Dysautonomia, Familial
Primary Dysautonomias
Autonomic Nervous System Diseases
Physical Conditioning, Human
Hypotension, Orthostatic
Pure Autonomic Failure
Tilt-Table Test
Sweat Glands
Autonomic Nervous System
Sweating
Cold face test demonstrates parasympathetic cardiac dysfunction in familial dysautonomia. (1/74)
In familial dysautonomia (FD), i.e., Riley-Day syndrome, parasympathetic dysfunction has not been sufficiently evaluated. The cold face test is a noninvasive method of activating trigeminal brain stem cardiovagal and sympathetic pathways and can be performed in patients with limited cooperation. We performed cold face tests in 11 FD patients and 15 controls. For 60 s, cold compresses (0-1 degrees C) were applied to the cheeks and forehead while we monitored heart rate, respiration, beat-to-beat radial artery blood pressure, and laser-Doppler skin blood flow at the first toe pulp. From these measurements heart rate variability parameters were calculated: root mean square of successive differences (RMSSD), coefficient of variation (CV), low- and high-frequency (LF and HF, respectively) power spectra of the electrocardiogram, and the LF transfer function gain between blood pressure and heart rate. All patients perceived cold stimulation and acknowledged discomfort. In controls, heart rate and skin blood flow decreased significantly during cold face test; in patients, both parameters decreased only briefly and not significantly. In controls, blood pressure, RMSSD, CV, and heart rate HF-power spectra increased but remained unchanged in patients. Respiration, as well as heart rate LF power spectra, did not change in either group. In controls, LF transfer function gain between blood pressure and heart rate indicated that bradycardia was not secondary to blood pressure increase. We conclude that the cold face test demonstrated that patients with FD have a reduced cardiac parasympathetic response, which implies efferent parasympathetic dysfunction. (+info)Fatal familial insomnia: clinical features and molecular genetics. (2/74)
Fatal familial insomnia (FFI) is an autosomal dominant prion disease clinically characterized by inattention, sleep loss, dysautonomia, and motor signs and pathologically characterized by a preferential thalamic degeneration. FFI is linked to a missense mutation at codon 178 of the prion protein gene, PRNP, coupled with the presence of the codon methionine at position 129, the locus of a methionine-valine polymorphism. Homozygotes at codon 129, expressing methionine also in the nonmutated allele, have a shorter disease course (often less than 1 year), prominent sleep and autonomic disturbances at disease onset, and pathology restricted to the thalamus. Heterozygotes at codon 129, expressing valine in the nonmutated allele, have a longer disease course (often longer than 1 year), ataxia and dysarthria at disease onset, and lesions widespread to cerebral cortex. Both in the thalamus and in the cortex, the limbic structures are those most consistently and severely involved: the anterior ventral and mediodorsal thalamic nuclei, the cingulate gyrus, and the orbitofrontal cortex. FFI is thus a prion disease selectively damaging the thalamocortical limbic structures. Loss of sleep, sympathetic hyperactivity, and flattening of vegetative and hormonal circadian oscillations characterize FFI and result from a homeostatic imbalance caused by the interruption of the thalamocortical limbic circuits, the phylogenetically most advanced structures involved in the control of the sleep-wake cycle and the body's homeostasis. The selective atrophy of the limbic thalamus that characterizes FFI might be due to the binding of FFI toxic PrP or PrPres to specific receptors on thalamolimbic neurons. (+info)Gynecological aspects of female familial dysautonomia. (3/74)
BACKGROUND: Familial dysautonomia is a genetic disease in which there is a defect in the autonomic and sensory nervous systems. These systems have a major role in the reproductive system. OBJECTIVE: To study the inter-relationship of autonomic and sensory dysfunction and gynecological function. METHODS: The gynecological histories of 48 women with familial dysautonomia were analyzed retrospectively. Their mean age was 22.25 years (range 12-47). Thirty-three women (65%) were available for further questioning and investigation of hormonal status. RESULTS: Menarche had occurred in 32 of the 48 (66.7%). Their average age of menarche was significantly delayed as compared to their unaffected mothers (15.5 vs. 13.6 years respectively, P = 0.002). The most prominent finding was the very high prevalence, 81.2%, of premenstrual symptoms. Seven of 26 had premenstrual syndrome symptoms of dysautonomic crisis. Blood sex hormone levels were normal in 27 of the 33 patients studied. None reached natural menopause. One patient had adenomyosis, and another, dysgerminoma. Three patients became pregnant and delivered healthy infants. CONCLUSION: Menarche is delayed in women with FD, and the physiological monthly hormonal fluctuations may disturb autonomic homeostasis sufficiently to precipitate dysautonomic crisis. (+info)Tissue-specific expression of a splicing mutation in the IKBKAP gene causes familial dysautonomia. (4/74)
