• Clinical Pain
• /
• 제19권1호
• /
• pp.32-35
• /
• 2020

Treatment-induced neuropathy in diabetes (TIND) is a reversible neuropathy that occurs in patients with diabetes, usually after a fast improvement in glycemic control. TIND is defined as the sudden onset of neuropathic pain or autonomic dysfunction with a large improvement in glycemic control (glycated hemoglobin [HbA1c] level of ≥ 2% over 3 months). We report the first case of a 24-year-old woman with type 1 diabetes mellitus who developed TIND in Korea. Her HbA1c level had decreased from 16.7% to 7.3% within a 3-month period. She developed acute-onset, severe, and continuous burning pain affecting her back and lower extremities. She was administered tapentadol (50 mg), pregabalin (75 mg), and vitamin B with minerals twice daily for neuropathic pain. She complained of orthostatic hypotension; thus, midodrine (2.5 mg) and anti-embolic stockings were prescribed. She almost completely recovered 6 months after the onset. A physician should be aware of TIND and gradually reduce HbA1c levels to prevent the occurrence of TIDN. They must also try to provide relief from severe pain or autonomic dysfunction and emphasize on an almost complete recovery.

• Annals of Clinical Neurophysiology
• /
• 제23권2호
• /
• pp.126-129
• /
• 2021

We present a patient with a primitive neuroectodermal tumor arising from the right atrium who experienced multiple syncope episodes daily, which had first appeared 1 month after surgery. The symptoms continued to worsen over the course of chemotherapy, and the autonomic function test (AFT) was performed after the 14th chemotherapy cycle. The AFT revealed orthostatic hypotension and reduced baroreflex-dependent sympathetic reactivity. Physical counterpressure techniques were applied with a visual biofeedback intervention, and were found to be effective in reducing the syncope episodes.

• The Korean Journal of Physiology and Pharmacology
• /
• 제27권1호
• /
• pp.49-59
• /
• 2023

Metabolic syndrome (MetS) involves multi-factorial conditions linked to an elevated risk of type 2 diabetes mellitus and cardiovascular disease. Pre-metabolic syndrome (pre-MetS) possesses two MetS components but does not meet the MetS diagnostic criteria. Although cardiac autonomic derangements are evident in MetS, there is little information on their status in pre-MetS subjects. In this study, we sought to examine cardiac autonomic functions in pre-MetS and to determine which MetS component is more responsible for impaired cardiac autonomic functions. A total of 182 subjects were recruited and divided into healthy controls (n=89) and pre-MetS subjects (n=93) based on inclusion and exclusion criteria. We performed biochemical profiles on fasting blood samples to detect pre-MetS. Using standardized protocols, we evaluated anthropometric data, body composition, baroreflex sensitivity (BRS), heart rate variability (HRV), and autonomic function tests (AFTs). We further examined these parameters in pre-MetS subjects for each MetS component. Compared to healthy controls, we observed a significant cardiac autonomic dysfunction (CAD) through reduced BRS, lower overall HRV, and altered AFT parameters in pre-MetS subjects, accompanied by markedly varied anthropometric, clinical and biochemical parameters. Furthermore, all examined BRS, HRV, and AFT parameters exhibited an abnormal trend and significant correlation toward hyperglycemia. This study demonstrates CAD in pre-MetS subjects with reduced BRS, lower overall HRV, and altered AFT parameters. Hyperglycemia was considered an independent determinant of alterations in all the examined BRS, HRV, and AFT parameters. Thus, hyperglycemia may contribute to CAD in pre-MetS subjects before progressing to MetS.

• 대한한방내과학회지
• /
• 제31권4호
• /
• pp.837-845
• /
• 2010

It has been shown that bilateral decrease of point H4,5,6 in Ryodoraku test is related with gastric dysmotility. This suggested that the system of Kyung-Rak related with anatomical gastric disease may not be the Stomach Meridian, in the view that the system of Kyung-Rak is similar to that of Ryodoraku, and which was not consistent with classical contents of Kyung-Rak principle. Therefore, this paper was done to investigate whether bilateral decrease of point H4,5,6 is a general sign of common gastric disease in Ryodoraku test and to study its relation between Kyung-Rak principle and autonomic nervous system as a mediator explaining Ryodoraku response. As shown in the results of this study, different electrical response of Ryodoraku between patients with dyspepsia of gastric dysmotility and gastric ulcer revealed discrepancy of location indicating anatomical stomach between Kyung-Rak principle and Ryodoraku and instability of explanation of autonomic nerve theory to Ryodoraku. Thus, it presented the possibility that artificial application of Kyung-Rak principle against Ryodoraku may destroy its originality in the clinical field. To correctly use Ryodoraku in the diagnosis or evaluation of disease, Ryodoraku test should be used according to Nakatani's suggestion and clinical indication of which is limited to the diseases complicated with dysfunction of the autonomic nervous system.

