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Stephen Porges’s polyvagal theory proposes to integrate various scientific disciplines such as anatomy, physiology, psychophysiology, evolutionary and developmental biology, social sciences and psychotherapy together with special evolutionary features of the vagus nerve in mammals putatively claimed by polyvagal conjectures. This specifically involves linking neuroanatomical hypotheses about the vagus nerve with social and psychological concepts, especially regarding socioemotional behavior and conditions of extreme stress. These concepts have particularly found increasing popularity among trauma therapists, and have sometimes been described as groundbreaking, as in the last issue of this journal (Ackermann, 2024; Grassmann, 2024; Rahm & Meggyesy, 2024). However, there is a broad state-of-the-knowledge consensus among experts that the fundamental physiological hypotheses of the polyvagal theory are untenable and must be considered largely refuted. Furthermore, the major psychological constituents of polyvagal theory – attachment, co-regulation, social engagement, and intero ceptive processes beyond conscious awareness – each predate polyvagal speculations by decades; there is also a depth of thought and literature readily available that does not require physiological justifications for their uses in psychology or psychotherapy. For those desiring a more biological understanding of these processes, there are other models of explanation, integrating the entire nervous system, that correspond with current understanding of body and mind. [ABSTRACT FROM AUTHOR]

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Polyvagal theory is a neurobiological approach developed by Dr. Stephen W. Porges to explain the physiological basis of social behaviors and emotional responses from the perspective of the autonomic nervous system. The theory is based on an understanding of the vagus nerve and its role in the autonomic nervous system. The theory identifies three evolutionary layers of the autonomic nervous system that show different responses to threat and safety. The theory emphasizes that the ability to switch between the different vagus nerve modes is crucial for adaptation to social situations and for the perception of safety. A well-regulated ventral vagus contributes to a sense of safety and social connectedness. In a clinical setting, polyvagal theory can help to develop therapeutic approaches that promote the regulation of the autonomic nervous system. This article explores various aspects of this theory, including its application in a therapeutic context. [ABSTRACT FROM AUTHOR]

Somatic Experiencing (SE)®, as developed by Peter A. Levine, will be presented as a basic neuropsychological concept that is suitable in particular for the treatment of trauma-related disorders and psychosomatic illnesses, as it works directly with the symptoms of trauma-related dysregulation in the autonomic nervous system (ANS), which can find expression in multiple levels of experience. Through various techniques and a mindful, targeted use of interventions – both activating and calming – the innate self-regulating abilities of the ANS are restored and strengthened, in order to help process and integrate what has been experienced. Basic neurological principles as well as SE intervention techniques will be described, and the interplay of these techniques will be illustrated in three case studies. [ABSTRACT FROM AUTHOR]

In rare cases, an HSV-Encephalitis can lead to sinus node dysfunction, as was the case in this 70-year old woman who suffered from recurrent syncopes. Diagnostic work-up showed sinus bradycardias and short-lasting sinus arrests, primarily considered to be of cardiac etiology. After development of fever and neurological alteration, an HSV1 encephalitis was diagnosed. As our research of the current literature showed, the connection between the two is not completely clear. The HSVtypical infestation of the insular cortex, which influences the autonomic nervous system, should be discussed by all means. However, due to cessation of arrhythmia after seizure-suppressing therapy, we suspected an epileptic cause in this case. This shows the importance of a thorough differential diagnostic evaluation. [ABSTRACT FROM AUTHOR]