Familial dysautonomia (FD; also known as "Riley-Day syndrome"), an Ashkenazi Jewish disorder, is the best known and most frequent of a group of congenital sensory neuropathies and is characterized by widespread sensory and variable autonomic dysfunction. Previously, we had mapped the FD gene, DYS, to a 0.5-cM region on chromosome 9q31 and had shown that the ethnic bias is due to a founder effect, with >99.5% of disease alleles sharing a common ancestral haplotype. To investigate the molecular basis of FD, we sequenced the minimal candidate region and cloned and characterized its five genes. One of these, IKBKAP, harbors two mutations that can cause FD. The major haplotype mutation is located in the donor splice site of intron 20. This mutation can result in skipping of exon 20 in the mRNA of patients with FD, although they continue to express varying levels of wild-type message in a tissue-specific manner. RNA isolated from lymphoblasts of patients is primarily wild-type, whereas only the deleted message is seen in RNA isolated from brain. The mutation associated with the minor haplotype in four patients is a missense (R696P) mutation in exon 19, which is predicted to disrupt a potential phosphorylation site. Our findings indicate that almost all cases of FD are caused by an unusual splice defect that displays tissue-specific expression; and they also provide the basis for rapid carrier screening in the Ashkenazi Jewish population. (+info)Familial dysautonomia is caused by mutations of the IKAP gene. (5/74)
The defective gene DYS, which is responsible for familial dysautonomia (FD) and has been mapped to a 0.5-cM region on chromosome 9q31, has eluded identification. We identified and characterized the RNAs encoded by this region of chromosome 9 in cell lines derived from individuals homozygous for the major FD haplotype, and we observed that the RNA encoding the IkappaB kinase complex-associated protein (IKAP) lacks exon 20 and, as a result of a frameshift, encodes a truncated protein. Sequence analysis reveals a T-->C transition in the donor splice site of intron 20. In individuals bearing a minor FD haplotype, a missense mutation in exon 19 disrupts a consensus serine/threonine kinase phosphorylation site. This mutation results in defective phosphorylation of IKAP. These mutations were observed to be present in a random sample of Ashkenazi Jewish individuals, at approximately the predicted carrier frequency of FD. These findings demonstrate that mutations in the gene encoding IKAP are responsible for FD. (+info)Purification and characterization of the human elongator complex. (6/74)
Human Elongator complex was purified to virtual homogeneity from HeLa cell extracts. The purified factor can exist in two forms: a six-subunit complex, holo-Elongator, which has histone acetyltransferase activity directed against histone H3 and H4, and a three-subunit core form, which does not have histone acetyltransferase activity despite containing the catalytic Elp3 subunit. Elongator is a component of early elongation complexes formed in HeLa nuclear extracts and can interact directly with RNA polymerase II in solution. Several human homologues of the yeast Elongator subunits were identified as subunits of the human Elongator complex, including StIP1 (STAT-interacting protein 1) and IKAP (IKK complex-associated protein). Mutations in IKAP can result in the severe human disorder familial dysautonomia, raising the possibility that this disease might be due to compromised Elongator function and therefore could be a transcription disorder. (+info)Transcranial Doppler sonography during head up tilt suggests preserved central sympathetic activation in familial dysautonomia. (7/74)
OBJECTIVE: Cerebral autoregulation was assessed by transcranial Doppler sonography in 10 patients with familial dysautonomia and 10 age matched controls. METHODS: Blood pressure, heart rate, and middle cerebral artery blood flow velocity (CBFV) were simultaneously recorded when supine and during 180 seconds of head up tilt. Cerebrovascular resistance (CVR) was calculated from CBFV and mean blood pressure was adjusted to brain level. RESULTS: In the controls, mean blood pressure remained stable during tilt, but heart rate increased significantly. In the patients with familial dysautonomia, mean (SD) blood pressure decreased by 15.0 (10.8)% (p < 0.05). Heart rate remained unchanged. In controls, systolic and mean CBFV decreased by 9.1 (4.7)% and 9.4 (7.0)%, respectively, while diastolic CBFV remained stable. In the patients, diastolic and mean CBFV decreased continuously by 32.1 (13.9)% and by 14.8 (31.4)%. Supine CVR was 28% higher in patients than in controls and decreased significantly less during head up tilt. CONCLUSIONS: Tilt evokes orthostatic hypotension without compensatory tachycardia in patients with familial dysautonomia owing to decreased peripheral sympathetic innervation. High supine CVR values and relatively preserved CVR during tilt suggest preserved central sympathetic activation in familial dysautonomia, assuring adaptation of cerebrovascular autoregulation to chronic supine hypertension and orthostatic hypotension. (+info)Vestibular dysfunction in familial dysautonomia. The Riley-Day syndrome. (8/74)
We report the bilateral absence of response to tests of vestibular function in 5 patients with familial dysautonomia. (+info)Familial dysautonomia (FD) is a genetic disorder that affects the autonomic nervous system (ANS), which controls automatic functions such as heart rate, blood pressure, body temperature, and digestion. It is also known as Riley-Day syndrome or Hereditary Sensory and Autonomic Neuropathy Type III (HSAN III).
