Effect of adrenalectomy or sympathectomy on spinal cord blood flow

We conclude that adrenalectomy near-totally ablates the hypothermia-associated increase in RSCBF (regional spinal cord blood flow) measured in intact rats and that abdominal sympathectomy totally ablates it. This evidence complements morphological evidence for adrenergic innervation of the spinal cord vasculature.

Heart and Circulatory Physiology, Vol 260, Issue 3 827-H831, Copyright © 1991 by American Physiological Society

A. Iwai, W. W. Monafo and S. G. Eliasson
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.

http://ajpheart.physiology.org/cgi/content/abstract/260/3/H827

Morphofunctional changes in the myocardium following sympathectomy

Vestn Akad Med Nauk SSSR. 1984;(2):80-5.
Related Articles, Links

[Morphofunctional changes in the myocardium following sympathectomy and their role in the development of sudden death from ventricular fibrillation]

[Article in Russian]

Beskrovnova NN, Makarychev VA, Kiseleva ZM, Legon'kaia , Zhuchkova NI.

Publication Types:

* English Abstract

Postoperative complications are frequent after sympathectomy

[Postoperative complications are frequent after surgery for palmar sweating and facial redness. Effects of the treatment must be considered with regard to the risk of side-effects]
[My paper] L Räf

Lakartidningen. 2001 Apr 11;98 (15):1764-5 11374001 (P,S,E,B)

inhalation of carbon dioxide

Minerva Med. 1958 Feb 14;49(13):514-6.Links
[Behavior of liquoral pressure after inhalation of carbon dioxide, as evaluative test of cerebral circulation with particular regard to treatment by sympathetic block in focal vascular cerebropathies.]
[Article in Italian]

POLETTI T, CAMERON-CURRY V, SGARBI M.

PMID: 13516803 [PubMed - OLDMEDLINE]

Cerebral accidents of vascular origin and cervical sympathectomy

Progr Med (Paris). 1955 Feb 10;83(3):43-7.Links
[Cerebral accidents of vascular origin and cervical sympathectomy.]
[Article in French]

CHAVANY JA, DJINDJIAN R, HAGEN-MULLER D.

Role of sympathectomy in the treatment of cerebrovascular occlusion

J Albert Einstein Med Cent (Phila). 1960 Jan;8:31-8.Links
Role of sympathectomy in the treatment of cerebrovascular occlusion.
SHENKIN HA, FINNESON BE.

Resection of the cervical sympathetic nerve in cerebrovascular diseases

Progr Med (Napoli). 1957 May 31;13(10):289-94.Links
[Resection of the cervical sympathetic nerve in cerebrovascular diseases.]
[Article in Italian]

POLETTI T, SGARBI M, CAMERON-CURRY

http://www.ncbi.nlm.nih.gov/pubmed/13453570?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedarticles&logdbfrom=pubmed

Acceptance by the medical community is not a substitute for rigorous testing

http://www.healthyplace.com/Communities/Depression/ect/news/newyork/krausstest.asp

A large proportion of psychiatrists claims ECT to be SAFE and EFFECTIVE. This is not the only parallel you can find between surgeons talking about ETS and psychiatrists talking about ECT.

TESTIMONY OF JOHN M. FRIEDBERG, M.D., NEUROLOGIST, BEFORE THE MENTAL HEALTH COMMITTEE OF THE NEW YORK STATE ASSEMBLY

MARTIN LUSTER PRESIDING

NYC, May 18, 2001

http://www.healthyplace.com/Communities/Depression/ect/news/newyork/friedbergtest.asp

From the ETS Discussion Forum

ETS surgeons should be measuring heart function, bronco-motor tone, thermoregulation, blood vessel constriction, and thyroid. They should be doing bone scans and exercise tests. They should measure changes in catecholomine levels. At least they should measure sweating. All of this is affected by ETS, and they simply dont want to know. Sorry, but the vast majority of ETS papers are not science. Dr. Goldstein at NIH is doing some good work, and showing some very disturbing results. All in all, ETS is still highly experimental, under-studied, and patients should be warned accordingly.

http://etsandreversals.yuku.com/reply/1861#reply-1861

Cervical sympathectomy in the treatment of cerebral vascular disorders

Lahey Clin Bull. 1953 Jul;8(5):142-8.Links
Cervical sympathectomy in the treatment of cerebral vascular disorders.
POPPEN JL, FAGER CA Jr.

PMID: 13070547 [PubMed - indexed for MEDLINE]

sympathectomy for palmar hyperhidrosis: effects on pulmonary function

In order to investigate the effect of sympathectomy, pulmonary function was compared before and four weeks after operation in 20 patients. Forced vital capacity (FVC) (-2.3%), forced expiratory volume in one second (FEV1) (-6.1%), and FEV1/FVC (-4.6%) were all slightly but significantly decreased four weeks after thoracoscopic sympathectomy. Also the instantaneous forced expiratory flow at 75%, 50% and 25% of the FVC (V_max 25, V_max 50, V_max75) in flow-volume curves were decreased (-1.6%, 8.4%, and -20% respectively). Therefore, thoracoscopic sympathectomy minimises pulmonary restrictive effects but allows subclinical small airway obstructive effects to become more evident.

TSENG Ming-Yuan ⁽¹⁾ ; TSENG Jen-Ho ⁽¹⁾ ;
⁽¹⁾ Division of Neurosurgery, Department of Surgery, Medical School and Hospital, National Taiwan University, 7 Chung-Shan South Road, Taipei, TAIWAN, PROVINCE DE CHINE
Journal of clinical neuroscience ISSN 0967-5868
2001, vol. 8, n^o6, pp. 539-541 (29 ref.)

Cerebral infarction due to carotid occlusion and carbon monoxide exposure. II. Influence of preganglionic cervical sympathectomy.

J Igloffstein and R Laas
J Neurol Neurosurg Psychiatry. 1983 August; 46(8): 768–773.

Unilateral cerebral infarcts were produced in the rat by ligation of one common carotid artery and subsequent exposure to carbon monoxide. The incidence and extension of brain infarcts was increased in animals with additional ipsilateral cervical preganglionic sympathectomy. Sympathectomy did not affect markedly the respiration and systemic circulation. The effect of sympathectomy was attributed to a cutaneous vasodilation, leading to an extracranial steal phenomenon.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1027532

Elevated levels of TH in major depression and after sympathectomy

Zhu MY, Klimek V, Dilley GE, Haycock JW, Stockmeier C, Overholser JC, Meltzer HY, Ordway GA.
Elevated levels of tyrosine hydroxylase in the locus coeruleus in major depression.
Biol Psychiatry. 1999 Nov 1;46(9):1275-86.

CONCLUSIONS: Elevated expression of TH in the LC in major depression implies a premortem overactivity of these neurons, or a deficiency of the cognate transmitter, norepinephrine."

