Introduction: It is common to find people sent to perform a Head Up Tilt Test (HUT) who suffered a single syncope, or syncopes that occur during certain periods and never appear again. We wonder how these people are d...Introduction: It is common to find people sent to perform a Head Up Tilt Test (HUT) who suffered a single syncope, or syncopes that occur during certain periods and never appear again. We wonder how these people are different from those who have never had syncope. Methods: We found 300 patients who suffered only one (unique) or a maximum of 5 vasovagal syncopes during their life. And their HUT was positive for vasovagal dysautonomia. We compared them, with 120 healthy volunteers who have never had syncope. We try to explain how some constitutional predisposing factors act in these patients, and are associated with environmental triggers to precipitate the syncope. Results: We found differences between cases and controls in predisposing factors such as: heredity, joint hypermobility, baroreflex failure, venous compliance and some neurological diseases. Then an environmental factor acts as a trigger for syncope: prolonged standing, stress, pain and emotions, dehydration, use of certain drugs, abundant food. Conclusions: There are people with minimally expressed vasovagal dysautonomia who have an organic predisposition to present vasovagal syncopes (heredity, joint hypermobility, baroreflex failure, venous compliance, some neurological diseases, etc.). But this predisposition is not enough by itself to produce syncopes. One or more environmental factors must be added, acting as a trigger that would be the reason why these episodes are so infrequent.展开更多
Multiple system atrophy is a sporadic,progressive,adult-onset,neurodegenerative disorder characte rized by autonomic dysfunction symptoms,parkinsonian features,and cerebellar signs in va rious combinations.An early di...Multiple system atrophy is a sporadic,progressive,adult-onset,neurodegenerative disorder characte rized by autonomic dysfunction symptoms,parkinsonian features,and cerebellar signs in va rious combinations.An early diagnosis of multiple system atrophy is of utmost impo rtance for the proper prevention and management of its potentially fatal complications leading to the poor prognosis of these patients.The current diagnostic criteria incorporate several clinical red flags and magnetic resonance imaging marke rs supporting diagnosis of multiple system atrophy.Nonetheless,especially in the early disease stage,it can be challenging to differentiate multiple system atrophy from mimic disorders,in particular Parkinson’s disease.Electromyography of the external anal sphincter represents a useful neurophysiological tool for diffe rential diagnosis since it can provide indirect evidence of Onuf’s nucleus degeneration,which is a pathological hallmark of multiple system atrophy.However,the diagnostic value of external anal sphincter electromyography has been a matter of debate for three decades due to controve rsial reports in the literature.In this review,after a brief ove rview of the electrophysiological methodology,we first aimed to critically analyze the available knowledge on the diagnostic role of external anal sphincter electromyography.We discussed the conflicting evidence on the clinical correlations of neurogenic abnormalities found at external anal sphincter electro myography.Finally,we repo rted recent prognostic findings of a novel classification of electromyography patterns of the external anal sphincter that could pave the way toward the implementation of this neurophysiological technique for survival prediction in patients with multiple system atrophy.展开更多
Introduction and Objectives: In patients with Post-Acute Sequelae of Coronavirus 2 infection (PASC), a post infectious autonomic dysfunction may be one of the underlying mechanisms. Patients often present with exercis...Introduction and Objectives: In patients with Post-Acute Sequelae of Coronavirus 2 infection (PASC), a post infectious autonomic dysfunction may be one of the underlying mechanisms. Patients often present with exercise intolerance and exaggerated heart rate response to exercise. We report a single centre experience of patients with PACS and suspected autonomic dysfunction. Methods: Forty-two patients evaluated in the Outpatient Cardiology Department with suspected PASC were included in the study. Patients complained of compromised exercise performance persisting >3 months after recovery from COVID-19 infection, compared to the pre-COVID-19 period. The patients were evaluated with 12-lead electrocardiogram, echocardiography, 24-hour ECG ambulatory monitoring and either exercise stress test or a 6-minute walk test. Results: All 42 patients demonstrated an exaggerated chronotropic response, defined as the inappropriate increase in heart rate before the 6th minute of exercise >100% of the age-predicted maximal heart rate value with reproduction of clinical symptoms. In addition, 24-hour ambulatory electrocardiography revealed an increased mean heart rate of 92 beats/minute and decreased mean standard deviation of sequential 5-minute N-N interval (SDNN) of 74.4 ms. Pharmaceutical treatment with b-blockers, ivabradine or both was administrated in 29 (69%) resulting in symptomatic improvement in 82.8% of those under treatment. However, residual symptoms persisted in 69% of patients after 3 months. Conclusions: In patients with “Post-acute COVID-19” syndrome, we found an excessive chronotropic response to exercise suggesting autonomic dysfunction as the underlying mechanism of symptoms. Treatment with beta blockers or ivabradine resulted in clinical improvement but a substantial proportion of patients remained symptomatic.展开更多