• Clinical and Experimental Pediatrics
• /
• 제59권sup1호
• /
• pp.125-128
• /
• 2016

Harlequin syndrome, which is a rare disorder caused by dysfunction of the autonomic system, manifests as asymmetric facial flushing and sweating in response to heat, exercise, or emotional factors. The syndrome may be primary (idiopathic) with a benign course, or can occur secondary to structural abnormalities or iatrogenic factors. The precise mechanism underlying idiopathic harlequin syndrome remains unclear. Here, we describe a case of a 6-year-old boy who reported left hemifacial flushing and sweating after exercise. He had an unremarkable birth history and no significant medical history. Complete ophthalmological and neurological examinations were performed, and no other abnormalities were identified. Magnetic resonance imaging was performed to exclude lesions of the cerebrum and cervicothoracic spinal cord, and no abnormalities were noted. His final diagnosis was classic idiopathic harlequin syndrome. Herein, we report the first pediatric case of idiopathic harlequin syndrome in Korea.

• 대한불안의학회지
• /
• 제2권2호
• /
• pp.101-107
• /
• 2006

Object : Since autonomic nerve system dysfunction was known as the mechanism of panic disorder, many researchers used heart rate variability (HRV) as means of measuring autonomic nerve function of patients with panic disorder. We aimed to examine the effect of paroxetine medication for 3 months on symptom improvement and change of heart rate variability of the patients with panic disorder. Methods : The subjects were patients with panic disorder who visited the psychiatric outpatient clinic of Samsung Medical Center in Seoul. We included panic disorder patients who were aged from 20 to 50 and in normal BMI range (from 18 to 30) to minimize the effect of age and weight on HRV data. We excluded the patients with EKG abnormalities, hypertension or other major psychiatric disorders. They took 20-40 mg paroxetine medication a day for 3 months. Alprazolam was used only during the first month to control the acute panic symptoms and was tapered off after that. We measured the acute panic inventory (API), Hamilton rating scale for anxiety and depression (HAM-A & HAM-D), Spielberger state-trait anxiety inventory (STAIS, STAIT), and Beck depression inventory (BDI) in order to assess clinical improvement of the patients. And we measured time and frequency domain HRV in the resting, standing and cognitive stress states to assess the change of HRV. All measurements were done before and after paroxetine treatment. Result : After paroxetine medication, patients showed significant improvement in all psychiatric scales. In time domain of HRV, standard deviations of all R-R intervals (SDNN) were significantly increased in all states. In frequency domain of HRV, the ratio of high frequency to total power (HF/TP) in the standing state was significantly increased. Conclusion : After 3 months paroxetine medication, panic disorder patients showed significant clinical improvement and change in HRV data such as SDNN in all states and HF/TP ratio in the standing state. This result suggests that paroxetine medication is effective for the improvement of autonomic nerve system dysfunction in panic disorder patients.

• Journal of Korean Neurosurgical Society
• /
• 제54권5호
• /
• pp.379-383
• /
• 2013

Objective : There are differences in the clinical characteristics and surgical results between upper (L1-2 and L2-3) and lower (L3-4, L4-5, and L5-S1) lumbar disc herniations. We conducted this study to compare the clinical features and surgical outcomes between the two types of lumbar disc herniations. Methods : We retrospectively reviewed the clinical features of patients who underwent microdiscectomies from 2008 to 2012. We evaluated the clinical characteristics such as age, preoperative autonomic dysfunction, the presence or absence of previous lumbar surgery and fusion required during surgery. Visual Analogue Scale (VAS) scores about back pain and leg pain were evaluated preoperatively and at the final follow-up. Results : Upper lumbar group (n=15) was significantly older than lower lumbar group (n=148). The incidence of autonomic dysfunction was significantly higher in upper lumbar group. The number of patients with a previous lumbar surgery was significantly greater in upper lumbar group. There was no statistical significance for fusion required during surgery between two groups. Both groups showed a significant decrease in the VAS scores of leg pain. VAS scores of back pain were significantly decreased in lower lumbar group. But this was not seen in upper lumbar group. Both groups showed significant improvement of Oswestry Disability Index score. Conclusion : Upper lumbar group had different clinical characteristics from those of lower lumbar group and these include older age, a higher incidence of autonomic dysfunctions and a higher incidence of patients with previous lumbar surgery. There were no significant differences in surgical outcomes, except for back pain, between two groups.