The human metabolic syndrome is accompanied by obesity, insulin dysregulation, arterial hypertension and cardiac dysfunction leading to an increased risk for heart diseases in the affected individuals. Insulin dysregulation can lead to an increased tone of the sympathetic nervous system. With the subsequent increased vascular tone, the perfusion in peripheral tissue might be reduced. Furthermore, increased sympathetic tone reduced the heart rate variability (HRV) and a reduction in HRV has been shown in patients suffering from metabolic syndrome even before an insulin resistance becomes clinical apparent. The equine metabolic syndrome (EMS) has several similitudes with the human metabolic syndrome. For instance, increased blood pressure has been reported in ponies with endocrine induced laminitis and this finding led to the hypothesis that endocrine induced laminitis was related to altered vascular tone in the dermal laminae within the hoof wall. Another study found an increased heart rate (HR) in ponies with EMS in comparison to a control population and a significant correlation between the left ventricular wall thickness and parameters of HRV as well as between left ventricular wall thickness and arterial blood pressure. However, no changes in the HRV could be shown in this population of ponies with EMS. Nevertheless, the aim of the presented study was to investigate further whether EMS had an effect on arterial blood pressure or the autonomic cardiac function in horses and whether the severity of general or regional adiposity was related to changes in parameters of HRV or arterial blood pressure. Therefore, the severity of general adiposity, regional adiposity and insulin resistance were assessed in horse with EMS and pooled in an EMS score. Further, heart rate variability was analyzed on recorded electrocardiograms to assess indirectly the autonomic function. Time domain parameters (mean HR; mean RR intervals; standard deviation of normal to normal RR intervals, SDNN; square root of mean squared differences between successive RR intervals, RMSSD) as well as frequency domain parameters (low frequency band, LF; high frequency band, HF; LF/HF ratio) were analyzed. Blood pressure was evaluated non-invasively at the coccygeal artery by oscillometry. 32 horses with EMS could be recruited for the study. The comparison between groups based on t tests or one-way ANOVAs showed that the HR (p=0.048) and pulse frequency (p=0.007) were increased in horses with more severe EMS score. Similarly, horses with severe insulin resistance (p=0.024) as well as obese ones (p=0.047) had increased HR. No difference could be documented in the analyzed parameters of HRV. Nevertheless, in our population older horses showed a shift of autonomic nervous tone towards sympathetic predominance (LF/HF, LF, HF each with p=0.014). In conclusion, we could show that the presence of severe obesity, the degree of insulin resistance and the EMS score had an influence on the HR. Horses with more severe degree of EMS had higher HR in our population. However, it was not possible to show a decrease in the parameters of HRV due to altered autonomous tone or an increased arterial blood pressure in the examined horses with EMS. [ABSTRACT FROM AUTHOR]

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Background: Neuropathic pain is difficult to diagnose and treat. Small fiber neuropathy (SFN) flies under the radar of nerve conduction studies., Objectives: The importance of a structured patient history and physical examination in the context of neuropathic pain is emphasized. Describing SFN as an important cause, the authors consider rare but partially treatable differential diagnoses. They conclude that autonomic symptoms are frequently associated, often presenting with diverse symptoms., Methods: A selective literature research to present SFN symptoms as well as differential diagnostic and therapeutic steps in the context of SFN and rare diseases focusing on the autonomic nervous system., Results: Neuropathic pain significantly reduces quality of life. To shorten the time until diagnosis and to initiate therapy, the authors recommend a structured patient history including sensory plus and minus symptoms and non-specific autonomic signs. If the initial search for the cause is not successful, rare causes such as treatable transthyretin (ATTR) amyloidosis and Fabry's disease or autoimmune causes should be considered, particularly in the case of progressive and/or autonomic symptoms., Conclusion: The diagnosis and therapy of rare SFN requires interdisciplinary collaboration and, in many cases, a referral to specialized centers to achieve the best patient care., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Heart rate variability is considered a marker of autonomous nervous system activity. Autonomic imbalance is found as a common component in a wide range of pathologies. It has been found to precede the onset of pathologic states and correlates with therapy response. In addition, heart rate variability at rest is a psychophysiological phenomenon with broad significance. Psychological experience affects physiological homeostasis, including immune processes, via the autonomous nerve system, which biologically underpins psychosomatic effects and makes them measurable by heart rate variability. The autonomous nerve system as the interface of this psychophysiological regulation is becoming increasingly important in heart rate variability research and allows a better understanding of the interactions between psyche, lifestyle, autonomous regulation and chronic illness. It requires a systemic, cross-organ view as well as an orientation towards long-term processes. The assessment and normalization of autonomic imbalance thus represents a novel therapeutic strategy from which numerous interventions and lifestyle modifications can be derived. Interventions that strengthen the vagal tone (aerobic or moderate physical training, relaxation techniques, vagus nerve stimulation, etc.) are becoming increasingly important. Despite the simple non-invasive measurement and popularity as a research instrument, interpretation is complex, and clinical implementation has been reluctant so far. Nevertheless, guidelines and data sets of reference values exist for users to apply. [ABSTRACT FROM AUTHOR]

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We report a 79-year-old female patient with recurrent episodes of presyncope/syncope over 15 years, accom panied by urge incontinence and nocturnal enuresis, referred to the psychosomtic ward, as her medical symptom swere unexplained. Based on a lack of neurological deficits, extensive clinical examinations with out any diagnostic cues, a typical history, orthostatic challenge a rdplasm a catecholam ine findings, we were able to diagnose pure autonomic failure. We could exclude psychosocial stress or a mental disorder as relevant causes for the symptoms. [ABSTRACT FROM AUTHOR]

