Hashemite University, Zarqa, Jordan
| | - K K Pritchett
- Department of Nutrition, Exercise and Health Science, Central Washington University, Ellensburg, WA, USA
| | - V Nethery
- Department of Nutrition, Exercise and Health Science, Central Washington University, Ellensburg, WA, USA
| | - P A Bishop
- Department of Kinesiology, University of Alabama, Tuscaloosa, USA
| | - J M Green
- Department of Health, Physical Education and Recreation, University of North Alabama, Florence, USA
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Pintér A, Cseh D, Sárközi A, Illigens BM, Siepmann T. Autonomic Dysregulation in Multiple Sclerosis. Int J Mol Sci 2015; 16:16920-52. [PMID: 26213927 PMCID: PMC4581177 DOI: 10.3390/ijms160816920] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 07/13/2015] [Accepted: 07/20/2015] [Indexed: 02/07/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, progressive central neurological disease characterized by inflammation and demyelination. In patients with MS, dysregulation of the autonomic nervous system may present with various clinical symptoms including sweating abnormalities, urinary dysfunction, orthostatic dysregulation, gastrointestinal symptoms, and sexual dysfunction. These autonomic disturbances reduce the quality of life of affected patients and constitute a clinical challenge to the physician due to variability of clinical presentation and inconsistent data on diagnosis and treatment. Early diagnosis and initiation of individualized interdisciplinary and multimodal strategies is beneficial in the management of autonomic dysfunction in MS. This review summarizes the current literature on the most prevalent aspects of autonomic dysfunction in MS and provides reference to underlying pathophysiological mechanisms as well as means of diagnosis and treatment.
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Affiliation(s)
- Alexandra Pintér
- Institute of Human Physiology and Clinical Experimental Research, Faculty of Medicine, Semmelweis University, Budapest 1085, Hungary.
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden 01067, Germany.
| | - Domonkos Cseh
- Institute of Human Physiology and Clinical Experimental Research, Faculty of Medicine, Semmelweis University, Budapest 1085, Hungary.
| | - Adrienn Sárközi
- Institute of Human Physiology and Clinical Experimental Research, Faculty of Medicine, Semmelweis University, Budapest 1085, Hungary.
| | - Ben M Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Timo Siepmann
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden 01067, Germany.
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany.
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany.
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Autonomic dysfunction in multiple sclerosis: implications for exercise. Auton Neurosci 2014; 188:82-5. [PMID: 25458432 DOI: 10.1016/j.autneu.2014.10.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 09/11/2014] [Accepted: 10/13/2014] [Indexed: 01/17/2023]
Abstract
Multiple sclerosis (MS), a progressive neurological disease, can result in autonomic dysfunction. Impairments in the autonomic control of cardiovascular and thermoregulatory function during exercise have been observed in MS. Attenuated elevations in blood pressure during exercise in MS patients can negatively impact blood flow to skeletal muscle. Diminished sweating during exercise may impair heat dissipation likely limiting the exercise intensity that can be performed before detrimental core temperatures are reached. Further understanding the physiologic mechanisms of autonomic dysfunction during exercise in MS may lead to the development of novel therapeutic strategies targeted at improving quality of life in individuals with this disease.