Familial dysautonomia （FD） is a rare children neurodegenerative disease caused due to a point mutation in the IKBKAP gene that results in decreased IKK complex-associated protein （IKAP） protein production. The dis...Familial dysautonomia （FD） is a rare children neurodegenerative disease caused due to a point mutation in the IKBKAP gene that results in decreased IKK complex-associated protein （IKAP） protein production. The disease affects mostly the dorsal root ganglion （DRG） and the sympathetic ganglion. Recently, we found that the molecular mechanisms underlying neurodegeneration in FD patients are defects in axonal transport of nerve growth factors and microtubule stability in the DRG. Neurons are highly polarized cells with very long axons. In order to survive and maintain proper function, neurons depend on transport of proteins and other cellular components from the neuronal body along the axons. We further demonstrated that IKAP is necessary for axon maintenance and showed that phosphatidylserine acts as an HDAC6 inhib- itor to rescue neuronal function in FD cells. In this review, we will highlight our latest research findings.展开更多
Findings in 1656 patients referred for evaluation of Ehlers-Danlos syndrome, 710 evaluated systematically using novel history and physical forms, defined a characteristic clinical pattern termed arthritis-adrenaline d...Findings in 1656 patients referred for evaluation of Ehlers-Danlos syndrome, 710 evaluated systematically using novel history and physical forms, defined a characteristic clinical pattern termed arthritis-adrenaline disorder, a genus that provides immediate therapy while delineation of particular tissue laxity/dysautonomia species is underway. Preliminary diagnoses, clinical findings, and laboratory results were entered into an MS Excel? database with IRB approval and correlations or statistical significance analyzed using Excel? functions. Frequencies of 80 findings by history and 40 on physical were similar among EDS groups, females paralleling males with more total history (35 versus 23) and physical (18 versus 15) findings. Finding frequencies in joint-skeletal (6.2 of 15) and dysautonomia (11 of 20) subcategories were substantial regardless of age, EDS diagnosis, or referral source, the latter was shown by 6.4 and 13 average findings for cardiology, 5.3 and 8.3 for orthopedic referrals. Early affliction evidenced by history findings averaging 19.5 in those under 12 increased dramatically to 25 for teens and 32 for adults with plateauing at older ages arguing against degenerative disease. Frequent neuromuscular symptoms in females emphasize surrounding muscle support and protection of joint-connective tissue as a key factor in decreased male severity. The congruent clinical profile suggests operation of an articulo-autonomic dysplasia cycle where lax vessels and lower body pooling elicit sympathetic response, autonomic imbalance in turn affecting small nerve fibers and enhancing connective tissue laxity. Recognition of this arthritis-adrenalin disorder can guide management strategies while underlying causes are pursued, among them, physical therapy, exercise, and vitamin D to build muscle/bone strength;lower gluten/dairy and antihistamine protocols for low bowel motility/mast-cell activation;hydration, salt, and exercise for postural orthostatic tachycardia syndrome.展开更多
<strong>Aim</strong><span><span><span style="font-family:;" "=""><strong>:</strong> To describe post-infectious neurological aspects of COVID-19 in a ...<strong>Aim</strong><span><span><span style="font-family:;" "=""><strong>:</strong> To describe post-infectious neurological aspects of COVID-19 in a patient with progressive post-infectious peripheral (PNS), autonomic (ANS) and central nervous system (CNS) involvement due to SARS-CoV-2 infection. <b>Background</b> <b>and</b> <b><strong>Purpose</strong></b><strong>:</strong> A variety of neurological manifestations have been described in association with Covid-19, however</span></span></span><span><span><span style="font-family:;" "="">,</span></span></span><span><span><span style="font-family:;" "=""> progressive multisystem neurological aspects have not been described. <b><strong>Methods</strong></b><strong>:</strong> A case report detailing the history, examination, and infectious serology associated with SARS-CoV-2, and subsequent neurodiagnostic laboratory testing and treatment. <b><strong>Results</strong></b><strong>:</strong> Neurodiagnostic laboratory studies showed large-fiber demyelinating sensorimotor and painful small fiber sensory polyneuropathy, orthostatic hypotension, and hypometabolism of bilateral anterior and mesial temporal lobes with a possible frontal seizure focus. Treatment was initiated with high-dose immune globulin therapy. <b><strong>Conclusions</strong></b><strong>:</strong> The combination of PNS, ANS <span>and</span> CNS involvement in this patient was associated with post-infectious acquired immunity to SARS-CoV-2.</span></span></span>展开更多