• Korean Journal of Acupuncture
• /
• 제24권4호
• /
• pp.25-36
• /
• 2007

Objectives : Acupuncture restores the flow of vital energy in the body by stimulating the organ-specific meridians and enhances cardiac vagal activity and suppresses sympathetic activity. The purpose of this review is to summarize and evaluate the acupuncture studies on autonomic nervous system (ANS). Methods : We conducted a PubMed search to obtain a fair sample of acupuncture studies related ANS published in English in 2007. Each article was reviewed for study objectives and outcomes, as well as acupuncture points, experimental and control interventions. Results : We reviewed a total of 15 studies published from 1997 to 2007. In normal states, acupuncture enhanced either vagal or sympathetic tone depending on the stimulated acupuncture point sites. On the other hand, most of studies demonstrated that acupuncture restored the autonomic dysfunctions in various kinds of stressful states. Conclusions : We reviewed studies that contributed to an understanding of the autonomic mechanisms of acupuncture with the hope that this review will be of benefit to the future studies. Although the relationship between acupuncture and ANS response is still uncertain, acupuncture would be a noteworthy modality for modulating autonomic dysfunction.

• 대한한의진단학회지
• /
• 제15권2호
• /
• pp.127-140
• /
• 2011

Objectives: Acupuncture has been shown to relieve pain and modulate biological function by stimulating the organ-specific meridians and enhances parasympathetic activity and suppresses sympathetic activity. The aim of this review is to summarize and understand the effects of acupuncture on autonomic nervous system. Methods: We reviewed a total of 29 studies published from 2000 to 2010 searched by PueMed and various domestic oriental medicine journals to obtain acupuncture studies related with ANS. Each article was classified by ANS measurement index and reviewed for study objectives, outcomes, acupuncture points, experimental and control interventions. Results: In the study of acupuncture about EEG, HRV, SCR, the experiment results are not the same by acupoints. Although same acupoint the results differ by subject's condition. But the study showed some clear tendency. In brief, in normal states acupuncture enhanced either vagal or sympathetic tone depending on the stimulated acupuncture point sites. On the other hand, most of studies demonstrated that acupuncture restored the autonomic dysfunctions in various kinds of tired or stressful states. Conclusions: We reviewed studies that contributed to an understanding of the effects and mechanisms of acupuncture on autonomic nervous system. Although the relationship between acupuncture and ANS response is still uncertain, acupuncture could be a excellent treatment method for modulating autonomic dysfunction.

• Korean Journal of Acupuncture
• /
• 제33권3호
• /
• pp.95-101
• /
• 2016

Objectives : This study aims to overview the therapeutic mechanism of back-shu points in terms of sympathetic visceral motor nervous system. Methods : Studies about autonomic nervous system, and studies and ancient texts about back-shu points were reviewed. We interpreted possible mechanism of back-shu points considering similarities of anatomical and physiological characteristics of back-shu points and visceral motor nervous system. Results : Afferent signals for organ lesions that can develop the symptoms of autonomic neurological symptoms, pain, hyperalgesia through the skin segment. Through a physical examination of the myotome and dermatome, it is possible to diagnose segmental disorders. Treatment stimulation of the thick fibers of the disorder segment skin can reduce abnormal autonomic influence over the sympathetic reflex mechanism. In addition, if spinal muscles are relaxed, the pressure on the nerve roots could be reduced and consequently the hyperactivity of the sympathetic visceral motor signal would be suppressed. Conclusions : The back-shu points treatments work through the mechanism of the sympathetic nervous reflex. Moreover, segmental acupuncture can reduce tension of the spinal muscles, thereby improving pathological conditions of the sympathetic nervous system.