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Cramer MN, Jay O. Selecting the correct exercise intensity for unbiased comparisons of thermoregulatory responses between groups of different mass and surface area. J Appl Physiol (1985) 2014; 116:1123-32. [DOI: 10.1152/japplphysiol.01312.2013] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We assessed whether comparisons of thermoregulatory responses between groups unmatched for body mass and surface area (BSA) should be performed using a metabolic heat production (Ḣprod) in Watts or Watts per kilogram for changes in rectal temperature (ΔTre), and an evaporative heat balance requirement ( Ereq) in Watts or Watts per square meter for local sweat rates (LSR). Two groups with vastly different mass and BSA [large (LG): 91.5 ± 6.8 kg, 2.12 ± 0.09 m2, n = 8; small (SM): 67.6 ± 5.6 kg, 1.80 ± 0.09 m2, n = 8; P < 0.001], but matched for heat acclimation status, sex, age, and with the same onset threshold esophageal temperatures (LG: +0.37 ± 0.12°C; SM: +0.41 ± 0.17°C; P = 0.364) and thermosensitivities (LG: 1.02 ± 0.54, SM: 1.00 ± 0.38 mg·cm−2·min−1·°C−1; P = 0.918) for sweating, cycled for 60 min in 25°C at different levels of Ḣprod (500 W, 600 W, 6.5 W/kg, 9.0 W/kg) and Ereq (340 W, 400 W, 165 W/m2, 190 W/m2). ΔTre was different between groups at a Ḣprod of 500 W (LG: 0.52 ± 0.15°C, SM: 0.92 ± 0.24°C; P < 0.001) and 600 W (LG: 0.78 ± 0.19°C, SM: 1.14 ± 0.24°C; P = 0.007), but similar at 6.5 W/kg (LG: 0.79 ± 0.21°C, SM: 0.85 ± 0.14°C; P = 0.433) and 9.0 W/kg (LG: 1.02 ± 0.22°C, SM: 1.14 ± 0.24°C; P = 0.303). Furthermore, ΔTre was the same at 9.0 W/kg in a 35°C environment (LG: 1.12 ± 0.30°C, SM: 1.14 ± 0.25°C) as at 25°C ( P > 0.230). End-exercise LSR was different at Ereq of 400 W (LG: 0.41 ± 0.18, SM: 0.57 ± 0.13 mg·cm−2·min−1; P = 0.043) with a trend toward higher LSR in SM at 340 W (LG: 0.28 ± 0.06, SM: 0.37 ± 0.15 mg·cm−2·min−1; P = 0.057), but similar at 165 W/m2 (LG: 0.28 ± 0.06, SM: 0.28 ± 0.12 mg·cm−2·min−1; P = 0.988) and 190 W/m2 (LG: 0.41 ± 0.18, SM: 0.37 ± 0.15 mg·cm−2·min−1; P = 0.902). In conclusion, when comparing groups unmatched for mass and BSA, future experiments can avoid systematic differences in ΔTre and LSR by using a fixed Ḣprod in Watts per kilogram and Ereq in Watts per square meter, respectively.
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Affiliation(s)
- Matthew N. Cramer
- Thermal Ergonomics Laboratory, School of Human Kinetics, University of Ottawa, Ottawa, Canada; and
| | - Ollie Jay
- Thermal Ergonomics Laboratory, School of Human Kinetics, University of Ottawa, Ottawa, Canada; and
- Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, New South Wales, Australia
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Collie JTB, Massie RJ, Jones OAH, LeGrys VA, Greaves RF. Sixty-five years since the New York heat wave: advances in sweat testing for cystic fibrosis. Pediatr Pulmonol 2014; 49:106-17. [PMID: 24249707 DOI: 10.1002/ppul.22945] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/02/2013] [Indexed: 12/20/2022]
Abstract
The sweat test remains important as a diagnostic test for cystic fibrosis (CF) and has contributed greatly to our understanding of CF as a disease of epithelial electrolyte transport. The standardization of the sweat test, by Gibson and Cooke [Gibson and Cooke (1959) Pediatrics 1959;23:5], followed observations of excessive dehydration amongst patients with CF and confirmed the utility as a diagnostic test. Quantitative pilocarpine iontophoresis remains the gold standard for sweat induction, but there are a number of collection and analytical methods. The pathophysiology of electrolyte transport in sweat was described by Quinton [Quinton (1983) Nature 1983;301:421-422], and this complemented the developments in genetics that discovered the cystic fibrosis transmembrane conductance regulator (CFTR), an epithelial-based electrolyte transport protein. Knowledge of CF has since increased rapidly and further developments in sweat testing include: new collection methods, further standardization of the technique with international recommendations and age related reference intervals. More recently, sweat chloride values have been used as proof of effect for the new drugs that activate CFTR. However, there remain issues with adherence to sweat test guidelines in many countries and there are gaps in our knowledge, including reference intervals for some age groups and stability of sweat samples in transport. Furthermore, modern methods of elemental quantification need to be explored as alternatives to the original analytical methods for sweat electrolyte measurement. The purpose of this review is therefore to describe the development of the sweat test and consider future directions.