Postural orthostatic tachycardia syndrome(POTS) is a relatively rare syndrome recognised since 1940. It is a heterogenous condition with orthostatic intolerance due to dysautonomia and is characterised by rise in hear...Postural orthostatic tachycardia syndrome(POTS) is a relatively rare syndrome recognised since 1940. It is a heterogenous condition with orthostatic intolerance due to dysautonomia and is characterised by rise in heart rate above 30 bpm from base line or to more than 120 bpm within 5-10 min of standing with or without change in blood pressure which returns to base line on resuming supine position. This condition present with various disabling symptoms such as light headedness, near syncope, fatigue, nausea, vomiting, tremor, palpitations and mental clouding, etc. However there are no identifiable signs on clinical examination and patients are often diagnosed to have anxiety disorder. The condition predominantly affects young female between the ages of 15-50 but is rarely described in older people. We describe an older patient who developed POTS which recovered over 12 mo. Recognising this condition is important as there are treatment options available to alleviate the disabling symptoms.展开更多
Small fiber polyneuropathy is a well-recognized syndrome mitigated by somatic sensory afferent and autonomic efferent nerve fibers that respectively mediate pain, heat and cold temperature afferent and autonomic effer...Small fiber polyneuropathy is a well-recognized syndrome mitigated by somatic sensory afferent and autonomic efferent nerve fibers that respectively mediate pain, heat and cold temperature afferent and autonomic efferent function in the skin. A patient with low serum titers of neuronal acetylcholine receptor ganglionic antibodies and autonomic failure had symptomatic small fiber polyneuropathy late in life in the setting of autoimmune dementia and encephalopathy and prostate cancer. Large and small fiber polyneuropathy and dysautonomia were detected in routine electrodiagnostic and autonomic laboratory studies, and epidermal nerve fiber analysis of the calf and thigh. Clinical improvement for one year concomitant with intravenous immune globulin therapy preceded?a?clinical?decline in neurocognitive function and death. Postmortem examination showed typical features of Alzheimer disease with neuropathic neuropathological changes in the peripheral nervous system,?and viable autonomic ganglia consistent with a channelopathy mechanism involving postsynaptic neuronal nAChRs.展开更多
There is some published evidence suggesting micro vascular endothelial dysfunction and dysautonomia involvement in Chagas disease in association with cardiomyocyte changes favoring disease progression. The combined tr...There is some published evidence suggesting micro vascular endothelial dysfunction and dysautonomia involvement in Chagas disease in association with cardiomyocyte changes favoring disease progression. The combined treatment between angiotensin converting enzyme (ACE) inhibitor drugs;Simvastatin, muscarinic antibody immunoadsorbent together with fungicidal drugs would open therapeutic possibilities in this disease.展开更多
It is not common to start suffering from syncopes after age 50. They are mainly male patients who present causes other than vasovagal syncope, which predominates at an early age. Orthostatic hypotension is the predomi...It is not common to start suffering from syncopes after age 50. They are mainly male patients who present causes other than vasovagal syncope, which predominates at an early age. Orthostatic hypotension is the predominant causal factor, which is attributed in many cases to advanced age, metabolic, cardiovascular or neurological diseases, to failure of baroreflexes, all of the above may be associated with the use of hypotensive drugs alone or in combination with psychotropic drugs. Furthermore, causes such as carotid sinus syncope, postprandial syncope and situational syncope become more frequent. Therefore, as people age, they present a favorable pathological terrain for the production of syncope. The older you are, the more likely you are to start with syncope. Finding the definitive diagnosis for their syncopes can be difficult, given the multiplicity of interacting factors. Their study is more exhaustive and requires a good anamnesis, knowing the drugs used by the patient, concomitant diseases and careful surveillance to get closer to the diagnosis.展开更多
This article reports a case of dysarthria which was successfully treated by Strannik Light Therapy (SLT). It briefly discusses the known etiology for the condition and illustrates that dysarthria must be a problem of ...This article reports a case of dysarthria which was successfully treated by Strannik Light Therapy (SLT). It briefly discusses the known etiology for the condition and illustrates that dysarthria must be a problem of autonomic dysfunction in which pathological changes can influence the structure and/or subsequent function of the dynamic interplay between the brain and the organs involving the autonomic nervous system and physiological systems. The author reports a particular case in which a patient undertaking SLT fully recovered the ability to speak within 6 days.展开更多
