The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.
Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.
www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

Thursday, April 17, 2008

Following sympathectomy the basal t-PA activity in plasma was 70% less than controls

Additional evidence that the sympathetic nervous system regulates the vessel wall release of tissue plasminogen activator.

Original Articles

Blood Coagulation & Fibrinolysis. 13(6):471-481, September 2002.
Wang, Y.; Jiang, X.; Hand, A. R.; Gilles, C.; Kirk, J.; Cone, R. E.; O'Rourke, J.
It is established that sympathetic neurons can synthesize, transport and store tissue plasminogen activator (t-PA) within axon terminals in the smooth muscle of vessel walls. Moreover, sympathetic excitations (e.g. physical and mental stress) are known to induce an acute release of t-PA into the circulation. However, relatively little is known about the nature and extent of sympathetic nervous system involvement in the release process per se. We inquired whether a chemical sympathectomy will alter the release of t-PA into the blood, and the intrinsic release of stored t-PA from isolated whole vessel explants. A long-term sympathectomy was induced in adult Sprague-Dawley rats by injection of guanethidine during a 5-week course. The destruction of ganglion neurons and vessel wall axons was verified immunohistochemically. t-PA release was assayed as the free activity in hind limb plasma and explant culture medium. Following sympathectomy: (i) the basal t-PA activity in plasma was 70% less than controls (2.92 +/- 1.96 versus 9.33 +/- 1.72 IU/ml;P <= 0.001); (ii) the acute release from isolated vessels induced by bradykinin or phenylephrine was comparably reduced; and (iii) the greatest reductions occurred in densely innervated small vessel explants. The results provide new support for an autonomic regulation of neural t-PA release into the vessel wall matrix and blood of densely innervated thin-walled microvessels.

Neuropeptide Y plasma levels and serum dopamine-beta-hydroxylase activity in MS patients with and without abnormal cardiovascular reflexes.

1994, N° 1 (Vol. 94/1)
Gallai V, Sarchielli P, Firenze C, Trequattrini A, Paciaroni M, Usai F, Franceschini M, Palumbo R
Abstract:
An impairment in the autonomic function has been demonstrated in patients with multiple sclerosis (MS) using electrophysiological, pupillary and biochemical tests. Particularly evident were alterations in the cardiovascular reflexes, cutaneous sympathetic response and lymphomonocyte adrenergic binding. Electrophysiological and biochemical findings in MS patients have only occasionally been compared. Among the peripheral markers of the autonomic system, Neuropeptide Y (NPY) and dopamine-beta-hydroxylase (DBH) have been singled out as reliable indices of sympathetic function. The former is a peptide with a strong vasoconstrictive action, which is released from adrenergic endings together with noradrenaline following sympathetic activation. The latter is the enzyme which catalyses the conversion of dopamine to norepinephrine. It is located both in sympathetic endings and the chromaffin granules of adrenal medulla. To verify a failure in autonomic function in the course of MS, a battery of cardiovascular tests (assessing sympathetic and parasympathetic functions) was performed on 25 MS patients.

Altered dopamine beta-hydroxylase (DBH) activity has been reported in mood disorders. Plasma DBH is reduced in major depression with psychosis

Plasma dopamine beta-hydroxylase activity in psychotic and non-psychotic post-traumatic stress disorder

Authors: Hamner M.B.1; Gold P.B.