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Affiliation(s)
- Jake T B Collie
- School of Applied Sciences, RMIT University, Melbourne, Victoria, Australia; Dorevitch Pathology, Heidelberg, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Long-term endurance exercise improves aerobic capacity in patients with relapsing–remitting Multiple Sclerosis: Impact of baseline fatigue. J Neurol Sci 2014; 336:29-35. [DOI: 10.1016/j.jns.2013.09.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 09/14/2013] [Accepted: 09/26/2013] [Indexed: 01/08/2023]
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Gagnon D, Crandall CG, Kenny GP. Sex differences in postsynaptic sweating and cutaneous vasodilation. J Appl Physiol (1985) 2012; 114:394-401. [PMID: 23154992 DOI: 10.1152/japplphysiol.00877.2012] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The current study aimed to determine whether a peripheral modulation of sweating contributes to the lower sudomotor thermosensitivity previously observed in females during exercise. We examined dose-response relationships in 12 males and 12 females to incremental doses of acetylcholine (ACh) and methylcholine (MCh) for sweating (ventilated capsule), as well as to ACh and sodium nitroprusside (SNP) for cutaneous vasodilation (laser-Doppler). All drugs were infused using intradermal microdialysis. On a separate day, potential sex differences in the onset threshold and/or thermosensitivity of heat loss responses were assessed during progressive increases in mean body temperature elicited by passive heating. Increases in sweating as a function of increasing concentration of ACh (P = 0.008) and MCh (P = 0.046) significantly differed between males and females. Although the concentration eliciting 50% of the maximal sweating response did not differ between sexes for either agonist (P > 0.1), maximum values were lower in females in response to ACh (0.34 ± 0.12 vs. 0.59 ± 0.19 mg·min(-1)·cm(-2), P = 0.04) and MCh (0.48 ± 0.12 vs. 0.78 ± 0.26 mg·min(-1)·cm(-2), P = 0.05). This observation was paralleled by a lower thermosensitivity of sudomotor activity in females during passive heating (1.29 ± 0.34 vs. 1.83 ± 0.33 mg·min(-1)·cm(-2)·°C(-1), P = 0.03), with no significant differences in the change in mean body temperature at which onset of sweating occurred (0.85 ± 0.19 vs. 0.67 ± 0.13°C, P = 0.10). No sex differences in cutaneous vasodilation were observed in response to ACh and SNP, as well as during passive heating (all P > 0.1). These findings provide direct evidence for a peripheral modulation of sudomotor activity in females. In contrast, sex does not modulate cutaneous vasodilation.
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Affiliation(s)
- Daniel Gagnon
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Canada
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Gagnon D, Ganio MS, Lucas RAI, Pearson J, Crandall CG, Kenny GP. Modified iodine-paper technique for the standardized determination of sweat gland activation. J Appl Physiol (1985) 2012; 112:1419-25. [PMID: 22323650 DOI: 10.1152/japplphysiol.01508.2011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Quantifying sweat gland activation provides important information when explaining differences in sweat rate between populations and physiological conditions. However, no standard technique has been proposed to measure sweat gland activation, while the reliability of sweat gland activation measurements is unknown. We examined the interrater and internal reliability of the modified-iodine paper technique, as well as compared computer-aided analysis to manual counts of sweat gland activation. Iodine-impregnated paper was pressed against the skin of 35 participants in whom sweating was elicited by exercise in the heat or infusion of methylcholine. The number of active glands was subsequently determined by computer-aided analysis. In total, 382 measurements were used to evaluate: 1) agreement between computer analysis and manual counts; 2) the interrater reliability of computer analysis between independent investigators; and 3) the internal reliability of sweat gland activation measurements between duplicate samples. The number of glands identified with computer analysis did not differ from manual counts (68 ± 29 vs. 72 ± 24 glands/cm(2); P = 0.27). These measures were highly correlated (r = 0.77) with a mean bias ± limits of agreement of -4 ± 38 glands/cm(2). When comparing computer analysis measures between investigators, values were highly correlated (r = 0.95; P < 0.001) and the mean bias ± limits of agreement was 4 ± 18 glands/cm(2). Finally, duplicate measures of sweat gland activation were highly correlated (r = 0.88; P < 0.001) with a mean bias ± limits of agreement of 3 ± 29 glands/cm(2). These results favor the use of the modified-iodine paper technique with computer-aided analysis as a standard technique to reliably evaluate the number of active sweat glands.