文摘Introduction: It is common to find people sent to perform a Head Up Tilt Test (HUT) who suffered a single syncope, or syncopes that occur during certain periods and never appear again. We wonder how these people are different from those who have never had syncope. Methods: We found 300 patients who suffered only one (unique) or a maximum of 5 vasovagal syncopes during their life. And their HUT was positive for vasovagal dysautonomia. We compared them, with 120 healthy volunteers who have never had syncope. We try to explain how some constitutional predisposing factors act in these patients, and are associated with environmental triggers to precipitate the syncope. Results: We found differences between cases and controls in predisposing factors such as: heredity, joint hypermobility, baroreflex failure, venous compliance and some neurological diseases. Then an environmental factor acts as a trigger for syncope: prolonged standing, stress, pain and emotions, dehydration, use of certain drugs, abundant food. Conclusions: There are people with minimally expressed vasovagal dysautonomia who have an organic predisposition to present vasovagal syncopes (heredity, joint hypermobility, baroreflex failure, venous compliance, some neurological diseases, etc.). But this predisposition is not enough by itself to produce syncopes. One or more environmental factors must be added, acting as a trigger that would be the reason why these episodes are so infrequent.
基金supported by the Italian Ministry of Health (’Ricerca Corrente’2020-2021)(to MT)。
文摘Multiple system atrophy is a sporadic,progressive,adult-onset,neurodegenerative disorder characte rized by autonomic dysfunction symptoms,parkinsonian features,and cerebellar signs in va rious combinations.An early diagnosis of multiple system atrophy is of utmost impo rtance for the proper prevention and management of its potentially fatal complications leading to the poor prognosis of these patients.The current diagnostic criteria incorporate several clinical red flags and magnetic resonance imaging marke rs supporting diagnosis of multiple system atrophy.Nonetheless,especially in the early disease stage,it can be challenging to differentiate multiple system atrophy from mimic disorders,in particular Parkinson’s disease.Electromyography of the external anal sphincter represents a useful neurophysiological tool for diffe rential diagnosis since it can provide indirect evidence of Onuf’s nucleus degeneration,which is a pathological hallmark of multiple system atrophy.However,the diagnostic value of external anal sphincter electromyography has been a matter of debate for three decades due to controve rsial reports in the literature.In this review,after a brief ove rview of the electrophysiological methodology,we first aimed to critically analyze the available knowledge on the diagnostic role of external anal sphincter electromyography.We discussed the conflicting evidence on the clinical correlations of neurogenic abnormalities found at external anal sphincter electro myography.Finally,we repo rted recent prognostic findings of a novel classification of electromyography patterns of the external anal sphincter that could pave the way toward the implementation of this neurophysiological technique for survival prediction in patients with multiple system atrophy.
文摘Introduction and Objectives: In patients with Post-Acute Sequelae of Coronavirus 2 infection (PASC), a post infectious autonomic dysfunction may be one of the underlying mechanisms. Patients often present with exercise intolerance and exaggerated heart rate response to exercise. We report a single centre experience of patients with PACS and suspected autonomic dysfunction. Methods: Forty-two patients evaluated in the Outpatient Cardiology Department with suspected PASC were included in the study. Patients complained of compromised exercise performance persisting >3 months after recovery from COVID-19 infection, compared to the pre-COVID-19 period. The patients were evaluated with 12-lead electrocardiogram, echocardiography, 24-hour ECG ambulatory monitoring and either exercise stress test or a 6-minute walk test. Results: All 42 patients demonstrated an exaggerated chronotropic response, defined as the inappropriate increase in heart rate before the 6th minute of exercise >100% of the age-predicted maximal heart rate value with reproduction of clinical symptoms. In addition, 24-hour ambulatory electrocardiography revealed an increased mean heart rate of 92 beats/minute and decreased mean standard deviation of sequential 5-minute N-N interval (SDNN) of 74.4 ms. Pharmaceutical treatment with b-blockers, ivabradine or both was administrated in 29 (69%) resulting in symptomatic improvement in 82.8% of those under treatment. However, residual symptoms persisted in 69% of patients after 3 months. Conclusions: In patients with “Post-acute COVID-19” syndrome, we found an excessive chronotropic response to exercise suggesting autonomic dysfunction as the underlying mechanism of symptoms. Treatment with beta blockers or ivabradine resulted in clinical improvement but a substantial proportion of patients remained symptomatic.