Adrenal Tyrosine Hydroxylase: Compensatory Increase in Activity after Chemical Sympathectomy

Robert A. Mueller ¹, Hans Thoenen ¹, and Julius Axelrod ¹

¹ Laboratory of Clinical Science, National Institute of Mental Health, Bethesda, Maryland 20014

Destruction of peripheral sympathetic nerve endings with 6-hydroxydopamine causes a disappearance of cardiac tyrosine hydroxylase, accompanied by a twofold increase in adrenal tyrosine hydroxylase and a small increase in phenyl-ethanolanine-N-methyl transferase.

Sympathectomy resulted in reduced antibody responses to T-dependent antigens

It has been exhaustively demonstrated that the regions in which lymphocytes T cells reside, and through which they recirculate, receive direct sympathetic neural input. Therefore, the immune system can be considered “hard-wired” to the brain. Chemical sympathectomy of adult mice resulted in reduced antibody responses to T-dependent antigens.

VOL. 31, NOS. 5 & 6, 2000 JOURNAL OF MEDICINE

JOURNAL OF MEDICINE, 2000

ENHANCEMENT OF NORADRENERGIC NEURAL TRANSMISSION: AN EFFECTIVE THERAPY OF

MYASTHENIA GRAVIS
Fuad. Lechin^1,2, Bertha van der Dijs^1,2, Betty Pardey-Maldonado¹,

Eduardo Jahn¹, Vladimir Jimenez¹, Beatriz Orozco¹,Scarlet Baez² and Marcel E. Lechin³

The abrupt increase and decrease in BP observed at the time when the lighting conditions are changed are eliminated by chemical sympathectomy

The disruption of the baroreflex selectively eliminates the circadian rhythm of BP, and the circadian rhythms of BP and HR are modulated by the autonomic nervous system in rats. The circadian rhythms of BP and HR are regulated by different mechanisms involving the autonomic nervous system.

Chemical sympathectomy with guanethidine may activate the influence of the parasympathetic
nervous system on the heart. The possible reasons for the decrease of MBP during the dark period seem to be the elimination of the sympathetic nervous system or the activation of the
parasympathetic nervous system, or both. Because the SBP and PP in sympathectomized rats during the dark period were suppressed, the decrease of stroke volume, which is reflected in SBP or PP, may be responsible for the decrease of MBP during the dark period. It seems definitive,
therefore, that the autonomic nervous system, particularly the sympathetic nervous system, is
important for the manifestation of 24-hour rhythms of BP and HR in rats.

The daily variations in MBP in intact rats, in which an abrupt rise was seen when the light was
turned off and a sharp fall in MBP was seen when the light was turned on, were not observed in sympathectomized rats. These results suggest that a change in autonomic nervous tone, the majority being the sympathetic nervous tone, is required for the abrupt changes in BP at the time when the lighting is altered. In humans, BP often rises abruptly around the time of awakening.1 If this early morning surge in BP were due to the same mechanisms as in rats, a change in autonomic nervous tone would be important for the formation of this morning surge in humans. In fact, -sympathetic vasoconstrictor activity is reportedly related to this early morning surge.
Furthermore, the autonomic nervous system may play some role in the high correlation between the HR and locomotor activity, because the slope of the regression line was decreased in sympathectomized rats. The correlation between the MBP (mean blood pressure) and locomotor activity was disrupted by both SAD and chemical sympathectomy.

The abrupt increase and decrease in BP observed at the time when the lighting conditions are changed are eliminated by chemical sympathectomy.

(Circulation. 1997;96:1667-1674.)
© 1997 American Heart Association, Inc.
Mitsutaka Makino, MD; Hiroshi Hayashi, MD;
Hiroto Takezawa, MD; Makoto Hirai, MD;
Hidehiko Saito, MD; ; Shizufumi Ebihara, PhD

Hemodynamic changes after sympathectomy and the number od sympathetic segments operated

After ETS, heart rate, systolic, diastolic, and mean blood pressures, rate-pressure product, and NOR decreased,whereas left ventricular end-systolic volume index, cardiac index, and ejection fraction did not change in the 2 groups.Among percent changes in all hemodynamic parameters and NOR occurring after ETS, only the percent decrease in systolic blood pressure in group Th2–4 was larger than that in group Th2–3 (–15 ± 12 % vs.–4±8%, respectively, p <>

Yukio Nakamura¹, Shin-ichiro Muramoto¹, Rira Kato¹, Takahiro Saeki¹, Manabu Fujimoto¹, Hiroshi Kida¹ and Yasushi Matsumoto²

(1)	Dept. of Cardiology, Kanazawa National Hospital, 1-1 Shimoishibiki-machi, Kanazawa, Ishikawa, 920–8650, Japan

(2)	Dept. of Cardiovascular Surgery, Kanazawa National Hospital, Kanazawa, Ishikawa, Japan

Sympathectomy as a treatment for Social Phobia

Pohjavaara P, Telaranta T, Väisänen E.

Tampere City Mental Health Care Centre, Finland. paipoh@koti.soon.fi

Social phobia is a neglected disorder, which can cause very debilitating consequences in patients' lives. The patients tend to isolate and suffer from comorbid disorders such as depression, other anxiety disorders, and drug and alcohol abuse. Traditional treatment methods such as medication and psychotherapy do not help everyone. A prospective, uncontrolled follow-up study with 169 social phobic patients was performed by uni- or bilateral endoscopic sympathetic block of the upper thoracic ganglia.

Endoscopic sympathetic block is recommended as the treatment of choice in severe, conservative therapy resistant social phobia.
Ann Chir Gynaecol. 2001;90(3):177-84.

Psychoneurological applications of endoscopic sympathetic blocks

Telaranta T.

University of Oulu, Oulu, Finland. timo.telaranta@privatix.fi

In addition to more widely and longer known indications of ETS, various neurological disorders and psychologically stressful situations in their worst expressions might be alleviated by the reversible ESB procedure. The patients with social phobia, especially those who have also blushing and/or stage fright type of heart racing, benefit from the ESB. The disturbances of the sympathetic nervous system, e. g. in Parkinson's disease and multiple system atrophy might be alleviated with sympathetic block, especially the extrapyramidal symptoms in these diseases. In migraine, sympathetic surgery has been noted to give some help. The unilateral left-sided block has been effective in long QT-syndrome type arrhythmias. In schizophrenia, the phobic, paranoic or confusional reactions have been tentatively treated by the sympathetic block.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=14673667&dopt=AbstractPlus

Vasodilator response to mental stress absent after sympathectomy

The idea that there might be sympathetic vasodilator nerves to skeletal muscle is an old concept that fits with the archaic `fight or flight' model of the sympathetic nervous system. Clear evidence for vasodilator nerves to skeletal muscle began to emerge in animals during the 1930s, when stimulation of selected brainstem areas was shown to evoke hypertension, tachycardia and skeletal muscle vasodilation (i.e. the `defense reaction'). By the 1940s and 1950s this idea was well established and it was shown in animals that the sympathetic dilator nerves to muscles were cholinergic. During this time, circumstantial evidence began to suggest the existence of sympathetic cholinergic vasodilator fibres in human skeletal muscle. In this context, the well- known forearm vasodilator response to mental stress was shown to be atropine-sensitive, and absent after surgical sympathectomy.

