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Botulism: Heart Rate Variation, Sympathetic Skin Responses, and Plasma Norepinephrine

Published online by Cambridge University Press:  05 August 2019

J.T. Chen ,
C.C. Chen ,
K.P. Lin ,
S.J. Wang ,
Z.A. Wu  and
K.K. Liao
J.T. Chen
Affiliation:
Department of Neurology, the Neurological Institute, Veterans General Hospital–Taipei and National Yang-Ming University School of Medicine, 201, Sec. 2, Shih-Pai Rd., Peitou District, Taipei, Taiwan, 11217, R.O.C.
C.C. Chen
Affiliation:
Department of Neurology, the Neurological Institute, Veterans General Hospital–Taipei and National Yang-Ming University School of Medicine, 201, Sec. 2, Shih-Pai Rd., Peitou District, Taipei, Taiwan, 11217, R.O.C.
K.P. Lin
Affiliation:
Department of Neurology, the Neurological Institute, Veterans General Hospital–Taipei and National Yang-Ming University School of Medicine, 201, Sec. 2, Shih-Pai Rd., Peitou District, Taipei, Taiwan, 11217, R.O.C.
S.J. Wang
Affiliation:
Department of Neurology, the Neurological Institute, Veterans General Hospital–Taipei and National Yang-Ming University School of Medicine, 201, Sec. 2, Shih-Pai Rd., Peitou District, Taipei, Taiwan, 11217, R.O.C.
Z.A. Wu
Affiliation:
Department of Neurology, the Neurological Institute, Veterans General Hospital–Taipei and National Yang-Ming University School of Medicine, 201, Sec. 2, Shih-Pai Rd., Peitou District, Taipei, Taiwan, 11217, R.O.C.
K.K. Liao*
Affiliation:
Department of Neurology, the Neurological Institute, Veterans General Hospital–Taipei and National Yang-Ming University School of Medicine, 201, Sec. 2, Shih-Pai Rd., Peitou District, Taipei, Taiwan, 11217, R.O.C.
*
Reprint requests to: KK Liao, MD, Neurological Institute, Veterans General Hospital - Taipei, Taiwan 11217
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Abstract:

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Background:

Botulism may involve the autonomic nervous system.

Methods:

We assessed the autonomic function of 6 botulism patients with heart rate variations, sympathetic skin responses, and plasma norepinephrine.

Results:

Two weeks after onset, all the patients had absent sympathetic skin response in the palm and sole. Compared with controls, the heart rate variation of botulism patients was significantly decreased at rest (3.1 ± 1.2% vs. 20.9 ± 2.0%, p = 0.0018) and during deep breathing (4.3 ± 2.3% vs. 29.7 ± 2.6%, p = 0.0018). The botulism patients had significantly lower plasma norepinephrine levels (supine 29.2 ± 10.1 pg/ml vs. 257.5 ± 65.8 pg/ml, p = 0.0018; standing 40.3 ± 13.1 pg/ml vs. 498.5 ± 85.6 pg/ml, p = 0.0018). The heart rate variation and sympathetic skin response was greatly improved 6 months after onset.

Conclusions:

Heart rate variation, absence of sympathetic skin response, and low plasma norepinephrine are all manifestations of autonomic dysfunction in botulism patients.

Résumé:

Résumé:Introduction:

Le botulisme peut toucher le système nerveux autonome.

Méthodes:

Nous avons mesuré les variations du rythme cardiaque, les réponses cutanées sympathiques et la norépinéphrine plasmatique pour évaluer la fonction du système nerveux autonome chez 6 patients atteints de botulisme.

Résultats:

Deux semaines après le début de la maladie, tous les patients présentaient une absence de réponse cutanée sympathique au niveau de la paume des mains et de la plante des pieds. La variation du rythme cardiaque des patients était significativement diminuée au repos par rapport aux contrôles (3.1 1.2% vs 20.9 2.0%, p = 0.0018) et pendant la respiration profonde (4.3 2.3% vs 29.7 2.6%, p = 0.0018). Les patients atteints de botulisme avaient des niveaux significativement plus bas de norépinéphrine plasmatique (29.2 ± 10.1 pg/ml vs 257.5± 65.8 pg/ml en décubitus dorsal, p = 0.0018; 40.3 ± 13.1 pg/ml vs 498.5 ± 85.6 pg/ml en position debout, p = 0.0018). La variation du rythme cardiaque et la réponse cutanée sympathique se sont beaucoup améliorées 6 mois après le début de la maladie.

Conclusions:

Notre étude suggère que la variation du rythme cardiaque, la réponse cutanée sympathique et la norépinéphrine plasmatique pourraient refléter la dysfonction neurovégétative chez les patients atteints de botulisme.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 2 , May 1999 , pp. 123 - 126
Copyright
Copyright © The Canadian Journal of Neurological 1999

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