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Quantitative analysis of dysautonomia in patients with autonomic dysreflexia

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Abstract

Autonomic dysreflexia (AD) is a life-threatening condition for individuals with cervical or high-thoracic spinal cord injury (SCI). The profile of autonomic dysfunction in AD using validated clinical autonomic tests has not been described so far, although it could be useful to identify SCI patients at greater risk of developing AD non-invasively. With this objective, 37 SCI patients (27% female) were recruited, and hemodynamic and cardiac parameters were continuously monitored to determine the presence of AD, defined as an increase of systolic blood pressure of 20 mmHg or higher after bladder filling with saline. Then, standard autonomic function testing was performed, including Deep Breathing, Valsalva Manoeuvre and Tilt Table Test. Finally, baroreflex sensitivity (BRS), and spectral analysis of heart rate and blood pressure variability were measured at rest. Catecholamines and vasopressin levels were also measured at supine and upright positions. The severity of SCI was assessed through clinical and radiological examinations. AD was observed in 73.3% of SCI patients, being 63.6% of them asymptomatic during the dysreflexive episode. AD patients displayed a drop in sympathetic outflow, as determined by decreased noradrenalin plasma levels, reduced sympathovagal balance and increased BRS. In line with decreased sympathetic activity, the incidence of neurogenic orthostatic hypotension was higher in AD patients. Our results provide novel evidence regarding the autonomic dysfunction in SCI patients with AD compared to non-AD patients, posing non-invasively measured autonomic parameters as a powerful clinical tool to predict AD in SCI patients.

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Funding

No authors have received any funding from any institution, including personal relationships, interests, grants, employment, affiliations, patents, inventions, honoraria, consultancies, royalties, stock options/ownership, or expert testimony for the last 12 months.

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Authors and Affiliations

  1. Spinal Cord Injury Unit, Cruces University Hospital, Baracaldo, Spain

    Nora Cívicos Sánchez, Montserrat Cuadrado, Arrate Orueta & María Luisa Jauregui Abrisqueta

  2. Autonomic Center (NeuroTek), San Juan de Dios Hospital, Santurtzi, Spain

    Marian Acera, Beatriz Tijero & Juan Carlos Gómez Esteban

  3. Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, CP 48903, Barakaldo, Bizkaia, Spain

    Marian Acera, Ane Murueta-Goyena, Beatriz Tijero, Tamara Fernández, Rocío Del Pino, Iñigo Gabilondo & Juan Carlos Gómez Esteban

  4. Department of Preventive Medicine, University of the Basque Country (UPV/EHU), Leioa, Spain

    Ane Murueta-Goyena

  5. Faculty of Engineering in Bilbao, University of the Basque Country (UPV/EHU), Leioa, Spain

    Nagore Sagastibeltza & Raquel Martínez

  6. Neurology Department, Cruces University Hospital, Barakaldo, Spain

    Beatriz Tijero, Tamara Fernández, Iñigo Gabilondo & Juan Carlos Gómez Esteban

  7. Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain

    Tamara Fernández & Juan Carlos Gómez Esteban

  8. Ikerbasque: The Basque Foundation for Science, Bilbao, Spain

    Iñigo Gabilondo

Authors
  1. Nora Cívicos Sánchez
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  2. Marian Acera
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  3. Ane Murueta-Goyena
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  4. Nagore Sagastibeltza
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  6. Montserrat Cuadrado
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  7. Arrate Orueta
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  8. Beatriz Tijero
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  12. María Luisa Jauregui Abrisqueta
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  13. Juan Carlos Gómez Esteban
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Corresponding author

Correspondence to Ane Murueta-Goyena.

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None of the authors have any conflicts of interest or financial ties to disclose.

Ethical approval

The study was approved by the local ethics committee (Basque Ethics Committee, Reference PI2013132) and patients gave written informed consent before inclusion in the study, in accordance with the tenets of the Declaration of Helsinki.

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Cívicos Sánchez, N., Acera, M., Murueta-Goyena, A. et al. Quantitative analysis of dysautonomia in patients with autonomic dysreflexia. J Neurol 268, 2985–2994 (2021). https://doi.org/10.1007/s00415-021-10478-w

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  • DOI: https://doi.org/10.1007/s00415-021-10478-w

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