Sympathetic vasodilation in human muscle

Authors: Joyner, M. J.¹; Dietz, N. M.¹

Source: Acta Physiologica, Volume 177, Number 3, March 2003 , pp. 329-336(8)

Publisher: Blackwell Publishing

Tyrosine hydroxylase, DOPA and catecholamines

Tyrosine hydroxylase (TH) mRNA and activity and concentrations of 3,4-dihydroxyphenylalanine (DOPA) and catecholamines were examined as markers of sympathetic innervation and catecholamine synthesis in peripheral tissues of sympathectomized and intact rats. Chemical sympathectomy with 6-hydroxydopamine (6-OHDA) markedly decreased norepinephrine and to a generally lesser extent TH activities and dopamine in most peripheral tissues (stomach, lung, testis, duodenum, pancreas, salivary gland, spleen, heart, kidney, thymus). Superior cervical ganglia, adrenals and descending aorta were unaffected and vas deferens showed a large 92% decrease in norepinephrine, but only a small 38% decrease in TH activity after 6-OHDA.
Differential Effects of Chemical Sympathectomy on Expression and Activity of Tyrosine Hydroxylase and Levels of Catecholamines and DOPA in Peripheral Tissues of Rats
Journal Neurochemical Research
Publisher Springer Netherlands Issue Volume 24, Number 1 / January, 1999

sympathectomy prevents them from responding to reflex or emotional changes in the central nervous system - psychosurgery

All the sympathetic ganglia that send postganglionic nerve fibres to structures in the head, neck and upper limb receive preganglionic fibres from the central nervous system only through the white rami communicates of the upper thoracic ventral rami. These preganglionic fibres ascend in the trunk and reach its ganglia directly and outlying ganglia through branches of the trunk. Thus destruction of the trunk at the root of the neck, whether as a result of a surgery (cervical sympathecotmy) or of some pathological condition, isolates all these sympathetic ganglion cells from the central nervous system and prevents them from responding to reflex or emotional changes in the central nervous system.
Cunningham's Manual of Practical Anatomy: Volume III: Head, Neck and Brain (Oxford Medical Publications)
G. J. Romanes
Paperback - Nov 20, 1986, page 87

Does bilateral thoracic sympathectomy predispose to reflex bronchospasm following tracheal intubation?

Patients with essential hyperhidrosis have sympathetic overactivity, associated with compensatory high parasympathetic tone. Sympathectomy results in a decrease of plasma norepinephrine,³ and parasympathetic predominance4 which may increase airway resistance.⁵ Intraoperative bronchospasm is usually cholinergically-mediated. Thus, patients with essential hyperhidrosis who have undergone bilateral thoracic sympathectomy, may be more liable to develop reflex bronchospasm under light levels of anesthesia.
Ahed Zeidan, MD^*, Nazih Nahle, MD^* and Anis Baraka, MD FRCA
Canadian Journal of Anesthesia 52:997-998 (2005)
© Canadian Anesthesiologists' Society, 2005

The severity and manifestations of the autonomic hyperreflexia are affected by the level of the sympathectomy

Autonomic Hyperreflexia is caused by noxious stimulation below the level of the lesion in a patient with a sympathectomy at or above T6.

...The efferent sympathetic fibers recover from the initial injury but remain unaffected by central inhibitory input from the brain stem and hypothalamus.
The severity and manifestations of autonomic hyperreflexia are affected by the level of the sympathectomy. With mid-thoracic lesions below the level of cardiac accelerator fibers, hypertension is accompanied by reflex bradycardia transmitted via cardiac accelerator fibers and the vagus. In patients whose sympathectomy is above the level of the thoracic cardiac accelerator fibers, tachycardia may occur because cardiac accelerator fibers become part of the efferent sympathetic activity rather than part of the central inhibitory input from the brain stem and hypothalamus. Arrythmias and occasional heart block may accompany changes in heart rate.
Clinical manifestations of autonomic hyperreflexia include vasodilation, decresed sympathetic activity, and increased vagal activity above the level of the lesion such as nasal congestion, flushing, headache, dyspnea, nausea, and visceral muscle contraction. Vasoconstriction and increased sympathetic activity below the level of the lesion cause vasoconstrictive pallor, sweating, piloerection, and somatic muscle fasciculation. Patients also develop hypertension with headache, blurred vision, myocardial infarction, andretinal, subarachnoid and cerebral hemorrhages that may lead to syncope, convulsion and death.
Handbook of Neuroanesthesia
page 343

By Philippa Newfield, James E. Cottrell

Contributor Philippa Newfield, Stephen Onesti, James E. Cottrell

Published 2006, Lippincott Williams & Wilkins

Results deteriorate progressively

Intermediate-term results of endoscopic transaxillary T2 sympathectomy for primary palmar hyperhidrosis. Chiou T S-M, Chen S-C. Br J Surg 1999; 86: 45-47.

It was concluded that the results of endoscopic sympathectomy deteriorated progressively from the immediate outcome and the compensatory hyperhidrosis was the principal reason for dissatisfaction.

It can diminish the body's physical reaction to exercise and/or strong emotion, and thus is considered psychiatric surgery

ETS can alter many bodily functions, including sweating, heart rate, heart stroke volume, blood pressure, thyroid, baroreflex, lung volume, pupil dilation, skin temperature, goose bumps and other aspects of the autonomic nervous system. It can diminish the body's physical reaction to exercise and/or strong emotion, and thus is considered psychiatric surgery. In rare cases sexual function or digestion may be modified as well.
©2006 LVHyperhidrosis.com
http://web.archive.org/web/20060706140821/www.lvhyperhidrosis.com/ets.html

Dr Nagy, Las Vegas

Electrical instability of the heart following desympathization

Arkh Patol. 1981;43(6):18-24.Links

Beskrovnova NN, Ul'ianinskiĭ LS, Makarychev VA, Vikhert AM.

The time course of ultrastructural and electrophysiological disorders and their role in sudden death of ventricular fibrillation at various intervals of desympathization caused by reserpine administration were studied. Early in the effect of reserpine (up to 30 min), glycogen granules were found to accumulate in the sarcoplasm of cardiomyocytes. At later intervals (1-24 hours), along with glycogen accumulation destructive lesions of organoids were observed in the form of myofibrillar recontraction, destruction of mitochondria, degeneration of sarcolemma. These changes are morphologic reflections of metabolic disorders developing in the myocardium under conditions of acute desympathization of the patient, and may be one of the causes of increased vulnerability of the heart in fibrillation.