基金provided by grants from the Dysautonomia Foundation.Israel Science Foundation(ISF)[142/13,1439/14]by Teva Pharmaceutical Industries Ltd as part of the Israeli National Network of Excellence in Neuroscience(NNE)[1234944]+2 种基金supported by grants from the Israel Science Foundation(ISF)[561/11]the European Research Council(ERC)[309377]supported by grants from Teva Pharmaceutical Industries Ltd.under the Israeli National Network of Excellence in Neuroscience
文摘Familial dysautonomia （FD） is a rare children neurodegenerative disease caused due to a point mutation in the IKBKAP gene that results in decreased IKK complex-associated protein （IKAP） protein production. The disease affects mostly the dorsal root ganglion （DRG） and the sympathetic ganglion. Recently, we found that the molecular mechanisms underlying neurodegeneration in FD patients are defects in axonal transport of nerve growth factors and microtubule stability in the DRG. Neurons are highly polarized cells with very long axons. In order to survive and maintain proper function, neurons depend on transport of proteins and other cellular components from the neuronal body along the axons. We further demonstrated that IKAP is necessary for axon maintenance and showed that phosphatidylserine acts as an HDAC6 inhib- itor to rescue neuronal function in FD cells. In this review, we will highlight our latest research findings.
文摘Findings in 1656 patients referred for evaluation of Ehlers-Danlos syndrome, 710 evaluated systematically using novel history and physical forms, defined a characteristic clinical pattern termed arthritis-adrenaline disorder, a genus that provides immediate therapy while delineation of particular tissue laxity/dysautonomia species is underway. Preliminary diagnoses, clinical findings, and laboratory results were entered into an MS Excel? database with IRB approval and correlations or statistical significance analyzed using Excel? functions. Frequencies of 80 findings by history and 40 on physical were similar among EDS groups, females paralleling males with more total history (35 versus 23) and physical (18 versus 15) findings. Finding frequencies in joint-skeletal (6.2 of 15) and dysautonomia (11 of 20) subcategories were substantial regardless of age, EDS diagnosis, or referral source, the latter was shown by 6.4 and 13 average findings for cardiology, 5.3 and 8.3 for orthopedic referrals. Early affliction evidenced by history findings averaging 19.5 in those under 12 increased dramatically to 25 for teens and 32 for adults with plateauing at older ages arguing against degenerative disease. Frequent neuromuscular symptoms in females emphasize surrounding muscle support and protection of joint-connective tissue as a key factor in decreased male severity. The congruent clinical profile suggests operation of an articulo-autonomic dysplasia cycle where lax vessels and lower body pooling elicit sympathetic response, autonomic imbalance in turn affecting small nerve fibers and enhancing connective tissue laxity. Recognition of this arthritis-adrenalin disorder can guide management strategies while underlying causes are pursued, among them, physical therapy, exercise, and vitamin D to build muscle/bone strength;lower gluten/dairy and antihistamine protocols for low bowel motility/mast-cell activation;hydration, salt, and exercise for postural orthostatic tachycardia syndrome.