Source: Psychiatry Research, Volume 77, Number 3, 27 February 1998 , pp. 175-181(7)

Recognition and treatment of comorbid chronic psychotic symptoms in post-traumatic stress disorder (PTSD) has become of increasing clinical interest. Altered dopamine beta-hydroxylase (DBH) activity has been reported in mood disorders. Plasma DBH is reduced in major depression with psychosis and elevated in bipolar disorder with psychosis compared with their respective non-psychotic diagnostic groups. DBH is likely a trait marker with interindividual variations secondary to genetic polymorphism. We therefore evaluated DBH activity in PTSD patients with and without psychotic features and compared these groups with age- and gender-matched control subjects. Vietnam combat veterans with PTSD (n=19) (including patients with and without psychotic features) and normal control subjects (n=22) had plasma DBH enzyme activity assayed photometrically. DBH was significantly higher in patients with PTSD with psychotic features than in patients without psychotic features (80.6±13.4 vs. 42.1±7.3 mM/min, P<0.01)>P<0.01).>

Rheumatoid arthritis and Autonomic Neuropathy

Rheumatoid arthritis, systemic lupus erythematosus, and connective tissue disorders

Rheumatoid arthritis, systemic lupus erythematosus, and other connective tissue disorders may have abnormalities of sympathetic postganglionic function. Some of these patients may have autoantibodies to ganglionic acetylcholine receptors. Autoimmune thyroiditis, as with chronic thyroiditis and Hashimoto thyroiditis, can be associated with some features of Sjögren syndrome such as xerostomia. Patients with systemic sclerosis and mixed connective tissue disorder may have abnormalities of autonomic functioning of esophageal motor activity.

http://www.emedicine.com/NEURO/topic720.htm

Autonomic Neuropathy

Chronic idiopathic anhidrosis (Mia: one of the side-effects of sympathectomy)

Chronic idiopathic anhidrosis is an acquired generalized loss of sweating without other autonomic features.

http://www.emedicine.com/NEURO/topic720.htm

Autonomic diseases: clinical features and laboratory evaluation

Minimally invasive endoscopic techniques for sympathectomy often are .... of the enzyme dopamine beta-hydroxylase (DBH), which converts dopamine into ...
jnnp.bmjjournals.com/cgi/content/full/74/suppl_3/iii31 - Similar pages - Note this

Autonomic dysfunction and multiple sclerosis

Multiple Sclerosis, Vol. 7, No. 5, 327-334 (2001)
DOI: 10.1177/135245850100700509
© 2001 SAGE Publications

Autonomic dysfunction in multiple sclerosis is related to disease activity and progression of disability

Peter Flachenecker
Karlheinz Reiners
Miriam Krauser
Annalaska Wolf
Klaus V Toyka
Background: Autonomic dysfunction is frequently observed in patients with multiple sclerosis (MS) but the evolution over time and the relationship to clinical characteristics are not yet established.
Objectives: We investigated the correlation of disease activity and progression of disability with composite scores of cardiovascular autonomic dysfunction and serum levels of catecholamines in a cross-sectional study of patients with clinically active and clinically stable MS.
Results: In the cross-sectional study, the number of patients with at least one abnormal sympathetic test was higher in the `active' patient group (39%) than in healthy controls (8%, P50.02) or `stable' patients (0%, P50.04), while no difference was seen in the parasympathetic score. Median catecholamine levels were significantly lower in `active' MS patients than in those with stable disease (norepinephrine, 204 ng/l (interquartile range 158-310 ng/l) vs 363 ng/l (269-507 ng/l), P50.02 and epinephrine, 23 ng/l (16-28 ng/l) vs 32 ng/l (24-107 ng/l), P50.04). In the subgroup of patients studied longitudinally, parasympathetic but not sympathetic dysfunction increased slightly during the follow-up period, with a significant correlation to the increase in clinical disability (r=0.7, P50.002).
Conclusions: Parasympathetic dysfunction was closely related to the progression of disability in patients with MS. In contrast, sympathetic dysfunction was associated to the clinical activity of MS. This is in line with previous observations suggesting that the autonomic nervous system may be intimately linked with the disordered immune regulation in MS.

