Autonomic Nervous System: Basic and Clinical Aspects

393 Pages·2018·23.792 MB·English

by  Daniel Pedro Cardinali

Daniel Pedro Cardinali
Autonomic
Nervous System
Basic and Clinical Aspects
123
Autonomic Nervous System
Daniel Pedro Cardinali
Autonomic Nervous
System
Basic and Clinical Aspects
Daniel Pedro Cardinali
Facultad de Ciencias Médicas
Pontificia Universidad Católica Argentina
Buenos Aires, Capital Federal
Argentina
ISBN 978-3-319-57570-4 ISBN 978-3-319-57571-1 (eBook)
DOI 10.1007/978-3-319-57571-1
Library of Congress Control Number: 2017949889
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Prologue
The autonomic nervous system (ANS) is an important component of the nervous
system consisting of a complex set of neurons and neural pathways that control the
function of the various visceral organ systems. The overall function of the ANS is to
maintain the body homeostasis and to react adaptively to changes in the external and
internal milieu.
The ANS innervates the heart, the smooth muscle in all the organs, the abdomi-
nal viscera, the exocrine and endocrine glands, and the immune system. Thus, the
ANS participates in the regulation of breathing, circulation, digestion, metabolism,
and the internal milieu, exocrine and endocrine gland secretion, immune responses,
body temperature, and reproduction [1, 2]. Unfortunately, such medical importance
tends to be underscored in many books on physiology or neural sciences in which
the subject takes up much less space than that accorded, for example, to somatosen-
sory or cognitive functions.
The basic structure and operation of the ANS were defined at the beginning of
the last century, primarily by Gaskell and Langley, who recognized its two main
divisions: the sympathetic and the parasympathetic [3]. Furthermore, Langley des-
ignated the enteric nervous system as a third division based on the submucous
plexus of Meissner and the myenteric plexus of Auerbach located in the wall of the
gastrointestinal tract, albeit controlled by the sympathetic and parasympathetic divi-
sions. Overcoming the classical concept of a purely efferent system, it is presently
accepted that the ANS is composed of visceral afferents, integration centers, par-
ticularly in the brainstem, hypothalamus, and limbic cortex, and visceral sympa-
thetic and parasympathetic efferents; thus, the ANS extends both into the central
nervous system (CNS) and to the periphery.
Conceptually, the bio-psycho-social-ecological nature of the individual is truly
expressed by the function of his or her ANS. Its name is misleading because none of
the components shows “autonomy” in an integrated body. Nor are they solely “pas-
sive” or generated “without elaboration by mind.” All body systems are dependent
and affected by the action of others in a multicellular organization.
These dynamic relationships are the core of homeostasis, a key concept in physiol-
ogy. “Homeostasis” is used today to define not only the strategies that allow the body’s
proper response to changes in the environment (reactive homeostasis), but also the
remarkably developed, temporal mechanisms that allow the body to predict the timing
of environmental stimuli (predictive homeostasis based on biological rhythms).
v
vi Prologue
Autonomic reflexes are mediated by neural pathways in the brainstem and spinal
cord and generally regulate organ and system performance very rapidly (in millisec-
onds). Autonomic control is also mediated by specific brain regions, such as the
hypothalamus, which is responsible for medium-term (minutes) and long-term
(hours/days) regulation of internal organ systems. Importantly, autonomic reflexes
are dynamic, where adaptations can alter rapid homeostatic control over longer time
scales [4].
This book discusses the ANS from both an enlarged and a timed perspective.
First, it presents how the organization of the ANS is built in four different hierarchi-
cal levels. Next, it discusses how the ANS function changes in the three body con-
figurations (wakefulness, slow- wave sleep, and rapid eye movement, REM, sleep)
found during a 24-h cycle. Finally, the most important clinical implications for this
enlarged and timed vision of the ANS are discussed.
The Autonomic Nervous System – Basic and Clinical Aspects is designed as a
comprehensive textbook for advanced medical students and health professionals. It
primes for a detailed and complete understanding of the neuroscience behind the
ANS and a proper clinical applicability of this knowledge. ANS dysfunction and
clinical manifestations involve multiple variables, which are often undervalued in
clinical practice. However, symptoms and signs of ANS disturbances should always
be considered according to their diagnostic implication, their impact on the quality
of life of patients, and their prognostic value for life expectancy.