Sympathectomy and avoidance learning

Di Giusto, E. L.; King, M. G.

Journal of Comparative and Physiological Psychology. 1972 Dec Vol 81(3) 491-500

Reports results of 5 experiments with male Wistar rats (N = 108). Depletion of peripheral sympathetic noradrenaline induced by administration of 6-hydroxydopamine, ip, led to significant decrements in escape and avoidance responding when the required response was difficult, but not when it was relatively easy to acquire. Results are similar to previous findings obtained with adrenal-demedullated Ss. Findings clarify the role of the sympathetic nervous system in the motivation of behavior elicited by aversive stimulation.
http://psycnet.apa.org/index.cfm?fa=main.doiLanding&uid=1973-08610-001

Morphofunctional changes in the myocardium following sympathectomy

Vestn Akad Med Nauk SSSR. 1984;(2):80-5.

Related Articles, Links

Morphofunctional changes in the myocardium following sympathectomy and their role in the development of sudden death from ventricular fibrillation

Beskrovnova NN, Makarychev VA, Kiseleva ZM, Legon'kaia , Zhuchkova NI.

http://www.ncbi.nlm.nih.gov/pubmed/6711115?dopt=Abstract

Cervical sympathectomy causes photoreceptor-specific cell death in the retina

Jena J. Steinle, Naarah L. Lindsay and Bethany L. Lashbrook

Department of Physiology, Southern Illinois University School of Medicine, Carbondale, IL 62901, United State, 2005.

The current study was designed to determine whether changes induced by sympathetic denervation causes significant loss of photoreceptors and increased glial cell reactivity in the retina. Sympathetic denervation was performed followed by immunohistochemistry, TUNEL staining, and protein expression analysis to investigate photoreceptor loss. There was a significant reduction (30%) in photoreceptor numbers in the sympathectomized eye. This loss was due to apoptosis, as there was over a doubling in apoptotic cell numbers after sympathectomy. This loss of photoreceptors in the sympathectomized eye resulted in a significantly reduced width of the outer nuclear layer of the retina when compared to the contralateral eye. Increased glial fibrillary acidic protein (GFAP) staining was also noted after sympathectomy in the ganglion cell layer with streaking toward the bipolar cell layer. These results suggest that loss of sympathetic innervation may cause significant changes to the physiology of the choroid.

sympathectomy enhances the severity of EAE

Regarding the modulation of autoimmunity, it was previously demonstrated that depletion of SNS transmitters by chemical sympathectomy enhances the severity of EAE (Experimental Autoimmune Encephalomyelitis.
Chelmicka-Schorr, E., M. Checincski, B. G. M. Arnason. 1988. Chemical sympathectomy augments the severity of experimental allergic encephalomyelitis. J. Neuroimmunol. 17:347.[Medline]
The Journal of Immunology, 2003, 171: 3451-3458. Copyright © 2003 by The American Association of Immunologists

Sammy Bedoui*, Sachiko Miyake*, Youwei Lin*, Katsuichi Miyamoto*,
Shinji Oki*, Noriyuki Kawamura*, Annette Beck-Sickinger ,
Stephan von Hörsten and Takashi Yamamura2,*

Loss of sensory innervation induces remarkable changes in the nerves that remain

The autonomic nervous system: Dysfunctions

Chemical denervation and selected ganglionectomy studies have shown that loss of sympathetic or sensory innervation induces remarkable changes in the nerves that remain...
Following chronic guanethidine sympathectomy there is complete depletion of sympathetic cotransmitters NA and NPY from the dura mater but an increase in the the expression of NPY in non-sympathetic axons (lacking small dense covered vesicles) supplying cerebral vessels and the iris. (Mione et al. 1990). The source of increased cerebrovascular NPY is thought to be preexisting parasympathetic cranial ganglia...(Gibbins and Morris 1988).

Indeed, sympathectomy-induced increased DBH-immunoreactivity in the sphenopalatine (parasympathetic) ganglion occurs at the same time as a loss in VIP-immunoreactivity (Fan and Smith 1993). In the cerebral artery and uterine artery, loss of sympathetic nerves also leads to increased DBH-immunoreactvity in non-sympathetic nerves that lack TH and NA (Morris et al. 1987); Mione et al. 1991)

In the lung, sympathectomy induces a marked increse in CGRP-immunoreactive nerve density around the airways, blood vessels and also in the vicinity of the neurepithelial bodies of the pulmonary epithelium (Van Ranst and Lauweryns 1990).
page 110,

By Otto Appenzeller, P. J. Vinken, G. W. Bruyn,

Contributor Otto, Appenzeller, P. J. Vinken, G. W. Bruyn

Published 2000 Elsevier Health Sciences

Autonomic nervous system / Pathophysiology

histochemical comparison of the normal and chronically sympathectomized heart

Jones CE, Cannon MS.

Using histochemical techniques, the reactivities of selected enzymes and other metabolic components were examined in the myocardium, coronary arteries, and coronary arterioles of normal, two-week-sympathectomized, and sham-operated canine hearts. There were no differences in the histochemistry of coronary arteries in any of the hearts, but important differences were noted in the myocardium and especially in the arterioles. The reactivities of the enzyme glucose-6-phosphate dehydrogenase and the nucleic acids were increased in arterioles of the sympathectomized heart, possibly indicating an increased protein synthesis. The reactivities of succinate dehydrogenase, NAD-isocitrate dehydrogenase, and cytochrome oxidase were reduced in myocardium and arterioles of sympathectomized hearts as well as in arterioles of sham-operated hearts; the changes were greater in the sympathectomized arterioles where there was also observed an increase in reactivity of lactate dehydrogenase. These findings suggest a depression in aerobic metabolic capacity and, in the case of the sympathectomized arteriole, imply a possible shift in adaptation from aerobic to anaerobic metabolism.
Histochem J. 1980 Jan;12(1):9-22.

Upregulation of Neuropeptide Y

Migraine and Headache Pathophysiology - Google Books Result

by Lars Edvinsson, Lars Edvinsson Edvinsson - 1999 - Medical - 184 pages
The mRNA may thus only indicate the possibility of forming the receptor protein. After sympathectomy an upregulation of NPY, probably of parasympathetic origin can be seen in some target organs.
books.google.com.au/books?isbn=1853177377...