Dopamine beta-hydroxylase deficiency impairs cellular immunity


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Vol. 8, No. 4, 2000

Free Abstract Article (References) Article (PDF 227 KB)

Original Paper

Interferon-Gamma Release in Sympathetically Denervated Rat Submaxillary Lymph Nodes
Patricia O. Castrillóna, Daniel P. Cardinalib, Agustín Arcea, Rodolfo A. Cutrerab, Ana I. Esquifinoa

DBH deficiency - depresssion and schizophrenia

Since norepinephrine and its receptor sites have long been postulated to play a role in a number of psychiatric disorders, the essentially normal mood and mental status of adult DBH-deficiency subjects so far encountered has elicited great interest among investigators in the area of depression and schizophrenia. http://www.mc.vanderbilt.edu/root/vumc.php?site=adc&doc=4792

Vanderbilt Autonomic Dysfunction Center

Norepinephrine and epinephrine are crucial determinants of minute-to-minute neural regulation of blood pressure and are also present at crucial central nervous system sites likely to be involved in a variety of behaviors. Norepinephrine and epinephrine thus seem so important to human beings that it seemed unlikely for many years that subjects without these catecholamines would survive the perinatal period and develop to adulthood.

This view has changed with recognition of a congenital syndrome of severe orthostatic hypotension, noradrenergic failure, and ptosis of the eyelids in two young adults. The syndrome differs from familial dysautonomia and various other autonomic disorders seen in adults in that the defect can be localized to the noradrenergic and adrenergic tissues. There is virtual absence of norepinephrine, epinephrine, and their metabolites. However, there is greatly increased dopamine in plasma, cerebrospinal fluid, and urine.

As children, DBH deficient patients have had a markedly reduced ability to exercise, perhaps because of hypotension engendered by the physical exertion. Because of occasional syncope, anticonvulsive medications have been given in some patients, even though no abnormality was seen on the electroencephalogram. Symptoms have generally worsened in late adolescence and by early adulthood, patients complain of profound orthostatic hypotension, especially early in the day and during hot weather or after alcohol ingestion. In addition to ptosis of the eyelids, there is reduced exercise tolerance, a tendency for nasal stuffiness to occur, especially in the supine posture. A male patient had appropriate erectal function, but retrograde rather than antegrade ejaculation. Presyncopal symptoms in these patients have included dizziness, blurred vision, dyspnea, nuchal discomfort, and occasionally chest pain.

Dopamine beta-hydroxylase deficiency

Dopamine beta-hydroxylase deficiency is a very rare
form of primary autonomic failure characterized by a
complete absence of noradrenaline and adrenaline in plasma
together with increased dopamine plasma levels resulting from
heterogenous molecular alterations of DbH gene.
DbH deficiency is characterized by by cardiovascular disorders
and severe orthostatic hypotension.
Children with DbH deficiency often exhibit reduced ability to exercise
because of blood pressure inadaptation with exertion and syncope.
Symptoms usually worsen during adulthood with severe orthostatic
hypotension, eyelid ptosis, nasal stuffiness and sexual disorders.

Authors: Prof. Jean-Michel Senard, Dr Philippe Rouet
INSERM Unit 586, Insittut Louis Bugnard, C.H.U. Rangueil, 31054,
Toulouse Cedex, France
July 2005

Serum dopamine-beta-hydroxylase and depression

Friedhelm Lamprecht1, Michael H. Ebert1, Ibrahim Turek1, 2 and Irwin J. Kopin1

(1) Laboratory of Clinical Science, NIMH, 20014 Bethesda, Maryland
(2) Maryland Psychiatric Research Center, Catonsville, Maryland

Received: 18 June 1974

Abstract Serum dopamine-beta-hydroxylase (DBH) activity was studied in unipolar and bipolar depressed patients who were free of medication and in normal controls. No significant difference was found. A second group of depressed patients were studied during a course of electroconvulsive shock treatment (ECT). A small, but significant, increase in DBH activity was found 5 min after a single modified convulsion, suggesting release of DBH into the circulation. Also a small, but significant, increase in the baseline level of DBH activity was found at the ninth treatment compared to the first treatment. A single electroconvulsive shock administered to rats produced a significant elevation of both plasma epinephrine and norepinephrine at 1 and 5 min post convulsion and a significant, but smaller, elevation of plasma DBH at 5 min post convulsion in adrenalectomized rats.