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Modulation of the parasympathetic tone leads to extensive physiological reactions at several levels, including the decreased production of proinflammatory cytokines. Many studies have demonstrated that chronic inflammatory diseases are associated with reduced parasympathetic and increased sympathetic activities. Moreover, it was demonstrated that a low parasympathetic and a high sympathetic activity in patients with rheumatoid arthritis (RA) predicts a poor therapeutic response to anti-tumor necrosis factor (TNF) treatment compared to RA patients with a more balanced autonomic nervous system. The autonomic equilibrium could be restored by electrical stimulation of the vagus nerve. Considering the patients who do not sufficiently respond to the available drugs, patients for whom the effectiveness of the drugs wanes over time, or have drug-related adverse events, a nonpharmacological approach such as bioelectronics might be a useful supplement as an instrument in the successful extension of the therapeutic armamentarium for rheumatic diseases; however, there is a great need for further studies and the development of novel therapeutic strategies in the field of neuroimmunology., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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Spinal cord injuries (SCI) are serious medical conditions, which are associated with severe and potentially fatal risks and complications depending on the location and extent of injury. Traffic accidents, falls and recreational activities are the leading causes for traumatic SCI (TSCI) worldwide whereas non-traumatic spinal cord injuries (NTSCI) are mostly due to tumors and congenital diseases. As chronification of the injuries progresses other organ systems are affected including anatomical changes, the respiratory and cardiovascular systems and endocrinological pathways. All these effects have to be considered in the anesthesiological management of patients with SCI. Autonomic dysreflexia (AD) is the most dangerous and life-threatening complication in patients with chronic SCI above T6 that results from an overstimulation of sympathetic reflex circuits in the upper thoracic spine and can be fatal. This article summarizes the specific pathophysiology of SCI and how AD can be avoided as well as also providing anesthetists with strategies for perioperative and intensive care management of patients with SCI. [ABSTRACT FROM AUTHOR]

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Zusammenfassung Synergetik ist geeignet, komplexe Systeme „in Betrieb” zu beschreiben. Bei Personen, die Autogenes Training praktizieren, emergiert der retikuläre Rhythmus (retR) durch Synchronisation verschiedener physischer Parameter im gemeinsamen Hirnstammsystem in der Formatio reticularis bei afferentem Input. Der retR zeigt eine stabile Frequenz bei 0,15 ± 0,03 Hz (=9/min bzw. 6,67 s). Im vorliegenden Artikel wird diskutiert, inwieweit der retR dem Phänomen des „cranial rhythmic impulse” (CRI) zugrunde liegen könnte. Das autonome Nervensystem ist der Vermittler des retR sowie der Übertragungen in den faszialen, mesodermalen Raum. Osteopathen können ihre Erfahrungen mit einem Zustand der „relax response” nutzen, um intero- von exterozeptiven Wahrnehmungen zu unterscheiden. In diesem Zustand findet intraindividuelle und interindividuelle „physiologische Beziehungsarbeit” durch afferente Fazilitation des Patientengewebes im Sinne eines „tactile mirroring” des Therapeuten statt. Idealerweise führt das zu einem stabilen retR (bzw. CRI) in der Zweite-Person-Perspektive einer Metaperson von Patient und Therapeut. Inhärente Rhythmen haben nicht die eine treibende Kraft, sondern emergieren synergistisch aus vielen komplexen psychophysischen Synchronisationen. Synergetic is suitable to describe complex working systems. The reticular rhythm (retR) emerges by synchronization of different physical parameters in the reticular formation of the common brainstem by afferent input during autogenic training. The retR shows a stable frequency of 0,15 ± 0,03 Hz (=9/min bzw. 6,67 s). In this article is discussed to what extent the retR could underlie the phenomenon of the „cranial rhythmic impulse” (CRI). The autonomic nervous system is the mediator of the retR and its transfer into the fascial mesodermal space. Osteopaths are able to use their experiences of a „relax response” to differentiate between intero- and exteroceptive perceptions. Within this state intra- and interindividual „physiological relationship work” takes place by afferent facilitation of the patients' tissue in the sense of a „tactile mirroring” of the practitioner. Ideally, this causes a stable retR (resp. CRI) in a second-person-perspective of a metaperson of the patient and the practitioner. Inherent rhythms do not occur only by one force but emerge synergistically by complex psychophysical synchronization. [ABSTRACT FROM AUTHOR]