FD is caused by a mutation in the IKBKAP gene, which provides instructions for making a protein that is essential for the development and function of certain nerves. The condition is inherited in an autosomal recessive manner, meaning that an individual must inherit two copies of the mutated gene (one from each parent) to have the disease.
The symptoms of familial dysautonomia can vary widely, but often include:
* Difficulty regulating blood pressure and heart rate, leading to fluctuations in blood pressure, dizziness, and fainting spells
* Poor temperature regulation, causing episodes of sweating or flushing
* Difficulty swallowing and poor muscle tone in the face and tongue
* Absent or reduced deep tendon reflexes
* Delayed growth and development
* Reduced sensitivity to pain and temperature changes
* Emotional lability and behavioral problems
There is no cure for familial dysautonomia, but treatment can help manage symptoms and improve quality of life. Treatment may include medications to regulate blood pressure and heart rate, physical therapy to improve muscle tone and coordination, and feeding tubes or special diets to ensure adequate nutrition.
Primary dysautonomias, also known as primary autonomic disorders or idiopathic dysautonomia, refer to a group of conditions that affect the autonomic nervous system (ANS) without an identifiable underlying cause. The ANS is responsible for regulating many automatic bodily functions such as heart rate, blood pressure, digestion, and body temperature.
In primary dysautonomias, the ANS fails to function properly, leading to a variety of symptoms that can affect different organ systems. These symptoms may include orthostatic intolerance (lightheadedness or fainting upon standing), irregular heart rate, excessive sweating, heat or cold intolerance, difficulty with digestion, and pupillary abnormalities.
Examples of primary dysautonomias include pure autonomic failure, multiple system atrophy, and familial dysautonomia. These conditions are typically progressive, meaning that symptoms tend to worsen over time. Treatment for primary dysautonomias is focused on managing symptoms and improving quality of life.
The Autonomic Nervous System (ANS) is a part of the nervous system that controls involuntary actions, such as heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. It consists of two subdivisions: the sympathetic and parasympathetic nervous systems, which generally have opposing effects and maintain homeostasis in the body.
Autonomic Nervous System Diseases (also known as Autonomic Disorders or Autonomic Neuropathies) refer to a group of conditions that affect the functioning of the autonomic nervous system. These diseases can cause damage to the nerves that control automatic functions, leading to various symptoms and complications.
Autonomic Nervous System Diseases can be classified into two main categories:
1. Primary Autonomic Nervous System Disorders: These are conditions that primarily affect the autonomic nervous system without any underlying cause. Examples include:
* Pure Autonomic Failure (PAF): A rare disorder characterized by progressive loss of autonomic nerve function, leading to symptoms such as orthostatic hypotension, urinary retention, and constipation.
* Multiple System Atrophy (MSA): A degenerative neurological disorder that affects both the autonomic nervous system and movement coordination. Symptoms may include orthostatic hypotension, urinary incontinence, sexual dysfunction, and Parkinsonian features like stiffness and slowness of movements.