Key words Electroconvulsive Shock Treatment - Serum Dopamine-Beta-Hydroxylase - Depression - Catecholamines - Sympathetic Nervous System

Serum dopamine-beta-hydroxylase in depressed patients and the effect of electroconvulsive shock treatment

JournalPsychopharmacology
PublisherSpringer Berlin / Heidelberg
ISSN0033-3158 (Print) 1432-2072 (Online)
IssueVolume 40, Number 3 / September, 1974

Sympathectomy resulted in marked reduction of dopamine beta-hydroxylase immunoreactivity

dopamine beta-hydroxylase (Dbh-/-), the enzyme responsible for synthesizing norepinephrine and epinephrine from dopamine,

Dbh - dopamine beta hydroxylase

Sympathectomy resulted in marked reduction of dopamine beta-hydroxylase immunoreactivity with no appreciable change in galanin immunoreactivity. ...
www.ihop-net.org/UniPub/iHOP/gs/321789.html - 342k

Serum Dopamine-Beta-Hydroxylase Activity -- WEINSHILBOUM and ...

Serum Dopamine-beta-Hydroxylase: Decrease after Chemical Sympathectomy Science, September 3, 1971; 173(4000): 931 - 934. [Abstract] [PDF] ...
circres.ahajournals.org/cgi/content/abstract/28/3/307?ck=nck

NASA Technical Reports Server

Anti-dopamine beta-hydroxylase immunotoxin administration produces a rapid, irreversible sympathectomy. NASA Center: NASA (non Center Specific) ...
ntrs.nasa.gov/

Serum Dopamine-beta-Hydroxylase (DBH) Activity and Blood Pressure ...

Serum Dopamine-beta-Hydroxylase (DBH) Activity ..... Weinshilboum R, Axelrod J: Serum dopamine-^-hydroxylase: Decrease after chemical sympathectomy. ...
www.psychosomaticmedicine.org/cgi/reprint/36/4/298.pdf

dopamine-ß -hydroxylase activity in the sympathetic ganglia is blocked by surgical decentralization

PNAS | June 15, 1970 | vol. 66 | no. 2 | 453-458
Copyright © 1970 by the National Academy of Sciences

Neurally Mediated Increase in Dopamine-ß -hydroxylase Activity

Perry B. Molinoff, Steven Brimijoin, Richard Weinshilboum, and Julius Axelrod

The development of a sensitive and specific enzymatic assay for dopamine-ß -hydroxylase has enabled us to measure the activity of this enzyme in several tissues where it has not previously been measured. The administration of reserpine leads to an increase in dopamine-ß -hydroxylase activity in the rat adrenal, heart, salivary gland, and in sympathetic ganglia. The increase in the heart is preceded by a small but significant fall. We have confirmed the increase in tyrosine hydroxylase which follows the administration of reserpine and have found that the activity of phenylethanolamine-N-methyltransferase also increases after administration of this drug. The activities of two enzymes not involved in the synthesis of catecholamines, monoamine oxidase and lactate dehydrogenase, are not affected by reserpine treatment. The rise of dopamine-ß -hydroxylase activity in the sympathetic ganglia is blocked by surgical decentralization.

chemical sympathectomy with 6-hydroxy-dopamine reproduces many of the ocular phenomena of surgical sympathectomy

