Distribution of GABA-immunoreactive nerve fibers and cells in the cervical and thoracic paravertebral sympathetic trunk

These data suggest that the GABAergic innervation of paravertebral sympathetic ganglia is more complex than previously suspected. What appears as preganglionic afferents from several spinal segments (C8-Th7) innervate GABAergic neurons in the sympathetic trunk which have ascending axons and focus their inhibitory effects on the cervical sympathetic ganglia, predominantly the SCG. These data suggest that GABAergic small interganglionic neurons form a feed-forward inhibition system, which may be driven by multisegmental spinal input in the paravertebral sympathetic ganglion chain.
http://onlinelibrary.wiley.com/doi/10.1002/cne.903340209/abstract

So numerous are the possible variations that the outcome of a sympathectomy is unpredictable

The sympathetic pathways to the heart are extremely variable in their topography, and the diversity of arrangements encountered accounts for the morphological contradictions in the literature. So numerous are the possible variations that the outcome of a sympathectomy is unpredictable. Where denervation is incomplete, collateral sprouting and regeneration of nerves could even lead to hyperstimulation via the sympathetic pathways.
http://onlinelibrary.wiley.com/doi/10.1002/aja.1001240203/abstract

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration

In consequence of right-sided smpathectomy at the level of C₅ it was found that in the sheep the cervical sympathetic trunk contains nerve fibres which proceed from cells situated in the first four segments of the thoracic part of the spinal cord and in the stellate ganglion. These fibres are about 85 per cent of all fibres of the sympathetic trunk. The remaining 15 per cent proceed from nerve cells situated nasally of the anterior cervical ganglion.

The spinal cord. Changes found in the segment Th1 – Th4 in sheep III and IV closely resembled those
seen in the stellate ganglion (Figures 6, 7).

2. After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within
a year.

3. After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion
undergo transneuronic degeneration.
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

sympathectomy created imbalance of autonomic activity and functional changes of the intrathoracic organs

Surgical thoracic sympathectomy such as ESD (endoscopic thoracic sympathectic denervation) or heart transplantation can result in an imbalance between the sympathetic and parasympathetic activities and result in functional changes in the intrathoracic organs.
Therefore, the procedures affecting sympathetic nerve functions, such as epidural anesthesia, ESD, and heart transplantation, may cause an imbalance between sympathetic and parasympathetic activities (1, 6, 16, 17). Recently, it has been reported that ESD results in functional changes of the intrathoracic organs.


In conclusion, our study demonstrated that ESD adversely affected lung function early after surgery and the BHR was affected by an imbalance of autonomic activity created by bilateral ESD in patients with primary focal hyperhidrosis.
Journal of Asthma, 46:276–279, 2009
http://informahealthcare.com/doi/abs/10.1080/02770900802660949

important relationship among cognitive performance, HRV, and prefrontal neural function

These findings in total suggest an important relationship among cognitive performance, HRV, and prefrontal neural function that has important implications for both physical and mental health. Future studies are needed to determine exactly which executive functions are associated with individual differences in HRV in a wider range of situations and populations.
http://www.ncbi.nlm.nih.gov/pubmed/19424767

Low HRV is a risk factor for pathophysiology and psychopathology

The intimate connection between the brain and the heart was enunciated by Claude Bernard over 150 years ago. In our neurovisceral integration model we have tried to build on this pioneering work. In the present paper we further elaborate our model. Specifically we review recent neuroanatomical studies that implicate inhibitory GABAergic pathways from the prefrontal cortex to the amygdala and additional inhibitory pathways between the amygdala and the sympathetic and parasympathetic medullary output neurons that modulate heart rate and thus heart rate variability. We propose that the default response to uncertainty is the threat response and may be related to the well known negativity bias. We next review the evidence on the role of vagally mediated heart rate variability (HRV) in the regulation of physiological, affective, and cognitive processes. Low HRV is a risk factor for pathophysiology and psychopathology. Finally we review recent work on the genetics of HRV and suggest that low HRV may be an endophenotype for a broad range of dysfunctions.
http://www.ncbi.nlm.nih.gov/pubmed/18771686