Increased ,&Nerve Growth Factor Messenger RNA and Protein

Peripheral NGF mRNA and protein levels following
sympathectomy
It has been shown previously that peripheral sympathectomy
causes a dramatic increase in NGF levels in the denervated
organs (Yap et al., 1984; Kanakis et al., 1985; Korsching and
Thoenen, 1985).
Increased ,&Nerve Growth Factor Messenger RNA and Protein
Levels in Neonatal Rat Hippocampus Following Specific Cholinergic
Lesions
Scott R. Whittemore,” Lena Liirkfors,’ Ted Ebendal,’ Vicky R. Holets, 2,a Anders Ericsson, and HBkan Persson
Departments of Medical Genetics and’ Zoology, Uppsala University, S-751 23 Uppsala, Sweden, and *Department of
Histology, Karolinska Institute, S-104 01 Stockholm, Sweden

Effect of sympathetic denervation on the rate of protein synthesis

On the other hand, clenbuterol or epinephrine (10-5 M) increased by 20% the rate of protein synthesis in soleus muscles from adrenodemedullated rats and prevented its decrease in muscles from fasted rats. The data suggest that the sympathetic nervous system stimulates protein synthesis in oxidative muscles, probably through the activation of {beta}2-adrenoceptors, especially in situations of hormonal or nutritional deficiency.
Luiz Carlos C. Navegantes, Neusa M. Z. Resano, Amanda M. Baviera, Renato H. Migliorini, and Isis C. Kettelhut

Department of Physiology, Biochemistry and Immunology, School of Medicine, University of São Paulo, 14049-900 Ribeirão Preto, São Paulo, Brazil

Submitted 18 August 2003 ; accepted in final form 28 November 2003

Recurrence of original symptoms

The global recurrence rate was 8.8%: 6.6% for palmar hyperhidrosis and 65% for axillary hyperhidrosis. Compensatory sweating was observed in 86.4% of the patients. It was considered as minor by 61% of them, as embarrassing by 31.5%, and as disabling by 7.5%. Other reported side effects were: Horner's syndrome in 3 patients (2.4%), healing in 2 of them; chronic rhinitis in 3 (2.4%); gustatory sweating in 9 (7.2%); and hand dryness in 42%.

Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis.

Gossot D, Galetta D, Pascal A, Debrosse D, Caliandro R, Girard P, Stern JB, Grunenwald D.

Thoracic Department, Institut Mutualiste Montsouris, Paris, France

http://www.ncbi.nlm.nih.gov/pubmed/12683540?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedarticles&logdbfrom=pubmed

Number of unsatisfied patients after T2, T3 Sympathectomy

moderate-to-severe reflex sweating was more common in the ETS2 and ETS3 groups. About 40% of ETS2 groups and 25% of ETS3 group patients were unsatisfied with their operation.

Mahdy T, Youssef T, Elmonem HA, Omar W, Elateef AA.

Department of Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Surgery. 2008 Jun;143(6):784-9. Epub 2008 Mar 20

sympathectomy impairs bone resorption

the sympathetic nervous system is not involved in osteoclast precursor recruitment; but has a significant effect on resorption by inhibiting preosteoclast differentiation and disturbing osteoclast activation. These data suggest that depletion of sympathetic mediators may disturb osteogenic cell-mediated osteoclast differentiation.
M Cherruau1, P Facchinetti2, B Baroukh1, J.L Saffar1

Received 2 November 1998; received in revised form 14 May 1999; accepted 9 July 1999.

http://www.journals.elsevierhealth.com/periodicals/bon/article/PIIS8756328299002112/abstract

Lumbar Sympathectomy - ejaculatory impotence and anorgasmia are almost certain consequences

European Handbook of Dermatological Treatments - Google Books Result

by Andreas D. Katsambas, Torello M. Lotti - 2003 - Medical - 804 pages
However, lumbar sympathectomy has no place in the treatment of pedal hyperhidrosis since ejaculatory impotence and anorgasmia are almost certain consequences ...

Mia: Lumbar Sympathectomy is still being offered by many surgeons as an effective and safe treatment for pedal hyperhidrosis.

Sympathalgia of the cervicobrachial region

Pain syndromes in the cervicobrachial region may be an expression of irritation of the
periarterial autonomic nervous system. They show a vasal, arterial topography (here of
the subclavian artery). If the cervical sympathetic chain is involved in the irritation, the
area supplied by the carotid artery, i.e. the homolateral half of the head is also affected.
Characteristics of these disturbances are their abnormal topography, which cannot be
classified either as a radicular nor a segmental pattern. In this region the perception of
pain is delayed. The quality of pain is protopathic (dull, intense, burning). In the
sympathalgia region there is lowering of the pain threshold (dysesthesia), vasomotor
disturbance (dyskinesia) local homeostatic disorders (dyscrasia), in certain circumstances
trophic disturbances (dystrophy) which are usually accompanied by marked depression
(dysthymia).
Gross D.
1: MMW Munch Med Wochenschr. 1979 Sep 14;121(37):1167-72.

local heterogeneous changes in cerebral blood flow

The local influence of sympathetic stimulation on the cerebral circulation during acute hypertension was investigated in anesthetized rats. From initial studies, intravenously administered angiotensin II was selected as the pressor agent. Local cerebral blood flow was measured with [14C]iodoantipyrine autoradiography during 1) unilateral electrical stimulation of the superior cervical ganglion plus moderate hypertension [mean arterial blood pressure (MABP) 162 +/- 2 mmHg], 2) unilateral stimulation plus severe hypertension (MABP 177 +/- 4 mmHg), and 3) unilateral preganglionic sympathetic nerve section (denervated) plus severe hypertension (MABP 186 +/- 4 mmHg). During moderate hypertension, blood flow was rather homogeneous and sympathetic stimulation produced modest (7-15%) regionally specific reductions in flow ipsilateral to the stimulation (P less than 0.05). During severe hypertension: 1) focal areas of marked hyperemia occurred throughout the brain, 2) local blood flow was similar within innervated and denervated hemispheres, and 3) with sympathetic stimulation the volume of hyperemic tissue was reduced ipsilaterally and blood flow was decreased by 7-25% in areas of basal ganglia, cerebral cortex, limbic system and thalamus. To conclude, 1) the local cerebral autoregulatory response is highly dependent on whether the area becomes hyperperfused and 2) sympathetic stimulation decreases brain blood flow by modestly reducing local tissue perfusion and by lessening the volume of extreme hyperemia.

U. I. Tuor
Division of Neonatology, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.

Am J Physiol Heart Circ Physiol 263: H511-H518, 1992;

Structural changes and in situ aortic pressure-diameter relationship in long-term chemical-sympathectomized rats

Chronic sympathetic denervation increased aortic diameter and compliance in 8D-GN rats, compared with those obtained at the same distending pressure in control rats, suggesting vascular smooth muscle relaxation. In contrast, in 5W-GN and 3M-GN rats, the distensibility pressure-curves were significantly shifted toward lower levels of distensibility and pressure, indicating a decreased aortic distensibility at the same level of arterial pressure. Sympathectomy produced a significant reduction in the content of elastin, one of the most distensible components of the arterial wall in 5W-GN and 3M-GN rats. These results suggest that intact sympathetic nerves are necessary to maintain normal functional and structural properties of large arteries in rat. The reduction in aortic distensibility, in long-term sympathectomized rats, could have resulted from complex interactions between local aortic denervation, change in the set point of distending pressure, and changes in aortic smooth muscle tone and/or wall composition.
Lacolley P, Glaser E, Challande P, Boutouyrie P, Mignot JP, Duriez M, Levy B, Safar M, Laurent S.