Anterior Segment Chemical Sympathectomy by 6-Hydroxy-Dopamine

I. Effect on Intraocular Pressure and Facility of Outflow

MONTE G. HOLLAND 1 and JAMES L. MINIS III 1

1 Department of Ophthalmology, Tulane University School of Medicine, New Orleans, La.

Histofluorometric techniques have confirmed that topical ocular application of 6-hydroxydopamine, a norepinephrine congener, causes a selective and reversible destruction of sympathetic nerve terminals in the anterior segment. An investigation of the effects of "chemical sympathectomy" on the pupil, intraocular pressure, and facility of outflow showed: the pupil underwent a sequence of changes characteristic of surgical sympathetic denervation, but with a different time course; the intraocular pressure .was significantly lowered, transiently in rabbits and of longer duration in monkeys; the facility of outflow was transiently increased in monkeys and probably in rabbits; the episcleral venous pressure was unchanged in both species. It was concluded that the lowered intraocular pressure and lowered outflow pressure were the result of a reduction of aqueous inflow. There was no unequivocal experimental demonstration of supersensitization to topical norepinephrine or isoproterenol following chemical sympathetic denervation; however, the experiments were not conclusive on this important point. It was concluded that chemical sympathectomy with 6-hydroxy-dopamine reproduces many of the ocular phenomena of surgical sympathectomy. 6-Hydroxy-dopamine is a useful drug for experimental ophthalmology, and may be useful clinically.

(Investigative Ophthalmology and Visual Science. 1971;10:120-143.)
© 1971 by The Association for Research in Vision and Ophthalmology, Inc.

Chemical sympathectomy disrupts the only known neural input to the pineal gland

  • The Pineal Gland: A Pacemaker within the Circadian System of the House Sparrow
  • Natille Headrick Zimmerman and Michael Menaker
  • Proceedings of the National Academy of Sciences of the United States of America, Vol. 76, No. 2 (Feb., 1979), pp. 999-1003 (article consists of 5 pages)
Chemical sympathectomy disrupts the only known neural input to the pineal gland.

Pacemaker after T2 Sympathectomy

Bradycardia and Permanent Pacing After Bilateral Thoracoscopic T2-Sympathectomy for Primary Hyperhidrosis

  • CHAO-LUN LAI,
  • WEN-JONE CHEN,
  • YEN-BIN LIU, and
  • YUAN-TEH LEE
  • Department of Emergency Medicine, Taipei, Taiwan, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
A 23-year-old woman with craniofacial hyperhidrosis underwent bilateral thoracoscopic T2-sympathectomy. Marked sinus bradycardia with a mean heart rate of 49 beats/min by Holter ECG monitoring occurred after the procedure and persisted for > 2 years. Normal sinus node function was found by an invasive electrophysiological study and unopposed vagotonia after sympathectomy was diagnosed. A permanent pacemaker was implanted. Although reduced heart rate is a common phenomenon after bilateral dorsal sympathectomy, intractable bradycardia with permanent pacing is rare. This patient demonstrates one of the potential cardiac complications of bilateral sympathectomy.

Pacing and Clinical Electrophysiology

Volume 24 Issue 4 Page 524-525, April 2001

Can Sympathectomy for Hyperhidrosis be classified as "cure" of hyperhidrosis

Sympathectomy in the case of (for example) Palmar HH exchanges a benign (although understandably uncomfortable condition) for an often disabling, uncontrollable (and more distressing than the original condition) full body sweating, that in some cases requires full clothes change 3 times a day. Patients after the surgery are unable to continue their life as they lived it before the operation. The psychological costs are high, and there have been reported suicides among patients who were struggling with the side-effects. The most recent one in Sydney, Australia.
Which part of this surgery can be called 'treatment' or 'cure'? What is the definition of a 'cure''?

Literature - summary

Wettervik C, Claes G, Drott C, Emanuelsson H, Lomsky M, Rådberg G et al. Endoscopic transthoracic sympathectomy for severe angina. Lancet 1995; 345: 97 - 8.
3.