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Affiliation(s)
- Daniel Gagnon
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ontario, Canada
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35
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Wingo JE, Low DA, Keller DM, Brothers RM, Shibasaki M, Crandall CG. Skin blood flow and local temperature independently modify sweat rate during passive heat stress in humans. J Appl Physiol (1985) 2010; 109:1301-6. [PMID: 20705945 DOI: 10.1152/japplphysiol.00646.2010] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sweat rate (SR) is reduced in locally cooled skin, which may result from decreased temperature and/or parallel reductions in skin blood flow. The purpose of this study was to test the hypotheses that decreased skin blood flow and decreased local temperature each independently attenuate sweating. In protocols I and II, eight subjects rested supine while wearing a water-perfused suit for the control of whole body skin and internal temperatures. While 34°C water perfused the suit, four microdialysis membranes were placed in posterior forearm skin not covered by the suit to manipulate skin blood flow using vasoactive agents. Each site was instrumented for control of local temperature and measurement of local SR (capacitance hygrometry) and skin blood flow (laser-Doppler flowmetry). In protocol I, two sites received norepinephrine to reduce skin blood flow, while two sites received Ringer solution (control). All sites were maintained at 34°C. In protocol II, all sites received 28 mM sodium nitroprusside to equalize skin blood flow between sites before local cooling to 20°C (2 sites) or maintenance at 34°C (2 sites). In both protocols, individuals were then passively heated to increase core temperature ~1°C. Both decreased skin blood flow and decreased local temperature attenuated the slope of the SR to mean body temperature relationship (2.0 ± 1.2 vs. 1.0 ± 0.7 mg·cm(-2)·min(-1)·°C(-1) for the effect of decreased skin blood flow, P = 0.01; 1.2 ± 0.9 vs. 0.07 ± 0.05 mg·cm(-2)·min(-1)·°C(-1) for the effect of decreased local temperature, P = 0.02). Furthermore, local cooling delayed the onset of sweating (mean body temperature of 37.5 ± 0.4 vs. 37.6 ± 0.4°C, P = 0.03). These data demonstrate that local cooling attenuates sweating by independent effects of decreased skin blood flow and decreased local skin temperature.
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Affiliation(s)
- Jonathan E Wingo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX 75231, USA
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Davis SL, Wilson TE, White AT, Frohman EM. Thermoregulation in multiple sclerosis. J Appl Physiol (1985) 2010; 109:1531-7. [PMID: 20671034 DOI: 10.1152/japplphysiol.00460.2010] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Multiple sclerosis (MS) is a progressive neurological disorder that disrupts axonal myelin in the central nervous system. Demyelination produces alterations in saltatory conduction, slowed conduction velocity, and a predisposition to conduction block. An estimated 60-80% of MS patients experience temporary worsening of clinical signs and neurological symptoms with heat exposure. Additionally, MS may produce impaired neural control of autonomic and endocrine functions. This review focuses on five main themes regarding the current understanding of thermoregulatory dysfunction in MS: 1) heat sensitivity; 2) central regulation of body temperature; 3) thermoregulatory effector responses; 4) heat-induced fatigue; and 5) countermeasures to improve or maintain function during thermal stress. Heat sensitivity in MS is related to the detrimental effects of increased temperature on action potential propagation in demyelinated axons, resulting in conduction slowing and/or block, which can be quantitatively characterized using precise measurements of ocular movements. MS lesions can also occur in areas of the brain responsible for the control and regulation of body temperature and thermoregulatory effector responses, resulting in impaired neural control of sudomotor pathways or neural-induced changes in eccrine sweat glands, as evidenced by observations of reduced sweating responses in MS patients. Fatigue during thermal stress is common in MS and results in decreased motor function and increased symptomatology likely due to impairments in central conduction. Although not comprehensive, some evidence exists concerning treatments (cooling, precooling, and pharmacological) for the MS patient to preserve function and decrease symptom worsening during heat stress.
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Affiliation(s)
- Scott L Davis
- Department of Applied Physiology and Wellness, Annette Caldwell Simmons School of Education and Human Development, Southern Methodist University, Dallas, TX 75275-0382, USA.
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Saari A, Tolonen U, Pääkkö E, Suominen K, Jauhiainen J, Sotaniemi KA, Myllylä VV. Sweating impairment in patients with multiple sclerosis. Acta Neurol Scand 2009; 120:358-63. [PMID: 19456306 DOI: 10.1111/j.1600-0404.2009.01164.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To measure sweating in patients with multiple sclerosis (MS). MATERIALS AND METHODS Sweating was measured by an evaporimeter after a heating stimulus in 29 MS patients and in 15 healthy control subjects. RESULTS The MS patients sweated markedly less than the controls. After 10 min of heating the sweating was significantly lower in the forehead (P = 0.034), feet (right, P = 0.033; left, P = 0.037) and legs (right, P = 0.043; left, P = 0.029) of the MS patients than in those of the controls. After 15 min of heating the difference was statistically significant only in the feet (right, P = 0.043; left, P = 0.029). The Expanded Disability Status Scale score correlated inversely with sweating at 15 min of heating in the left hand (r = 0.42, P < 0.05), and in the left (r = 0.36, P < 0.05) and right foot (r = 0.37, P < 0.05). CONCLUSIONS MS is associated with an impairment in thermoregulatory sweating which seems to be related to the disease severity.