* Autonomic Neuropathy associated with Parkinson's Disease: Some individuals with Parkinson's disease develop autonomic symptoms such as orthostatic hypotension, constipation, and urinary dysfunction due to the degeneration of autonomic nerves.
2. Secondary Autonomic Nervous System Disorders: These are conditions that affect the autonomic nervous system as a result of an underlying cause or disease. Examples include:
* Diabetic Autonomic Neuropathy: A complication of diabetes mellitus that affects the autonomic nerves, leading to symptoms such as orthostatic hypotension, gastroparesis (delayed gastric emptying), and sexual dysfunction.
* Autoimmune-mediated Autonomic Neuropathies: Conditions like Guillain-Barré syndrome or autoimmune autonomic ganglionopathy can cause autonomic symptoms due to the immune system attacking the autonomic nerves.
* Infectious Autonomic Neuropathies: Certain infections, such as HIV or Lyme disease, can lead to autonomic dysfunction as a result of nerve damage.
* Toxin-induced Autonomic Neuropathy: Exposure to certain toxins, like heavy metals or organophosphate pesticides, can cause autonomic neuropathy.
Autonomic nervous system disorders can significantly impact a person's quality of life and daily functioning. Proper diagnosis and management are crucial for improving symptoms and preventing complications. Treatment options may include lifestyle modifications, medications, and in some cases, devices or surgical interventions.
Physical conditioning in the context of human health refers to the process of improving physical fitness and overall health through regular exercise and physical activity. This involves engaging in various forms of exercise such as cardio, strength training, flexibility exercises, and balance exercises to enhance various components of physical fitness including:
1. Cardiovascular endurance: The ability of the heart and lungs to supply oxygen to the muscles during sustained physical activity.
2. Muscular strength: The amount of force a muscle can exert in a single effort.
3. Muscular endurance: The ability of a muscle or muscle group to sustain repeated contractions over time.
4. Flexibility: The range of motion around a joint.
5. Body composition: The proportion of lean body mass (muscle, bone, and organs) to fat mass in the body.
Physical conditioning aims to improve these components of fitness, leading to overall improvements in health, functional capacity, and reduced risk of chronic diseases such as obesity, diabetes, heart disease, and cancer. It is an essential component of a healthy lifestyle and is recommended for people of all ages and abilities.
Kinetin is a type of plant growth hormone, specifically a cytokinin. It plays a crucial role in cell division and differentiation, as well as promoting growth and delaying senescence (aging) in plants. Kinetin has also been studied for its potential use in various medical applications, including wound healing, tissue culture, and skin care products. However, it is primarily known for its role in plant biology.
Orthostatic hypotension is a type of low blood pressure that occurs when you stand up from a sitting or lying position. The drop in blood pressure causes a brief period of lightheadedness or dizziness, and can even cause fainting in some cases. This condition is also known as postural hypotension.
Orthostatic hypotension is caused by a rapid decrease in blood pressure when you stand up, which reduces the amount of blood that reaches your brain. Normally, when you stand up, your body compensates for this by increasing your heart rate and constricting blood vessels to maintain blood pressure. However, if these mechanisms fail or are impaired, orthostatic hypotension can occur.
Orthostatic hypotension is more common in older adults, but it can also affect younger people who have certain medical conditions or take certain medications. Some of the risk factors for orthostatic hypotension include dehydration, prolonged bed rest, pregnancy, diabetes, heart disease, Parkinson's disease, and certain neurological disorders.
If you experience symptoms of orthostatic hypotension, it is important to seek medical attention. Your healthcare provider can perform tests to determine the underlying cause of your symptoms and recommend appropriate treatment options. Treatment may include lifestyle changes, such as increasing fluid intake, avoiding alcohol and caffeine, and gradually changing positions from lying down or sitting to standing up. In some cases, medication may be necessary to manage orthostatic hypotension.
Pure Autonomic Failure (PAF) is a rare neurological disorder characterized by the progressive loss of function of the autonomic nervous system, which regulates involuntary bodily functions such as heart rate, blood pressure, sweating, digestion, and bladder control. In PAF, there is no evidence of any other underlying disease or neurological condition that could explain these symptoms.