Fundamentals of psychoneuroimmunology

The long-held concept that the nervous, endocrine and immune systems are separate entities has given way to a new understanding of human biology. Psychoneuroimmunology addresses the realisation that the neural, immune, and endocrine systems are inextricably linked and that the effects of each affect all-the systems work together as a complicated set of triggers and balances, an intertwining of the physiological and emotional states. Beginning with the fundamentals of immune and neuroendocrine function, Fundamentals of Psychoneuroimmunology explores the complexities of behavioural assessment, the basic types of immunity, the importance of immune cell redistribution in the response to challenges such as infection and stress, and the multifaceted roles of nerves, hormones and cytokines.
http://books.google.com/books/about/Fundamentals_of_psychoneuroimmunology.html?id=h0mEge8Oec8C

Limbic-cortical dysregulation: a proposed model of depression

cognition and reward processing

Recent functional magnetic resonance imaging (fMRI) investigations of the interaction between cognition and reward processing have found that the lateral prefrontal cortex (PFC) areas are preferentially activated to both increasing cognitive demand and reward level. Conversely, ventromedial PFC (VMPFC) areas show decreased activation to the same conditions, indicating a possible reciprocal relationship between cognitive and emotional processing regions. We report an fMRI study of a rewarded working memory task, in which we further explore how the relationship between reward and cognitive processing is mediated. We not only assess the integrity of reciprocal neural connections between the lateral PFC and VMPFC brain regions in different experimental contexts but also test whether additional cortical and subcortical regions influence this relationship. Psychophysiological interaction analyses were used as a measure of functional connectivity in order to characterize the influence of both cognitive and motivational variables on connectivity between the lateral PFC and the VMPFC.

These findings provide evidence for a dynamic interplay between lateral PFC and VMPFC regions and are consistent with an emotional gating role for the VMPFC during cognitively demanding tasks. Our findings also support neuropsychological theories of mood disorders, which have long emphasized a dysfunctional relationship between emotion/motivational and cognitive processes in depression.
http://dl.acm.org/citation.cfm?id=1480468

depression that may occur as part of stress system dysfunction

Stress precipitates depression and alters its natural history. Major depression and the stress response share similar phenomena, mediators and circuitries. Thus, many of the features of major depression potentially reflect dysregulations of the stress response. The stress response itself consists of alterations in levels of anxiety, a loss of cognitive and affective flexibility, activation of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system, and inhibition of vegetative processes that are likely to impede survival during a life-threatening situation (eg sleep, sexual activity, and endocrine programs for growth and reproduction).
http://www.nature.com/mp/journal/v7/n3/full/4001032a.html

Limbic-cortical dysregulation: a proposed model of depression

A working model of depression implicating failure of the coordinated interactions of a distributed network of limbic-cortical pathways is proposed. Resting state patterns of regional glucose metabolism in idiopathic depressed patients, changes in metabolism with antidepressant treatment, and blood flow changes with induced sadness in healthy subjects were used to test and refine this hypothesis. Dorsal neocortical decreases and ventral paralimbic increases characterize both healthy sadness and depressive illness; concurrent inhibition of overactive paralimbic regions and normalization of hypofunctioning dorsal cortical sites characterize disease remission. Normal functioning of the rostral anterior cingulate, with its direct connections to these dorsal and ventral areas, is postulated to be additionally required for the observed reciprocal compensatory changes, since pretreatment metabolism in this region uniquely predicts antidepressant treatment response. This model is offered as an adaptable framework to facilitate continued integration of clinical imaging findings with complementary neuroanatomical, neurochemical, and electrophysiological studies in the investigation of the pathogenesis of affective disorders.
http://neuro.psychiatryonline.org/cgi/content/short/9/3/471

ELECTRICAL STIMULATION OF THE SYMPATHETIC NERVE CHAIN

The present invention provides a method of affecting physiological disorders by stimulating a specific location along the sympathetic nerve chain. Preferably, the present invention provides a method of affecting a variety of physiological disorders or pathological conditions by placing an electrode adjacent to or in communication with at least one ganglion along the sympathetic nerve chain and stimulating the at least one ganglion until the physiological disorder or pathological condition has been affected.