Matsumoto Y, Ueyama T, Endo M, Sasaki H, Kasashima F, Abe Y et al. Endoscopic thoracic sympathectomy for Raynaud’s phenomenon. J Vasc Surg 2002; 36: 57 - 61.
4.Flørenes T. Torakoskopisk sympatektomi - operasjon for håndsvette og ansiktsrødming Tidsskr Nor Lægeforen 2003; 123: 463 - 4.
5.
Drott C, Claes G, Rex L, Dalman P, Gothberg G, Fahlen T. Långtidsresultat efter operation mot handsvett och ansiktsrodnad. Patienterna nöyda trots besvärande biverkningar. Läkartidningen 2001; 98: 1766 - 72.
6.
Telaranta T. Reversal surgery for reducing the side effects of ETS. (SIC!) A case report. Ann Chir Gynaecol 2001; 90: 175 - 6.
7.
Furlan AD, Mailis A, Papagapiou M. Are we paying a high price for surgical sympathectomy? A systematic literature review of late complications. J Pain 2000; 1: 245 - 57.
8.
Abraham P, Picquet J, Bickert S, Papon X, Jousset Y, Saumet J et al. Infra-stellate upper thoracic sympathectomy results in a relative bradychardia during exercise, irrespective of the operated side. Eur J Cardiothorac Surg 2001; 20: 1095 - 100.
9.
DRUMMOND PD. A caution about surgical treatment for facial blushing. Br J Dermatol 2000; 142: 194 - 5.

Sympathectomy induces adrenergic excitability of cutaneous

Bossut DF, Shea VK, Perl ER.
Sympathectomy induces adrenergic excitability of cutaneous
C-fiber nociceptors.
J Neurophysiol 1996;75:514-7.

Degeneration patterns of postganglionic fibers following sympathectomy.

Andres KH, Düring M von, Jänig W, Schmidt RF (1985)
Degeneration patterns of postganglionic fibers following sympathectomy.
Anat Embryol 172:133-143

Denervation Supersensitivity

Neurology 2003;60:1770-1776
© 2003 American Academy of Neurology

Differential effects of surgical sympathetic block on sudomotor and vasoconstrictor function

C. H. Schick, MD, K. Fronek, A. Held, F. Birklein, MD, W. Hohenberger, MD and M. Schmelz, MD
Before surgery, rewarming kinetics was significantly slower in the patients (n = 61) than in the healthy control subjects (n = 28). Two days after the block, baseline skin temperature increased by about 5 °C, and rewarming was massively accelerated in each of the patients. Three months postoperatively, rewarming kinetics was still accelerated in 36 hands, was unchanged from the preoperative condition in 42, and had worsened in 12. These changes were accompanied by parallel alterations of laser–Doppler flux.

Recurrent and enhanced vasoconstrictor function 3 months following endoscopic sympathetic block has major implications for its use to treat enhanced vasoconstriction.

Predicting changes in the distribution of sweating following thoracoscopic sympathectomy

Predicting changes in the distribution of sweating following thoracoscopic sympathectomy

Authors: ANDREWS B.T.1; RENNIE J.A.1, *

Source: British Journal of Surgery, Volume 84, Number 12, December 1997 , pp. 1702-1704(3)

Publisher: John Wiley & Sons, Ltd.

Abstract:

Background Compensatory sweating is a common symptom following thoracic sympathectomy; however, the reported incidence of this complication varies greatly, and its severity has not been quantified.

Methods In this study changes in the distribution of sweating following bilateral T2-3 thoracoscopic sympathectomy for hyperhidrosis were assessed in 42 patients. Sweat production in the palms, axillae, face, trunk and feet was assessed using a linear analogue scale.

Results The operation was most successful in reducing sweat production in the palms, axillae and face (in descending order). The operation also reduced pedal sweat production in 12 of the 29 patients who suffered concomitant pedal hyperhidrosis. Compensatory truncal sweating occurred in 36 of the 42 patients; it was severe in ten, moderate in 16 and minimal in ten.

Conclusion Patients should be warned about compensatory sweating before thoracic sympathectomy.

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