자율신경실조증 한의표준임상진료지침 개발을 위한 한의임상 실태조사

박희영,송금주,이현우,박찬,윤석인,박정환,정선용,김종우 대한한방신경정신과학회 2023 동의신경정신과학회지 Vol.34 No.4

Objectives: The study aimed to understand the current treatment patterns in Korean medicine to develop clinical practice guidelines for autonomic dysfunction in Korean medicine. Methods: This study sent an online survey vai text message to 25,900 Korean medicine doctors whose contact information was registered with the Association of Korean Medicine. A total of 1,410 Korean medical doctors completed the online survey. Results: When autonomic treating dysfunction clinically, 77% of the cases included only a description without entering a diagnosis code. The most commonly used information to diagnose o autonomic dysfunction was history-taking and symptoms (79%), and the main symptoms of autonomic dysfunction were palpitations, dizziness, sleeping difficulties, anxiety/nervousness, and depression/lethargy. The most frequently mentioned cause of autonomic dysfunction was mental problems (54%). The most commonly used Korean medicine treatment method for autonomic dysfunction was herbal medicine (70%), and Soyo-san/Gamisoyo-san is the most frequently used herbal medicine preparation. Liver qi depression used to indicate the most often mentioned Korean medicine pattern identification used to indicate autonomic dysfunction (31%). When asked whether cardiac neurosis in Chinese medicine can be considered autonomic dysfunction, opinions for and against it are determined almost equally. Conclusions: Our results serve are a foundation for developing clinical practice guidelines for autonomic dysfunction in Korean medicine and are expected to catalyst promoting future clinical research on autonomic dysfunction.

There is No Association between Cardiovascular Autonomic Dysfunction and Peripheral Neuropathy in Chronic Hemodialysis Patients

Elefterios Stamboulis,Konstantinos Voumvourakis,Thomas Zambelis,Athina Andrikopoulou,Demetrios Vlahakos,Athanasios Tsivgoulis, 대한신경과학회 2010 Journal of Clinical Neurology Vol.6 No.3

Background and Purpose: The potential association between the severity of autonomic dysfunction and peripheral neuropathy has not been extensively investigated, with the few studies yielding inconsistent results. We evaluated the relationship between autonomic dysfunction and peripheral neuropathy in chronic hemodialysis patients in a cross-sectional study. Methods: Cardiovascular autonomic function was assessed in 42 consecutive patients with chronic renal failure treated by hemodialysis, using a standardized battery of 5 cardiovascular reflex tests. Symptoms of autonomic dysfunction and of peripheral neuropathy were evaluated using the Autonomic Neuropathy Symptom Score (ANSS) and the Neuropathy Symptoms Score. Neurological deficits were assessed using the Neuropathy Disability Score. Conduction velocities along the sensory and motor fibers of the sural and peroneal nerves were measured. Thermal thresholds were documented using a standardized psychophysical technique. Results: Parasympathetic and sympathetic dysfunction was prevalent in 50% and 28% of cases,respectively. Peripheral neuropathy was identified in 25 cases (60%). The prevalence of peripheral neuropathy did not differ between patients with impaired (55%) and normal (75%) autonomic function (p=0.297; Fisher’s exact test). The electrophysiological parameters for peripheral nerve function, neuropathic symptoms, abnormal thermal thresholds, age, gender, and duration of dialysis did not differ significantly between patients with and without autonomic dysfunction. Patients with autonomic dysfunction were more likely to have an abnormal ANSS (p=0.048). The severity of autonomic dysfunction on electrophysiological testing was positively correlated with ANSS (r=0.213, p=0.036). Conclusions: The present data indicate that although cardiovascular autonomic dysfunction is prevalent among patients with chronic renal failure, it is not associated with the incidence of peripheral neuropathy.

만성신부전 환자의 자율신경 기능장애

이상호(Sang Ho Lee),최수철(Soo chul choi),홍성표(Seoung Pyo Hong),이태원(Tae Won Lee),임천규(Chun Gyu Lim),김명재(Myung Jae Kim) 대한내과학회 1998 대한내과학회지 Vol.55 No.2