[0009] A number of treatment regiments utilizing electrical stimulation can be employed for a vast array of physiological disorders or pathological conditions associated with the sympathetic and parasympathetic nervous system. Physiological disorders that may be treated include, but are not limited to, hyperhydrosis, complex regional pain syndrome and other pain syndromes such as headaches, cluster headaches, abnormal cardiac sympathetic output, cardiac contractility, excessive blushing condition, hypertension, renal disease, heart failure, angina, hypertension, and intestinal motility disorders, dry eye or mouth disorders, sexual dysfunction, asthma, liver disorders, pancreas disorders, and heart disorders, pulmonary disorders, gastrointestinal disorders, and biliary disorders. The number of disorders to be treated is limited only by the number, variety, and placement of electrodes (or combinations of multiple electrodes) along the sympathetic nervous system.

http://www.faqs.org/patents/app/20110098762

Sympathectomy should not be considered for such persons because of the risk of permanent worsening of erythromelalgia symptoms

The literature contains reports of remission with sympathectomy, but careful case selection is imperative before this procedure is performed.  Sympathectomy should be considered only for those whose erythromelalgia improves with blocks.  Conversely, if a sympathetic block causes worsening of a person's erythromelalgia, treatment should be discontinued.  Sympathectomy should not be considered for such persons because of the risk of permanent worsening of erythromelalgia symptoms.
Jay S. Cohen MD,
medicationsense.com/articles/2010/erythromelalgia0510.pdf

changes in the intracranial vascular bed due to the leakage and disappearance of the noradrenaline transmitter from the degenerating nerve terminals followed by denervation supersensitivity

The intracranial pressure, measured as the ventricular fluid pressure (VFP), was recorded continuously during about 2 days via a cannula inserted into the left lateral ventricle of the brain of conscious rabbits. The effect of bilateral removal of the superior cervical ganglia on the VFP was studied at various time-periods after operation, and the results were compared with those from unoperated control animals. The pressure changes attributed to the sympathectomy are referred to as the net VFP. The operation ultimately caused a disappearance of noradrenaline from intracranial sympathetic nerves. The net VFP was not affected during an 8-hr period of the recording starting 5–8 hrs after sympathectomy. During the following 35 hrs it was reduced by approximately 25 mm physiological saline followed by a return to initial or somewhat higher levels. Four days after sympathectomy the net VFP was significantly increased throughout the recording period. Two weeks after the operation the pressure had returned to the same, or even lower level compared with the non-sympathectomized control animals. The variations in the net VFP at different time-periods after sympathectomy are considered to reflect mainly changes in the intracranial vascular bed due to the leakage and disappearance of the noradrenaline transmitter from the degenerating nerve terminals followed by denervation supersensitivity. The results are discussed in terms of a sympathetic influence on the intracranial pressure mediated through the volume of the intracranial vascular bed, and/or the cerebrospinal fluid production in the choroid plexuses.
http://onlinelibrary.wiley.com/doi/10.1111/j.1748-1716.1971.tb05049.x/abstract

Endoscopic sympathetic block--new treatment of choice for social phobia?

Ann Chir Gynaecol. 2001 ;90 (3):177-84  11695789  Cit:3

Central neural integration for he control of auonomic responses associated with emotion

http://www.ncbi.nlm.nih.gov/pubmed/6370083
http://www.google.com.au/search?q=neural+integration+for+the+control+of+autonomic+responses+associated+with+emotion&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a

ganglion block for unbalanced sympathetic nervous system disorders

Stellate ganglion blocks (SGB) are widely used for pain relief in outpatient clinics due to its many therapeutic indications and easy maneuvering. It is used locally over stellate ganglion territory disorders in the craniocervical (head and neck) or upper limbs and systemically for angina pectoris, psychosomatic disorders, hormonal disorders, or unbalanced sympathetic nervous system disorders [1].
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872892/