References
1. Saper CB. The central autonomic nervous system: conscious visceral perception and auto-
nomic pattern generation. Annu Rev Neurosci. 2002;25:433–69.
2. Benarroch EE. The central autonomic network: functional organization, dysfunction, and per-
spective. Mayo Clin Proc. 1993;68:988–1001.
3. Oakes PC, Fisahn C, Iwanaga J, DiLorenzo D, Oskouian RJ, Tubbs RS. A history of the auto-
nomic nervous system: part II: from Reil to the modern era. Childs Nerv Syst. 2016;32:2309–15.
4. McDougall SJ, Munzberg H, Derbenev AV, Zsombok A. Central control of autonomic func-
tions in health and disease. Front Neurosci. 2014;8:440.
Contents
1 The Enlarged Autonomic Nervous System . . . . . . . . . . . . . . . . . . . . . . 1
The Control of Homeostasis Is the Most Important
Function of the ANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
There Are Functional Similarities in the Hierarchical Organization
of the Autonomic and Somatic Motor Pathways . . . . . . . . . . . . . . . . . . . 6
The Autonomic Posture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Basic Neuronal Organization of ANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2 The Timed Autonomic Nervous System . . . . . . . . . . . . . . . . . . . . . . . . 19
Biological Rhythms Are the Basis of Predictive Homeostasis . . . . . . . . . 20
The Sleep/Wake Cycle as the Major 24-h Rhythm . . . . . . . . . . . . . . . . . . 31
Neurophysiology of Sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Three Different ANS Programs (“Body Configurations”)
Occur in a 24-h Day/Night Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
The Meaning of Dreaming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
The Glymphatic System and Sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
3 F irst Level: Peripheral Sympathetic
and Parasympathetic Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . 57
The Organization of the ANS at a Peripheral
Level Comprises Two Neurons in a Series . . . . . . . . . . . . . . . . . . . . . . . . 58
Cholinergic and Adrenergic Neurotransmission
and Peptidergic Co-transmission Are the Basis
of the Peripheral Motor Constituents of the ANS . . . . . . . . . . . . . . . . . . . 63
Sensory Autonomic Neurons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Spinal Autonomic Reflexes Have Homologies
and Differences with Spinal Motor Reflexes . . . . . . . . . . . . . . . . . . . . . . 87
Urination, Defecation, and Pupillary and Sexual Responses
Are Examples of Spinal Autonomic Reflexes . . . . . . . . . . . . . . . . . . . . . . 89
The Enteric ANS as an Individual Entity . . . . . . . . . . . . . . . . . . . . . . . . . 95
vii
viii Contents
The Overlooked Role of the Local Autonomic Projections
in Neuroendocrine Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
The ANS Contributes to the Maintenance of Healthy Bone Tissue . . . . . 106
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
4 Second Level: The Brainstem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
At the Brainstem, Various Complex Autonomic Responses
Are Coordinated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Monoaminergic Systems in the Brainstem Modulate
24-h Rhythms in Physiological Function . . . . . . . . . . . . . . . . . . . . . . . 120
24 -h Rhythms in Cardiovascular Control . . . . . . . . . . . . . . . . . . . . . . . . 125
24 -h Rhythms in Respiratory Control . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
The Cerebellum and the Autonomic Posture . . . . . . . . . . . . . . . . . . . . . 138
24 -h Rhythms in the Immune Response . . . . . . . . . . . . . . . . . . . . . . . . . 144
24 -h Rhythms in Gastrointestinal Function . . . . . . . . . . . . . . . . . . . . . . 160
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
5 Third Level: The Hypothalamus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Hypothalamic Behaviors Comprise Coordinated
Mechanisms, Including Autonomic, Neuroendocrine,
and Motivational Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
24 -h Rhythms in Neuroendocrine Function . . . . . . . . . . . . . . . . . . . . . . . 180
Defense Behavior as a Paradigm of Reactive Homeostasis . . . . . . . . . . . 190
24 -h Rhythms in Food Intake, Energy Storage, and Metabolism . . . . . . . 203
24 -h Rhythms in Plasma Osmolality and the Intravascular Volume . . . . . 221
24 -h Rhythms in Body Temperature Control . . . . . . . . . . . . . . . . . . . . . . 228