N/A Objectives: Impaired autonomic function in patients with chronic renal failure has been well documented in a number of studies to assess the degree of cardiovascular autonomic dysfunction and to assess the relationship with plasma catecholamines. The purpose of the present study was to evaluate the prevalence of autonomic dysfunction and to determine the effect of autonomic dysfunction on the increment of plasma catecholamine, dialysis-induced hypotension and hypotension during chronic dialysis. Methods: We measured the degree of autonomic damage and the concentration of plasma catecholamines in 20 patients on maintenance hemadialysis, 12 predialysis patients with chronic renal failure and 20 normal controls using a standardized battery of five cardiovascular reflex tests, Results: 1) In normal controls, 70% of cases had a normal or early parasympathetic abnormalities however in patients with chronic renal failure, 45.2% of patients had severe abnormalities. The prevalence of autonomic dysfunction was 62.5% and there was significant correlation between sympathetic and parasympathetic score in patients with chronic renal failure. 2) Although overall autonomic function was not different in two chronic renal failure groups, the magnitude of heart rate response to Valsalva maneuver was increased and the magnitude of fall of blood pressure in response to standing-up was reduced in dialyzed patients compared with nondialyzed petients. 3) Patients with autonomic dysfunction was older and had higher postdialysis concentration of plasma norepinephrine than those with normal autonomic function. 4) In dialyzed patients, predialysis concentration of plasma norepinephrine at rest varied widely and was significantly related to the duration of dialysis. Postdialysis concentration of norepinephrine was significantly correlated with the degree of parasympathetic damage. 5) There were no significant differences in autonomic damage or plasma catecholamines whether dialysisinduced hypotension and hypotension in chronic hemodialysis or not. Conclusion: Disturbances of autonomic nerve system are common in chronic renal failure with distinct abnormalities of parasympathetic function and additional sympathetic dysfunction. Elevated plasma norepinephrine seems to be related to the compensatory response of sympathetic nerve system to parasympathetic damage. Impairment of autonomic function does not appear specifically related to dialysis-induced hypotension or hypotension in chronic dialysis.

류마티스 관절염 환자의 자율 신경 장애

홍영훈 ( Young Hoon Hong ),이은영 ( Eun Young Lee ),이충기 ( Choong Ki Lee ) 대한류마티스학회 2001 대한류마티스학회지 Vol.8 No.2

Objective: To investigate the frequency of autonomic nervous dysfunction and assess the factors associated with autonomic nervous dysfunction in patients with rheumatoid arthritis (RA). Methods: Three battery of cardiovascular autonomic nervous function tests (CAN test); heart rate response to Valsalva maneuver, deep breathing and standing up, were performed in 68 patients who met the 1987 American Rheumatism Association revised criteria for RA and 58 healthy controls. Autonomic nervous dysfunction was defined as 2 of 3 CAN tests were abnormal. Clinical and radiographic variables such as age, sex, disease duration, erythrocyte sedimentation rate (ESR) and bone destruction, were analyzed in patients with or without autonomic nervous dysfunction. Results: In patients with RA, the frequency of autonomic nervous dysfunction was higher than healthy controls (50.8% in RA vs 15.5% in healthy controls, p<0.05). Age, sex, disease duration, ESR and bone destruction were not associated with autonomic nervous dysfunction in patients with RA. Conclusions: This results suggest that autonomic nervous dysfunction may be a significant feature in patients with RA.

직장암에서 자율신경보존술후 배뇨기능의 변화에 대한 요역동학적 연구

조원상,이상전,송영진 대한대장항문학회 1996 Annals of Coloproctolgy Vol.12 No.4

Effects of White-coat Hypertension on Heart Rate Recovery and Blood Pressure Response during Exercise Test

진솔,허정호,Bong Jun Kim 고신대학교(의대) 고신대학교 의과대학 학술지 2020 고신대학교 의과대학 학술지 Vol.35 No.2

Objectives: White-coat hypertension is defined as high blood pressure (BP) on clinical assessment but normal BP elsewhere or on ambulatory measurement. Autonomic dysfunction may be one of the mechanisms causing white-coat hypertension. Slowed heart rate recovery and excessive BP response during exercise test are associated with autonomic dysfunction. The purpose of this study was to determine the association between white-coat hypertension and abnormal autonomic nervous system response. Methods: We assessed 295 patients stratified into three groups via 24hr ambulatory BP monitoring, following 2017 ACC/AHA guidelines : normal BP group, white-coat hypertension group, and a hypertension group. We analyzed medical history, blood test, echocardiography, 24hr ambulatory BP monitoring, and exercise test data. Results: There was no difference in basement characteristics and echocardiography among the groups. Blunted heart rate recovery of each group showed a significant difference. Control group had 0% blunted heart rate recovery, but 33.3% in white coat group and 27.6% in true hypertension group (P < 0.001). Also, in the control group, 4.5% showed excessive BP response, but 31.5% in the white coat hypertension group and 29.3% in the true hypertension group (P < 0.001). Excessive BP response during the exercise test or blunted heart rate recovery, which is an indicator of autonomic nervous system abnormality, was more common in the hypertensive group and white-coat hypertension group than in the normal BP group. Conclusions: These results confirmed that white-coat hypertension has an autonomic nervous system risk. Therefore, white-coat hypertension can be a future cardiovascular risk factor.