Presentations at the 4th International Symposium on Sympathetic Surgery

http://www.angelfire.com/ab/ets/201.htm#_Hlt521158972

Bilateral cervical vagotomy

Bilateral cervical vagotomy was followed by prolonged changes in heart rate, blood pressure, and respiration, and a progressive deterioration of cardiac function. This study was based on recordings from 18 unanesthetized, unrestrained, reclining dogs prior to and after gastroenterostomy, arterial catheterization, and bilateral cervical vagotomy. During the first 7 days after denervation, the heart rate was almost doubled and the pulse pressure was decreased. The diastolic pressure was increased only on the first day, whereas on the second day after denervation the systolic pressure became significantly lower. The markedly elevated heart rate was maintained for 3 weeks. There was a complete loss of inspiratory tachycardia for 20 weeks, a prolonged inspiratory period for 2 weeks, and a high incidence of retching and vomiting for over 43 weeks. Although the animals refused to exercise strenuously, they were fully ambulatory and showed normal interest in their surroundings. Death in 13 cases occurred by the second week postvagotomy and was associated with lung congestion or consolidation, and in two cases the liver had a nutmeg appearance.
http://ajplegacy.physiology.org/content/206/2/265.abstract

sympathectomy can result in spinal cord infarction

Uncommon causes include decompression sickness, which has a predilection for spinal ischemic damage; complications of abdominal surgery, particularly sympathectomy;...

http://www.neurology-asia.com/Spinal_Cord_Infarction.php

For blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy...

Norepinephrine (Levophed ®) -
For blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions).
http://www.globalrph.com/norepinephrine_dilution.htm

Unilateral sympathectomy leads to decreases in ventral prostate weight

http://www.biolreprod.org/content/51/1/99

Sympathectomy decreased NE and DA concentrations of muscles to approximately 10% of control values

We studied the effect of unilateral sympathectomy on rat quadriceps and gastrocnemius muscle concentrations of endogenous dihydroxyphenylalanine (DOPA), dopamine (DA), and norepinephrine (NE) and assessed the relationships between these catecholamines in several rat tissues. Catecholamines were measured by reverse-phase high-performance liquid chromatography with electrochemical detection. Sympathectomy decreased NE and DA concentrations of muscles to approximately 10% of control values, whereas the DOPA concentration tended to increase. Relatively high concentrations of DOPA were found in the gastrointestinal tract, kidney, and spleen. No correlations were obtained between the tissue concentration of DOPA and NE. A DA-to-NE ratio approximately 1% was observed in liver, muscle, pancreas, spleen, and heart, whereas we found exponentially increasing DA values with increasing NE concentration in tissues obtained from stomach, small and large intestine, kidney, and lung. In conclusion, endogenous DOPA in muscle tissue is not located in sympathetic nerve terminals but probably in muscle cells. DA concentrations in the gastrointestinal tract and in the kidneys were greater than could be ascribed to its role as a precursor in the biosynthesis of NE.
http://ajpendo.physiology.org/content/256/2/E284.abstract

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.
After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration.


The spinal cord. Changes found in the segment Th1 – Th4 in sheep III and IV closely resembled those
seen in the stellate ganglion (Figures 6, 7). Changes in sheep I and II were the same as described in the
previous paper (5).
The nervus caroticus internus. In all the sheep a myelinated fasciculus was found in this nerve
(Figure 8), which proves that the nervus caroticus internus contains a fasciculus of fibres which run
from the front to the rear in the anterior sympathetic trunk (5).
www.date.hu/acta-agraria/2002-08i/welento.pdf

painful vasospastic condition in the right arm following surgical sympathectomy on the left side

Spinal dorsal column stimulation has been used in the treatment of a patient with a painful vasospastic condition in the right arm following surgical sympathectomy on the left side. After sympathectomy the left arm became constantly dry and warm and consistently lacked skin vasomotor (laser Doppler flowmetry) responses to arousing stimuli, indicating a complete loss of sympathetic vasomotor innervation.
http://www.springerlink.com/content/n823388l26q330m3/