Sexual and Maternal Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
6 F ourth Level: The Limbic System . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
The Limbic System Is Essential in Emotionality,
Motivation, Learning, and Memory . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
The Amygdala Is the Main “Motor Nucleus” of the Limbic System . . 252
Emotions Comprise Feelings and Moods, and Their Expression
in Somatic and Autonomic Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Limbic Components of the Basal Ganglia . . . . . . . . . . . . . . . . . . . . . . . 262
Functional Neuroimaging of ANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Chronotypes, 24-h Rhythms and Emotion . . . . . . . . . . . . . . . . . . . . . . . 271
24 -h Rhythms and Learning and Memory . . . . . . . . . . . . . . . . . . . . . . . 274
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
7 C linical Implications of the Enlarged Autonomic Nervous System 287
Semiological Aspects of ANS Disorders . . . . . . . . . . . . . . . . . . . . . . . 288
Classification of ANS Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Some Clinical Autonomic Entities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Peripheral Neuropathies with Dysautonomia . . . . . . . . . . . . . . . . . . 293
α-Synucleinopathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
Contents ix
Diabetes Mellitus Autonomic Dysfunction . . . . . . . . . . . . . . . . . . . . 298
Autoimmune Autonomic Ganglionopathy . . . . . . . . . . . . . . . . . . . . . 299
Paraneoplastic Autonomic Dysfunction . . . . . . . . . . . . . . . . . . . . . . . 299
Amyloidotic Autonomic Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Autonomic Dysfunction in Primary Sleep Disorders . . . . . . . . . . . . . 300
Autonomic Dysfunction in Cardiovascular Disorders . . . . . . . . . . . . 303
Autonomic Dysfunction Associated with Aging . . . . . . . . . . . . . . . . 305
Guillain–Barré Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
Hereditary Autonomic Neuropathies . . . . . . . . . . . . . . . . . . . . . . . . . 306
Autonomic Disturbances in Spinal Cord Injuries . . . . . . . . . . . . . . . . 307
Drug-Induced Autonomic Dysfunction . . . . . . . . . . . . . . . . . . . . . . . 307
Autonomic Disorder in Fibromyalgia, Chronic Fatigue
Syndrome and Chronic Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Hyperthermia, Hypothermia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
8 Clinical Implications of the Timed Autonomic Nervous System . . 313
Due to the “24/7 Society,” the ANS Has Lost Adequate
Experience of Day and Night . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
The Disruption of the Three ANS Physiological Programs
(“Body Configurations”) Is a Major Consequence
for the “24/7 Society” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316
Jet Lag, Shift Work, and Chronodisruption as Examples
of a Desynchronized ANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Jet Lag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Shift-Work Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
Chronodisruption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Chronobiological Treatment of a Desynchronized ANS . . . . . . . . . . . . 328
Some Clinical Autonomic Entities Associated
with a Desynchronized ANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332
Metabolic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332
Mental Illnesses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Brain Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Abbreviations
3V Third ventricle
5-HT Serotonin
ACh Acetylcholine
ACTH Adrenocorticotropin
AD Alzheimer’s disease
AgRP Agouti protein-related peptide
AMPK AMP-activated protein kinase
AN Ambiguous nucleus
ANP Atrial natriuretic peptide
ANS Autonomic nervous system
AP Area postrema
APP Amyloid precursor protein
ARC Arcuate nucleus
AV3V Anterior ventral region of the third ventricle
AVP Arginine vasopressin
AVPV Anteroventral periventricular
Aβ Amyloid β
BAT Brown adipose tissue
BCRs B cell receptors
BF Basal forebrain
BMD Bone mineral density
BNP Brain natriuretic peptide
BP Blood pressure
BRAC Basic rest–activity cycle
BZD Benzodiazepine
CALB Calbindin
CALR Calretinin
CART Cocaine and amphetamine-regulated transcript
CCG Controlled clock genes
CCK Cholecystokinin
CGRP Calcitonin gene-related peptide
CNP C-type natriuretic peptide
CNS Central nervous system
CO Carbon monoxide
xi