Department of Pharmacology, Institut National de la Santé et de la Recherche Médicale U. 337, Paris, France.

Am J Physiol. 1995 Aug;269(2 Pt 2):H407-16.

Hypoperfusion of the brainstem

.The sudden and profound sympathectomy ass/w neuraxial anesthesia at this level can produce apnea form hypoperfusion of the brainstem.

Clinical Anesthesiology, Chapter 17

Peripheral Nerve Blocks, p. 298~ 8/22/2004 3:07 PM

Increased Ocular Blood Vessel Numbers and Sizes Following Chronic Sympathectomy

These findings show that sympathetic innervation is critical in regulating choroidal and retinal vascularity, and that chronic loss of sympathetic activity may contribute to abnormal vascular proliferation in diseases such as age-related macular degeneration and diabetic retinopathy.

Increased Ocular Blood Vessel Numbers and Sizes Following Chronic Sympathectomy in Rat

Jena J. Steinle^{b, a, f1}, Janet D. Pierce^a, Richard L. Clancy^a and Peter G. Smith^{b, a, f2}

Experimental Eye Research

Volume 74, Issue 6, June 2002, Pages 761-768

catecholamines modulating immune function

Experimental and clinical evidence has demonstrated extensive communication between the CNS and the immune system. To analyse the role of central catecholamines in modulating peripheral immune functions, we injected the neurotoxin 6-hydroxydopamine (6-OHDA) i.c.v. in rats. This treatment significantly reduced brain catecholamine content 2, 4 and 7 days after injection, and in the periphery splenic catecholamine levels were reduced 4 days after treatment. Central catecholamine depletion induced an inhibition of splenic and blood lymphocyte proliferation and splenic cytokine production and expression (interleukin-2 and interferon-γ) 7 days after injection. In addition, central treatment with 6-OHDA reduced the percentage of spleen and peripheral blood natural killer (CD161 +) cells, and T-cytotoxic (CD8 +) cells in peripheral blood. The reduction in splenocyte proliferation was not associated with a glucocorticoid alteration but was completely abolished by prior peripheral sympathectomy. These data demonstrate a crucial role of central and peripheral catecholamines in modulating immune function.

Central catecholamine depletion inhibits peripheral lymphocyte responsiveness in spleen and blood

Authors: Pacheco-López, Gustavo¹; Niemi, Maj-Britt¹; Kou, Wei¹; Bildhäuser, Andre¹; Gross, Claus M.¹; Goebel, Marion U.¹; del Rey, Adriana²; Besedovsky, Hugo O.²; Schedlowski, Manfred¹

Source: Journal of Neurochemistry, Volume 86, Number 4, August 2003 , pp. 1024-1031(8)

decreased conditioning-related activity in insula and amygdala

Critchley HD, Mathias CJ, Dolan RJ.
Wellcome Department of Imaging Neuroscience, 12 Queen Square, Institute of Neurology
and Institute of Cognitive Neuroscience, UCL, WC1N 3BG, London, United Kingdom.

The degree to which perceptual awareness of threat stimuli and bodily states of arousal
modulates neural activity associated with fear conditioning is unknown. We used
functional magnetic neuroimaging (fMRI) to study healthy subjects and patients with
peripheral autonomic denervation to examine how the expression of conditioning-related activity is modulated by stimulus awareness and autonomic arousal. In controls,
enhanced amygdala activity was evident during conditioning to both "seen" (unmasked)
and "unseen" (backward masked) stimuli, whereas insula activity was modulated by
perceptual awareness of a threat stimulus. Absent peripheral autonomic arousal, in
patients with autonomic denervation, was associated with decreased conditioning-related activity in insula and amygdala. The findings indicate that the expression of
conditioning-related neural activity is modulated by both awareness and representations
of bodily states of autonomic arousal.
Neuron. 2002 Feb 14;33(4):653-63. Links

Sympathectomy leads to hyperfunction of the serotoninergic system and pathology

We studied the balance of activity of sympathetic, parasympathetic, and serotoninergic divisions of the autonomic nervous system in the regulation of the heart function in rabbits. High activities of the sympathetic and parasympathetic system are associated with antagonistic interactions between them. Moderation of activity of these systems could be accompanied by activation of the serotoninergic system. Physiological sympathectomy and parasympathectomy lead to hyperfunction of the serotoninergic system and pathology.

Balance of Activity of Sympathetic, Parasympathetic, and Serotoninergic Divisions of the Autonomic Nervous System in Rabbits

Author: Lychkova, A.

Source: Bulletin of Experimental Biology and Medicine, Volume 140, Number 5, November 2005 , pp. 486-488(3)

Publisher: Springer

Depression following Sympathectomy

Depression accompanying compensatory hyperhidrosis following endoscopic thoracic sympathectomy

Authors: Hashim, N.; Wilson, N. J. E.

Source: Clinical & Experimental Dermatology, Volume 31, Number 6, November 2006 , pp. 818-819(2)

Publisher: Blackwell Publishing

norepinephrine depletion commonly is the desired effect

Although norepinephrine depletion commonly is the desired effect, other costored neurotransmitters (eg ATP, NPY and enkephalins) are depleted by sympathetic denervation. The multitude of research studying the effects of sympathetic loss is made possible by the morphologically defined anatomy of the postganglionic sympathetic chains, the sensitivity of postganglionic NA neurons to nerve growth factor (NGF) deprivation, and the phenotypic specialty of these neurons that allows for the selective uptake of neurotoxins."

Primer on the Autonomic Nervous System

By David Robertson

Published 2004

Both responses were abolished by sympathectomy

In control rats, nicotine caused a dose-dependent tachycardiac and pressor response. Both responses were abolished by sympathectomy, whereas the α-blockade left the tachycardiac response unaffected but inhibited the pressor response; the V₁ vasopressin receptor blockade had no effect on either the tachycardiac or pressor response. Conclusions: We conclude that in the conscious rat: (1) the pressor response to nicotine mainly depends on peripheral a-adrenergically-mediated vasoconstriction; (2) the vasomotor effect is caused by neural rather than adrenomedullary catecholamine release; (3) the nicotine-induced increase in heart rate (and presumably cardiac output) is per se unable to raise blood pressure, and (4) the nicotine-induced release of vasopressin plays no significant role in the pressor response.
MARANO G. ⁽¹⁾ ; RAMIREZ A. ^{(2 3)} ; MORI I. ^{(2 3)} ; FERRARI A. U. ^{(2 3 4)} ;
http://cat.inist.fr/?aModele=afficheN&cpsidt=1739277
Cardiovascular research ISSN 0008-6363 CODEN CVREAU

1999, vol. 42, n^o1, pp. 201-205 (18 ref.)