독활지황탕가미방을 포함한 한의치료로 자율신경장애가 호전된 MSA-C 환자에 대한 치험 1례

허경화,김동주,허혜민,황예채,조승연,박정미,고창남,박성욱,Kyeong-Hwa Heo,Dong-Joo Kim,Hye-Min Heo,Ye-Chae Hwang,Seung-Yeon Cho,Jung-Mi Park,Chang-Nam Ko,Seong-Uk Park 대한중풍순환신경학회 2023 대한중풍.순환신경학회지 Vol.24 No.1

■Objectives This study is to report the effectiveness of Korean medicine on the treatment for multiple system atropy(MSA-C) patient complaining of autonomic dysfunction. ■Methods The patient was treated with Korean medicine(mainly DokhwalJihwang-tang Gami-bang) for 39 days. The evaluations were performed using UMSARS(Unified Multiple System Atrophy Rating Scale), SCOPA-AUT(The Scale for Outcomes in Parkinson's disease-Autonomic), K-OGS(Korean version of the Orthostatic Grading Scale). ■Results After treatment, the UMSARS score decreased from 25 to 18, the SCOPA-AUT score decreased from 21 to 14, K-OGS score decrease from 15 to 8. ■Conclusion This case suggests that Korean medicine treatment may be effective for MSA-C patients with autonomic dysfuction.

Hyperperfusion Syndrome after Carotid Stent-Supported Angioplasty in Patients with Autonomic Dysfunction

Kim, Dong-Eun,Choi, Seong-Min,Yoon, Woong,Kim, Byeong C. The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.52 No.5

Cerebral hyperperfusion syndrome (CHS) is a rare, serious complication of carotid revascularization either after carotid endarterectomy or carotid stent placement. Although extensive effort has been devoted to reducing the incidence of CHS, little is known about the prevention. Postprocedural hypertension is very rare due to autoregulation of carotid baroreceptors but may occur if presented with autonomic dysfunction. We present two cases of CHS after cerebral revascularization that presented autonomic dysfunction.

자율신경 기능 이상을 동반한 Guillain-Barre 증후군 1례

김동웅,신선호,조권일,신학수,한명아,최진영,최우정,양재훈,정용준,김관식,Kim, Dong-Ung,Shin, Sun-Ho,Cho, Gwon-Il,Shin, Hak-Su,Han, Myung-A,Choi, Jin-Young,Choi, Woo-Jung,Yang, Jae-Hun,Chung, Yong-Jun,Kim, Kwan-Sick 대한한방내과학회 2001 大韓韓方內科學會誌 Vol.22 No.3

Guillain-Barre syndrome, or acute inflammatory demyelinating Polyradiculoneuropathy, is frequently accompanied by cardiac and autonomic dysfunction. We report a patient who had tachycardia, orthostatic hypotension, hypertension, pronounced blood pressure fluctuations, abnormal sweating, constipation and urinary frequency as well as qudriparesis. We thought that the GBS was incurred by Damp-Heat, used Heat-Clearing and Dampness-Transforming decoction(Chongjoo-tang) in the early stage. In the later stage, fortifying the Spleen and Boosting Qi plus Supplementing the Kidney decoction(Palmultang+chongawon) was used to remove low back pain and boost recovery. The patient reached the nadir 14 days after onset. He became bed-bound and autonomic dysfunction was very severe. From 3rd week, abnormalities of autonomic function and paresis impoved gradually and he could walk above 5m without walker or equivalent support at the 5th week after onset.

Indomethacin 이 말기 신부전증 환자의 자율신경계 기능에 미치는 영향에 관한 연구

하성규(Sung Kyu Ha),한대석(Dae Suk Han),주현영(Hyung Young Ju),김형직(Hyung Jik Kim),구철회(Chul Hoe Koo),김문재(Moon Jae Kim),이호영(Ho Yung Lee) 대한내과학회 1987 대한내과학회지 Vol.33 No.2

N/A The authors studied autonomic nervous system fucntion in 63 patients with uremia and 56 normal control subjects. Among these, automonic nervous system function was evaluated in 11 normal control subjects, 18 hemodialysis patients and 6 CAPD patients before and after indomethacin administration. The results were as follow: 1) The valsalva ratio and heart rate variation ratio were significantly lower in CRF group than normal control group (p<0.05); however, there was no statistically significant differences among CRF patient group (p<0.l). 2) The change of diastoloic blood pressure after orthostasis was significantly lower in CRF group than normal control group (p<0.05). The heart rate was more rapid in normal cantrol group, hemoidalysis patients group and CAPD patient group than predialysis patient group (p<0.05). 3) The change of blood pressure after hand grip exercise was lower in predialysis (p<0.05), The degree of increase in heart rate was lower in predialysis patients than normal control group. 4) Although the valsalva ratio and heart rate variation ratio seem to improve after indomethacin administration, they were not statistically significanct (p<0.1), The change of heart rate in response to valsalva maneuver after indomethacin administration was not sign-ficiant (p<0.1). 5) The change in blood pr re and heart rate before and after indomethacin administration were not statistically significant (p>0.05). However, there was significant increase in systologic and diastolic blood pressure in CAFD patients with hand grip exercise after indomethacin administration (p<0.025). In summary, the function of ANS in patients with CRF was significantly reduced than the normal control group. Although, the function of ANS seemed to improve slightly after indomethacin administration in patients with CRF, the results were not satatistically significant, The prostaglandin has been proposed to play a role in ANS dysfunction. However, the results of this study does not seem to support this theory. Futher studies would be required in odrer to show the role of prostaglandin in ANS dysfunction in patients with CRF.