Clinical Implications of Excess Parasympathetic Responses to Sympathetic Challenges

Autonomic nervous system (ANS) monitoring based on real-time heart rate variability and wavelet spectral analysis provides an independent, objective means of monitoring both ANS branches at the same time. Recent findings from concurrent parasympathetic and sympathetic measurements in response to sympathetic stimuli have uncovered an unexpected, clinically relevant condition, which has been labeled the Paradoxic-Parasympathetic Syndrome (PPS). PPS is a dynamic ANS imbalance that seems to accompany many diffuse and ill defined symptoms mostly occurring together, including sleep difficulties, night edema (with jittery legs), mild cognitive difficulties, and low grade morning headaches. PPS has also been found to manifest as different disorders in different patients.

PPS seems to destabilize the disease response or the therapy response or both. Whether PPS is the cause of the disorder or is caused by the disease or a little of both is not known, and probably an individual by individual issue, however, physicians have observed that correcting for this dynamic autonomic imbalance can reduce the severity of the disease or disorder, and in some cases eliminate the symptoms all together. The current working hypothesis is that PPS is independent of the clinical state of the patient and can be treated independently.

Current therapy for PPS targets systemic parasympathetic outflow from the ANS centers in the Medullary Brainstem. To date, patients with healthier ANSs have had this imbalance corrected in 9 to 12 months and have been weaned, thus, utilizing the plasticity of the patient's nervous system to re-establish and maintain a new more appropriate operating balance for the patient.

Sample longitudinal studies from ADD patients are included to illustrate the syndrome and demonstrate the possible therapy plans. The patients are diagnosed with ADD or ADHD and some included depression. The patients (as previously diagnosed) were on Aderol or Ritalin. After beginning the ANS therapy (25 mg Elavil QMS with 100 mg Norpace BID) the patients were weaned from the Aderol or Ritalin with no change in their ability to concentrate and focus. As and if needed, patients can be titrated up to 50 mg Elavil and 200 mg Norpace). In some cases, orthostasis can exist or can be unmasked as the PPS is reduced, in these cases, 2.5 mg ProAmatine BID for four to six months, or until the orthostasis is resolved. The patients depicted here all reported feeling "more alive" and still able to concentrate and focus, even after being weaned from therapy and are now drug free.

- 2003 Clinical Electroencephalography Vol 34 No 3 Page 159