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Evaluation of autonomic nervous system function with spectral analysis of heart rate variability in a case of tetanus

      Abstract

      The autonomic nervous system is affected in a wide variety of neurological disorders. Its dysfunction may play an important role in the clinical course and may result in serious complications, such as cardiac arrest. We report a case of tetanus who presented with severe autonomic nervous system dysfunction which was detected by spectral analysis of heart rate variability monitored over 24 h. This is a semi-quantitative method for evaluation of the status of the autonomic nervous system. In the present case, the analysis revealed profoundly decreased activity of both sympathetic and parasympathetic nervous system modulation of cardiac rhythm. The parasympathetic nervous system activity was more severely impaired than that of the sympathetic nervous system. The relative predominance of the sympathetic nervous system in the present case may have resulted in unopposed sympathetic nervous system hyperactivity manifested in this patient by tachycardia and excessive sweating. We further infer that the documented diminished buffering capacity of the autonomic nervous system may have lead to a sudden cardiac arrest in our case. Thus, spectral analysis of heart rate variability is a non-invasive and sensitive method for evaluating the status of the autonomic nervous system of critically ill patients in the hospital setting.

      Keywords

      Abbreviations:

      ANS, autonomic nervous systems (), SNS, sympathetic nervous systems (), PNS, parasympathetic nervous systems (), HRV, heart rate variability (), DTP, diphtheria, tetanus, and pertussis (), EEG, electroencephalogram (), ECG, electrocardiogram ()
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      References

        • Kandel E.R
        • Schwartz J.H
        • Jessel T.M
        Principles of neural science. 4th ed. Appleton & Lange, Norwalk, CT1999
        • Swaiman K.F
        • Ashwal S
        Pediatric neurology principles & practice. 3rd ed. Mosby, Inc, St. Louis, MO1999
        • Prys-Roberts C
        • Corbett J.L
        • Kerr J.H
        • Smith A.C
        • Spalding J.M
        Treatment of sympathetic overactivity in tetanus.
        Lancet. 1969; 1: 542-545
        • Kautzner J
        • Camm A.J
        Clinical relevance of heart rate variability.
        Clin Cardiol. 1997; 20: 162-168
        • Hoffman R.P
        • Kienzle M.G
        Circadian control of heart rate in young insulin-dependent diabetes mellitus patients.
        J Diabetes Complications. 1996; 10: 220-222
        • Wawryk A.M
        • Bates D.J
        • Couper J.J
        Power spectral analysis of heart rate variability in children and adolescents with IDDM.
        Diabetes Care. 1997; 20: 1416-1421
        • Massin M.M
        • Derkenne B
        • Tallsund M
        • Rocour-Brumioul D
        • Ernould C
        • Lebrethon M.C
        • et al.
        Cardiac autonomic dysfunction in diabetic children.
        Diabetes Care. 1999; 22: 1845-1850
        • Pfeiffer G
        • Netzer J
        Spectral analysis of heart rate and blood pressure in Guillain–Barré patients with respiratory failure.
        J Neurol Sci. 1997; 150: 39-48
        • Yotsukura M
        • Sasaki K
        • Kachi E
        • Sasaki A
        • Ishihara T
        • Ishikawa K
        Circadian rhythm and variability of heart rate in Duchenne-type progressive muscular dystrophy.
        Am J Cardiol. 1995; 76: 947-951
        • Yotsukura M
        • Fujii K
        • Katayama A
        • Tomono Y
        • Ando H
        • Sakata K
        • et al.
        Nine-year follow-up study of heart rate variability in patients with Duchenne-type progressive muscular dystrophy.
        Am Heart J. 1998; 136: 289-296
        • Mandell G.L
        • Bennett J.E
        • Dolin R
        Principles and practice of infectious diseases. 5th ed. Churchill Livingstone, Philadelphia, PA2000
        • Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology
        Heart rate variability. Standards of measurement, physiological interpretation, and clinical use.
        Circulation. 1996; 93: 1043-1065
        • Malliani A
        • Lombardi F
        • Pagani M
        Power spectrum analysis of heart rate variability: a tool to explore neural regulatory mechanisms.
        Br Heart J. 1994; 71: 1-2
        • Bernardi L
        • Ricordi L
        • Lazzari P
        • Solda P
        • Calciati A
        • Ferrari M.R
        • et al.
        Impaired circadian modulation of sympathovagal activity in diabetes. A possible explanation for altered temporal onset of cardiovascular disease.
        Circulation. 1992; 86: 1443-1452
        • Domenighetti G.M
        • Savary G
        • Stricker H
        Hyperadrenergic syndrome in severe tetanus: extreme rise in catecholamines responsive to labetalol.
        Br Med J (Clin Res Ed). 1984; 288: 1483-1484
        • Wesley A.G
        • Hariparsad D
        • Pather M
        • Rocke D.A
        Labetalol in tetanus. The treatment of sympathetic nervous system overactivity.
        Anaesthesia. 1983; 38: 243-249
        • Moughabghab A.V
        • Prevost G
        • Socolovsky C
        Fentanyl therapy controls autonomic hyperactivity in tetanus.
        Br J Clin Pract. 1996; 50: 477-478
        • Lindahl S.G
        • Dahlgren N
        • Lundberg D
        • Norden N
        Adrenergic hyperactivity and epidural block in severe tetanus. A case report.
        Acta Anaesthesiol Scand. 1985; 29: 87-89
        • Meckler R.L
        • Baron R
        • McLachlan E.M
        Selective uptake of C-fragment of tetanus toxin by sympathetic preganglionic nerve terminals.
        Neuroscience. 1990; 36: 823-829
        • Rie M.A
        • Wilson R.S
        Morphine therapy controls autonomic hyperactivity in tetanus.
        Ann Intern Med. 1978; 88: 653-654
        • Rocke D.A
        • Wesley A.G
        • Pather M
        • Calver A.D
        • Hariparsad D
        Morphine in tetanus — the management of sympathetic nervous system overactivity.
        S Afr Med J. 1986; 70: 666-668