The primary feature of PAF is orthostatic hypotension, a sudden drop in blood pressure when standing up from a sitting or lying down position, which can lead to dizziness, lightheadedness, and even fainting. Other common symptoms include:
* Anhidrosis (inability to sweat) or hyperhidrosis (excessive sweating)
* Constipation or diarrhea
* Urinary incontinence or retention
* Sexual dysfunction
* Tachycardia (rapid heart rate) or bradycardia (slow heart rate)
* Difficulty regulating body temperature
The exact cause of PAF is unknown, but it is believed to be related to the degeneration of nerve cells in the autonomic nervous system. There is no cure for PAF, and treatment is focused on managing symptoms and preventing complications. This may include lifestyle changes such as increasing fluid and salt intake, wearing compression stockings, and avoiding prolonged periods of standing or sitting. Medications may also be prescribed to help regulate blood pressure, heart rate, and other autonomic functions.
A tilt-table test is a diagnostic procedure used to evaluate symptoms of syncope (fainting) or near-syncope. It measures your body's cardiovascular response to changes in position. During the test, you lie on a table that can be tilted to change the angle of your body from horizontal to upright. This simulates what happens when you stand up from a lying down position.
The test monitors heart rate, blood pressure, and oxygen levels while you're in different positions. If you experience symptoms like dizziness or fainting during the test, these can provide clues about the cause of your symptoms. The test is used to diagnose conditions like orthostatic hypotension (a sudden drop in blood pressure when standing), vasovagal syncope (fainting due to an overactive vagus nerve), and other heart rhythm disorders.
Sweat glands are specialized tubular structures in the skin that produce and secrete sweat, also known as perspiration. They are part of the body's thermoregulatory system, helping to maintain optimal body temperature by releasing water and heat through evaporation. There are two main types of sweat glands: eccrine and apocrine.
1. Eccrine sweat glands: These are distributed throughout the body, with a higher concentration on areas like the palms, soles, and forehead. They are responsible for producing a watery, odorless sweat that primarily helps to cool down the body through evaporation.
2. Apocrine sweat glands: These are mainly found in the axillary (armpit) region and around the anogenital area. They become active during puberty and produce a thick, milky fluid that does not have a strong odor on its own but can mix with bacteria on the skin's surface, leading to body odor.
Sweat glands are controlled by the autonomic nervous system, meaning they function involuntarily in response to various stimuli such as emotions, physical activity, or changes in environmental temperature.
The Autonomic Nervous System (ANS) is a part of the peripheral nervous system that operates largely below the level of consciousness and controls visceral functions. It is divided into two main subdivisions: the sympathetic and parasympathetic nervous systems, which generally have opposing effects and maintain homeostasis in the body.
The Sympathetic Nervous System (SNS) prepares the body for stressful or emergency situations, often referred to as the "fight or flight" response. It increases heart rate, blood pressure, respiratory rate, and metabolic rate, while also decreasing digestive activity. This response helps the body respond quickly to perceived threats.
The Parasympathetic Nervous System (PNS), on the other hand, promotes the "rest and digest" state, allowing the body to conserve energy and restore itself after the stress response has subsided. It decreases heart rate, blood pressure, and respiratory rate, while increasing digestive activity and promoting relaxation.
These two systems work together to maintain balance in the body by adjusting various functions based on internal and external demands. Disorders of the Autonomic Nervous System can lead to a variety of symptoms, such as orthostatic hypotension, gastroparesis, and cardiac arrhythmias, among others.
Sweating, also known as perspiration, is the production of sweat by the sweat glands in the skin in response to heat, physical exertion, hormonal changes, or emotional stress. Sweat is a fluid composed mainly of water, with small amounts of sodium chloride, lactate, and urea. It helps regulate body temperature by releasing heat through evaporation on the surface of the skin. Excessive sweating, known as hyperhidrosis, can be a medical condition that may require treatment.
The Valsalva maneuver is a medical procedure that involves forced exhalation against a closed airway, typically by closing one's mouth, pinching the nose shut, and then blowing. This maneuver increases the pressure in the chest and affects the heart's filling and pumping capabilities, as well as the pressures within the ears and eyes.
It is often used during medical examinations to test for conditions such as heart murmurs or to help clear the ears during changes in air pressure (like when scuba diving or flying). It can also be used to help diagnose or monitor conditions related to the autonomic nervous system, such as orthostatic hypotension or dysautonomia.
However, it's important to perform the Valsalva maneuver correctly and under medical supervision, as improper technique or overdoing it can lead to adverse effects like increased heart rate, changes in blood pressure, or even damage to the eardrum.