Surgeon declares result of sympathectomy "almost miraculous"

The results seem almost miraculous. In over 95% of all cases, the patients hands are dry and warm right after surgery. Hyperhidrosis of the feet is eliminated in about 60% of the cases. Facial sweating is helped in about 65% to 75% of the cases. Rapid heart rate and palpitations are also reduced dramatically. (Sic!)

http://users.rcn.com/szarnick/hidrosis.html

After the operation, some patients might experience some degree of sweating in other locations such as the thighs or back. Most patients say that they are not troubled by this extra perspiration and it is preferable to sweaty palms. In most cases, the condition improves over time.

Definition

Surgical Sumpathectomy and adrenergic function

Theodore Cooper, Department of Surgery, St Louis University School of Medicine

The excision on neutral structures which elaborate adrenergic substances during the process of regulating visceral function continues to be a valuable investigative and therapeutic maneuver. In the past several years, surgical sympathectomy has helped clarify certain aspects of adrenergic function. The operation as a therepeutic tool has been favorably reconsidered particularly since it has become clear that current reconstructive techniques do not provide cure or satisfactory palliation in all instances.
In general sympathectomy has been used for one or more of the following purposes:
1) to eliminate tonic or engendered responses which depend upon impulses in adrenergic nerves;
2) to eliminate visceral stores or adrenergic substances which depend upon the integrity of the postganglionic sympathetic innervation;
3) to eliminate postganglionic sympathetic tissue as a locus for the synthesis, uptake, binding, release and metabolism of adrenergic substances;
4) to eliminate visceral afferent fibers which are frequently distributed in common with autonomic nerves. The extent to which the surgical procedure is adjudged successful is usually related to the anatomical extent of the denervation and the time after operation at which the result is evaluated.
It is clear that "sympathectomy" is not a selective excision of adrenergic elements only. It is well recognized that preganglionic sympathectomy involves division of cholinergic elements ad sensory fibers.
Pharmacological Reviews, 1966 Vol. 18, No. 1. Part I

No pain from perforated ulcer after sympathectomy

Pain impulses from the stomach are carried by visceral afferent fibers that accompany sympathetic nerves. This fact is evident because pain of a recurrent peptic ulcer may persist after complete vagatomy, whereas patients who have had a bilateral sympathectomy may have a perforated peptic ulcer and experience no pain.

Clinically Oriented Anatomy, page 257

By Keith L. Moore, Arthur F. Dalley, A. M. R. Agur

Published 2006 Lippincott Williams & Wilkins

Human anatomy

1209 pages

ISBN:0781736390

Blocked the vomiting response...

Nausea and Vomiting: Recent Research and Clinical Advances - Google Books Result

by John Kucharczyk, David J. Stewart, Alan D. Miller - 1991 - Medical - 251 pages
Vagotomy and sympathectomy blocked the vomiting response, ... The role of visceral afferents in radiation sickness is discussed in Chapter 6, ...
books.google.com.au/books?isbn=0849367816...

Sympathectomy - impaired wound healing

The involvement of peripheral nerves in dermal wound healing, particularly in the inflammatory response has not been extensively studied. Therefore, this study was performed to examine the role of peripheral nerves in the healing of rat skin linear incisions. We report that chemical sympathectomy with 6-hydroxydopamine significantly impaired wound healing as measured on days 7, 11, and 14 postsurgery (by day 14, 48% of the sympathectomized rats were healed in contrast with 84% of the controls; p = 0.0104)...
These results support the hypothesis that sympathetic efferents are important for wound healing. Unlike previous research, which showed that peripheral nerves influence ischemic skin flaps, we are the first to demonstrate a role for peripheral nerves in the healing of skin incisions. Because inflammation is an important step in cutaneous wound healing, we propose that a reduction of neurogenic inflammation caused by sympathectomy may explain the impaired wound healing that we observed in our study.
Kim LR, Whelpdale K, Zurowski M, Pomeranz B.

Departments of Physiology and Zoology, University of Toronto, Toronto, Ontario, Canada.

http://www.ncbi.nlm.nih.gov/pubmed/9776863

Sympathectomy reduces immune responses

Sympathectomy Protects Denervated Skin from Graft-Versus-Host Disease

Mohamed A. Kharfan-Dabaja MDa, Claudio Anasetti MDa and James L.M. Ferrara MDb

Division of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa, Florida

Departments of Pediatrics and Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan

Biology of Blood and Marrow Transplantation
Volume 13, Issue 3, March 2007, Pages 369-370

T2 - innervation to the face/head

T2 Sympathetic Innervation to The Sweat Glands of the Face

Over several years of experience in treating patients with recurrent and/or persistent sweating of the face after undergoing T2 sympathectomy, Dr. Nielson has found that persistence of any sympathetic nerve innervation across the second rib level, just above the T2 ganglion, plays a significant role in persistent sweating conditions of the face after undergoing a T2. T3, or T4 sympathectomy.

It is apparent in some patients that there are neuronal contributions from lower levels such as the T3 that pass up over the second rib level on their way to the face that participate in the sweating symptoms of the face. Some physicians misunderstand the sympathetic nerve innervation of the face and believe in order to cure facial sweating it is important to cut the sympathetic nerve at the T1 level or above, thereby causing the dreaded Horner’s Syndrome. In Dr. Nielson's experience, he has found this not to be the case.

In summary, for successful treatment of facial sweating, it is imperative that all sympathetic nerve innervation crossing the second rib level be divided as opposed to clamped or having lower levels cut or clamped. Also, accessory nerve branch pathways bypassing the T2 ganglion can or may contribute to persistent facial symptoms.

http://www.hyperhidrosis-usa.com/Facial_Blushing.html

Every surgeon decides which complication and side effect to disclose:

ETS Side Effects | Potential Complications

Possible perforation of breast implants if present
Sensitive Pleurae (chest lining sensitivity) limiting exercise
Horners Syndrome occurrence rate 0.3%
Heat intolerance
Pneumothorax (collapsed lung)
Bleeding
Postop Neuralgia and parasthesias are uncommon
Possible hair loss
Bradycardia (slow heart rate) possibly requiring a pacemaker
Subcutaneous emphysema
Possible conversion to open thoracotomy
Possible recurrence of symptoms
Possible necessity for re-do operations

Gustatory sweating (increased sweating while smelling or eating) occurs in some patients.
http://www.hyperhidrosis-usa.com/SideEffects.html

MIA: DOES THIS SOUND LIKE A DESCRIPTION OF A SAFE PROCEDURE?!
The essential conflict lies in the fact that the surgeons are partly right: the surgery is relatively safe (to perform) and immediate outcome, if only palmar sweating is taken into account - would indicate it as an effective surgery. BUT at what cost?! The success rates decline with time, as sweating seems to return with nerve regeneration (even after cutting), in some cases within 6 months. (This is as long as the Botox treatment would last...without any of the adverse effects of the surgery....) Most importantly these exclamations re safety and effectiveness do not take into account the damage caused by the autonomic dysfunction. As the saying goes: The operation was successful, the patient did not make it...