Zusammenfassung Die Herzratenvariabilität (HRV) ist eine häufig verwendete Messgröße für die Funktion des autonomen Nervensystems (ANS), das eine zentrale Rolle bei der Anpassungsfähigkeit eines Organismus spielt. Die Osteopathie hat die Bedeutsamkeit des ANS erkannt und integriert, bislang fehlen aber reproduzierbare wissenschaftliche Beweise für die Beeinflussung von Sympathikus und Parasympathikus durch osteopathische Techniken. Die aktuelle Studienlage zeigt die Möglichkeiten der HRV-Messung zur Therapiekontrolle auf und impliziert eine weitere Standardisierung der Messverfahren und ihre Nutzung zur Beurteilung der physischen und psychischen Regulationsfähigkeit. Heart rate variability (HRV) is frequently used as an indicator to measure autonomic nervous system (ANS) function, which plays a major role in the adaptability of an organism. Osteopathy has recognized and integrated the importance of the ANS, but so far there is a lack of reproducible scientific evidence for the influence of osteopathic techniques on the sympathetic and parasympathetic nervous system. Current research is showing the potential of using HRV-analysis to control therapeutic effects and implicates further standardization of the measuring procedure and its use to evaluate the ability of physical and psychological regulation. [ABSTRACT FROM AUTHOR]

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Gastrointestinal dysfunction is frequent during all stages of Parkinson's disease. The entire gastrointestinal tract becomes involved and symptoms include sialorrhea, dysphagia (difficulties swallowing), delayed gastric emptying, absorption problems and constipation. These non-motor symptoms can be manifested even prior to the initial Parkinson diagnosis, i.e. during the so-called premotor phase of the disorder and may serve as prodromal markers of the early non-motor disease phase. In addition to causing patients major discomfort and a reduced quality of life, such gastrointestinal complaints can also negatively influence the therapy with antiparkinsonian medications. Thus, delayed gastric emptying is an important cause of unforeseen motor fluctuations. Gastrointestinal dysfunction is attributable in part to the presence of synucleinopathy (Lewy pathology) both in the dorsal motor nucleus of the vagus nerve, which supplies the parasympathetic innervation of the gut from the distal esophagus to the left colonic flexure, as well as in the intramural Meissner and Auerbach plexuses of the enteric nervous system (ENS). In all probability the development of the lesions in the lower brainstem and in the ENS precedes neurodegeneration of the dopaminergic nigrostriatal system. From a diagnostic standpoint, neurologists need not only a carefully taken patient history and the clinical findings but also esophagography (barium study), gastric scintigraphy and assessment of the colonic transit time. The therapeutic options for impaired upper gastrointestinal tract motility are still limited. Sialorrhea can be reduced by prescribing anticholinergics or injections of botulinum toxin and the peristalsis can be modulated by domperidone. In the lower gastrointestinal tract, constipation can be conservatively treated by using macrogol (polyethylene glycol) and, in the future, perhaps by serotonine (5-HT4) agonists. [ABSTRACT FROM AUTHOR]

The article analyzes the heart rate variability (HRV) with an instant change of the intervals between consecutive normal heart beats. It states that the autonomic nervous system controls the changes in heart rate where the variability is a sign of good adaptability and healthy individual. It also mentions the non-invasive measurements the occur in HRV analysis including the time domain, frequency domain and non-linear techniques.

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Nocturnal cardiac arrhythmias occur in patients with obstructive sleep apnea as a consequence of autonomic effects of recurrent apneas with subsequent desaturation, arousal, and intrathoracic pressure changes. Bradyarrhythmias (BA) in obstructive sleep apnea (OSA) are induced by a cardioinhibitory vagal reflex due to the obstructed airway. Tachyarrhythmias in OSA and CSA-CSR (central sleep apnea and Cheyne-Stokes respiration) patients are mainly found in combination with cardiovascular comorbidity (coronary heart disease, chronic heart insufficiency), hypoxia and increased sympathetic activity. CPAP (continuous positive airway pressure) therapy has been demonstrated to reduce BA and TA significantly. Increases in apnea-associated sympathetic activity contribute to cardiovascular and cerebrovascular morbidity and mortality. [ABSTRACT FROM AUTHOR]