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Affiliation(s)
- A Saari
- Department of Neurology, Oulu University Hospital, Oulu, Finland.
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Marino FE. Heat reactions in multiple sclerosis: an overlooked paradigm in the study of comparative fatigue. Int J Hyperthermia 2009; 25:34-40. [PMID: 19219698 DOI: 10.1080/02656730802294020] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Multiple sclerosis (MS) is a demyelinating and debilitating disease characterised by a range of symptoms such as motor dysfunction and muscle weakness. A significant MS symptom is heat sensitivity so that exposure to heat will increase body temperature and consequently the appearance of neurological signs. Although some people with MS can undertake exercise, it is thought to be limited by the sensitivity to heat and the subsequent rise in body temperature which occurs. It has been found that central fatigue is a determining factor in muscle activation and performance in normal healthy subjects. However, it is unknown whether thermal strain also induces central fatigue in MS even though muscular fatigue in MS is due mainly to central rather than peripheral factors. This review focuses on the similarities in the manifestation of central fatigue in both MS and healthy subjects with reference to thermal strain and heat reactions.
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Affiliation(s)
- Frank E Marino
- School of Human Movement Studies & Exercise & Sports Science Laboratories, Charles Sturt University, Bathurst, New South Wales, Australia.
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Yawning and thermoregulation. Physiol Behav 2008; 95:10-6. [DOI: 10.1016/j.physbeh.2008.05.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 04/02/2008] [Accepted: 05/05/2008] [Indexed: 01/07/2023]
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40
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Gonzalo-Ruiz J, Mas R, de Haro C, Cabruja E, Camero R, Alonso-Lomillo MA, Muñoz FJ. Early determination of cystic fibrosis by electrochemical chloride quantification in sweat. Biosens Bioelectron 2008; 24:1788-91. [PMID: 18823769 DOI: 10.1016/j.bios.2008.07.051] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 07/22/2008] [Accepted: 07/22/2008] [Indexed: 01/15/2023]
Abstract
A novel and rapid approach to quantify chloride concentration in sweat for early detection of cystic fibrosis (CF) is shown in this work. Disposable screen-printed sensor (SPS) devices capable to induce sweat and measure the chloride concentration are presented. Pilocarpine, which was forced into de skin by means of iontophoresis, has been used to stimulate the sweat glands. Chloride concentration has been directly measured on the skin by potentiometry. The performance of the devices has been tested in synthetic samples, obtaining good agreement with the Nernst equation. Sensors reproducibility has been analyzed in terms of residual standard deviation (RSD), obtaining a value of 8% (n=6 and alpha=0.05). Finally, the application of these sensors in several volunteers has been carried out. The results were compared with the method generally used in hospitals, obtaining deviations minor than 8%.
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Affiliation(s)
- Javier Gonzalo-Ruiz
- Centro Nacional de Microelectrónica (IMB-CNM), CSIC, Esfera UAB, Campus Universidad Autónoma de Barcelona, Bellaterra, Barcelona, Spain.
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Abstract
Multiple sclerosis (MS) is the most frequent chronic neurological disease affecting young persons in developed countries. MS is, however, considered as a secondary cause, of central origin, for autonomic dysfunction. The most common autonomic symptoms in MS are disorders of micturation, impotence, sudomotor and gastrointestinal disturbances, orthostatic intolerance as well as sleep disorders. The majority of the patients suffer at some period of the disease from lower urinary tract symptoms and sexual dysfunction. Awareness and treatment of these conditions is vital to improving health and quality of life in patients with MS. The increased understanding of the pathophysiological mechanisms in autonomic dysfunction in MS, along with technological and pharmaceutical developments has advanced our ability to treat the multiple aspects complicating autonomic failure in MS.
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Affiliation(s)
- Carl-Albrecht Haensch
- Dept. of Neurology, HELIOS Klinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Germany.
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