Emotion - memory

Phelps EA.

Department of Psychology, 6 Washington Place, 8(th) floor, New York, New York 10003, USA. liz.phelps@nyu.edu

The amygdala and hippocampal complex, two medial temporal lobe structures, are linked to two independent memory systems, each with unique characteristic functions. In emotional situations, these two systems interact in subtle but important ways. Specifically, the amygdala can modulate both the encoding and the storage of hippocampal-dependent memories. The hippocampal complex, by forming episodic representations of the emotional significance and interpretation of events, can influence the amygdala response when emotional stimuli are encountered. Although these are independent memory systems, they act in concert when emotion meets memory.

Curr Opin Neurobiol. 2004 Apr;14(2):198-202.http://www.ncbi.nlm.nih.gov/pubmed/15082325?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed

Feedback - integreation of emotion and bodily arousal

In health, emotions are integrated with autonomic bodily
responses. Emotional stimuli elicit changes in somatic
(including autonomic) bodily states, which feedback to
influence the expression of emotional feelings. In patients with
spinal cord injury (SCI), this integration of emotion and bodily
arousal is partially disrupted, impairing both efferent generation
of sympathetic responses and afferent sensory feedback of
visceral state via the spinal cord. A number of theoretical
accounts of emotion predict emotional deficits in SCI patients, particularly at the level of emotional
feelings, yet evidence for such a deficit is equivocal. We used functional MRI (fMRI) and a basic
emotional learning paradigm to investigate the expression of emotion-related brain activity
consequent upon SCI.

We suggest that the observed functional abnormalities including enhanced anterior cingulate and PAG reflect central sensitization of the pain matrix, while decreased subgenual cingulate activity may represent a substrate underlying affective vulnerability in SCI patients consequent upon perturbation of autonomic control and afferent visceral representation. Together these observations may account for motivational and affective sequelae of SCI in some individuals.

Alessia Nicotra1,2, Hugo D. Critchley1,3,4,
Christopher J. Mathias1,2 and Raymond J. Dolan3
Brain 2006 129(3):718-728; doi:10.1093/brain/awh699

Norepinephrine - motivation and pleasure

Both norepinephrine and dopamine (sometimes called the "feelgood" chemical, because it's associated with motivation and pleasure) are the triggers for communication along the pathways between the basal ganglia, deep in the brain, and the prefrontal cortex, sometimes referred to as the brain's command centre because it controls executive functions such as problem-solving, attention and reasoning. It's believed (though it's hard to find strong evidence) that ADHD results from function reduction in dopamine and/or norepinephrine levels in the brain.
Nikki Barrowclough

31 March 2007
The Age

Hypoperfusion - risk of cerebral infarct

Current Opinion in Neurology - Fulltext: Volume 15(2) April 2002 p ...
Other work has described variations in sympathectomy and omental ... studies that show regions of cortex at risk of infarct secondary to hypoperfusion. ...
www.co-neurology.com/pt/re/coneuro/fulltext.00019052-200204000-00007.htm;jsessionid=HysC8T2LJypVjsV5nPrwS... -

Sympathectomy - Neurologic disorder

Other neurologic disorders
• Idiopathic orthostatic hypotension
• Multiple sclerosis
• Parkinsonism
• Posterior fossa tumor
• Shy-Drager syndrome
• Spinal cord injury with paraplegia
• Surgical sympathectomy
• Syringomyelia
• Syringobulbia
• Tabes dorsales (syphilis)
• Wernicke’s encephalopathy

Dizziness in Orthopaedic Physical Therapy Practice: Classification
and Pathophysiology
Peter Huijbregts, PT, MSc, MHSc, DPT, OCS, MTC, FAAOMPT, FCAMT
Paul Vidal, PT, MHSc, DPT, OCS, MTC
The Journal of Manual & Manipulative Therapy
Vol. 12 No. 4 (2004), 199 - 214

Syncope and sudden loss of consciousness

Causes of *Collapse and Acute Decreased Conscious State
(* = collapse, as in sudden loss of consciousness)

*Syncope via autonomic failure:
i) Neuropathy with autonomic involvement
ii) Antihypertensives, esp. beta-blockers
iii) Surgical sympathectomy
iv) CNS autonomic failure: eg.primary autonomic failure, MSA, spinal cord lesion

www.medicine.utas.edu.au/teaching/year6/cam615_616/info/additionaltutes/additionaltutes/med.pdf

Orthostatic hypotension

Orthostatic hypotension is commonly associated with prolonged bed rest (24 hours or longer). It may also result from sympathectomy, which disrupts normal vasoconstrictive mechanisms. http://www.wrongdiagnosis.com/m/multiple_system_atrophy_msa_with_orthostatic_hypotension/causes.htm

Influence of sympathetic autonomic arousal on cortical arousal

Influence of sympathetic autonomic arousal on cortical arousal: implications for a therapeutic behavioural intervention in epilepsy.

Nagai Y, Goldstein LH, Critchley HD, Fenwick PB.

Negative amplitude shifts of cortical potential are related to seizure activity in epilepsy. Regulation of the cortical potential with biofeedback has been successfully used to reduce the frequency of some patients' seizures. Although such behavioural treatments are increasingly popular as an alternative to pharmacotherapy, there has been no investigation of the mechanisms that might bridge the behavioural index of peripheral autonomic activity and the central regulation of arousal. Galvanic Skin Response (GSR) is a sensitive measurement of autonomic arousal and physiological state which reflects one's behaviour. Thus we investigated the effect of peripheral autonomic modulation on cortical arousal with the future intention of using GSR biofeedback as a therapeutic treatment for epilepsy. http://www.ncbi.nlm.nih.gov/pubmed/15120749?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

Fear conditioning - the influence of awareness and autonomic arousal on functional neuroanatomy

Absent peripheral autonomic arousal, in patients with autonomic denervation, was associated with decreased conditioning-related activity in insula and amygdala. The findings indicate that the expression of conditioning-related neural activity is modulated by both awareness and representations of bodily states of autonomic arousal.
Critchley HD, Mathias CJ, Dolan RJ.

Neuron. 2002 Feb 14;33(4):653-63.

http://www.ncbi.nlm.nih.gov/pubmed/11856537