文摘<strong>Aim</strong><span><span><span style="font-family:;" "=""><strong>:</strong> To describe post-infectious neurological aspects of COVID-19 in a patient with progressive post-infectious peripheral (PNS), autonomic (ANS) and central nervous system (CNS) involvement due to SARS-CoV-2 infection. <b>Background</b> <b>and</b> <b><strong>Purpose</strong></b><strong>:</strong> A variety of neurological manifestations have been described in association with Covid-19, however</span></span></span><span><span><span style="font-family:;" "="">,</span></span></span><span><span><span style="font-family:;" "=""> progressive multisystem neurological aspects have not been described. <b><strong>Methods</strong></b><strong>:</strong> A case report detailing the history, examination, and infectious serology associated with SARS-CoV-2, and subsequent neurodiagnostic laboratory testing and treatment. <b><strong>Results</strong></b><strong>:</strong> Neurodiagnostic laboratory studies showed large-fiber demyelinating sensorimotor and painful small fiber sensory polyneuropathy, orthostatic hypotension, and hypometabolism of bilateral anterior and mesial temporal lobes with a possible frontal seizure focus. Treatment was initiated with high-dose immune globulin therapy. <b><strong>Conclusions</strong></b><strong>:</strong> The combination of PNS, ANS <span>and</span> CNS involvement in this patient was associated with post-infectious acquired immunity to SARS-CoV-2.</span></span></span>
文摘Postural orthostatic tachycardia syndrome(POTS) is a relatively rare syndrome recognised since 1940. It is a heterogenous condition with orthostatic intolerance due to dysautonomia and is characterised by rise in heart rate above 30 bpm from base line or to more than 120 bpm within 5-10 min of standing with or without change in blood pressure which returns to base line on resuming supine position. This condition present with various disabling symptoms such as light headedness, near syncope, fatigue, nausea, vomiting, tremor, palpitations and mental clouding, etc. However there are no identifiable signs on clinical examination and patients are often diagnosed to have anxiety disorder. The condition predominantly affects young female between the ages of 15-50 but is rarely described in older people. We describe an older patient who developed POTS which recovered over 12 mo. Recognising this condition is important as there are treatment options available to alleviate the disabling symptoms.
文摘Small fiber polyneuropathy is a well-recognized syndrome mitigated by somatic sensory afferent and autonomic efferent nerve fibers that respectively mediate pain, heat and cold temperature afferent and autonomic efferent function in the skin. A patient with low serum titers of neuronal acetylcholine receptor ganglionic antibodies and autonomic failure had symptomatic small fiber polyneuropathy late in life in the setting of autoimmune dementia and encephalopathy and prostate cancer. Large and small fiber polyneuropathy and dysautonomia were detected in routine electrodiagnostic and autonomic laboratory studies, and epidermal nerve fiber analysis of the calf and thigh. Clinical improvement for one year concomitant with intravenous immune globulin therapy preceded?a?clinical?decline in neurocognitive function and death. Postmortem examination showed typical features of Alzheimer disease with neuropathic neuropathological changes in the peripheral nervous system,?and viable autonomic ganglia consistent with a channelopathy mechanism involving postsynaptic neuronal nAChRs.
文摘There is some published evidence suggesting micro vascular endothelial dysfunction and dysautonomia involvement in Chagas disease in association with cardiomyocyte changes favoring disease progression. The combined treatment between angiotensin converting enzyme (ACE) inhibitor drugs;Simvastatin, muscarinic antibody immunoadsorbent together with fungicidal drugs would open therapeutic possibilities in this disease.
文摘It is not common to start suffering from syncopes after age 50. They are mainly male patients who present causes other than vasovagal syncope, which predominates at an early age. Orthostatic hypotension is the predominant causal factor, which is attributed in many cases to advanced age, metabolic, cardiovascular or neurological diseases, to failure of baroreflexes, all of the above may be associated with the use of hypotensive drugs alone or in combination with psychotropic drugs. Furthermore, causes such as carotid sinus syncope, postprandial syncope and situational syncope become more frequent. Therefore, as people age, they present a favorable pathological terrain for the production of syncope. The older you are, the more likely you are to start with syncope. Finding the definitive diagnosis for their syncopes can be difficult, given the multiplicity of interacting factors. Their study is more exhaustive and requires a good anamnesis, knowing the drugs used by the patient, concomitant diseases and careful surveillance to get closer to the diagnosis.
文摘This article reports a case of dysarthria which was successfully treated by Strannik Light Therapy (SLT). It briefly discusses the known etiology for the condition and illustrates that dysarthria must be a problem of autonomic dysfunction in which pathological changes can influence the structure and/or subsequent function of the dynamic interplay between the brain and the organs involving the autonomic nervous system and physiological systems. The author reports a particular case in which a patient undertaking SLT fully recovered the ability to speak within 6 days.
