Rachael Brown

Autonomic markers of emotional processing: skin sympathetic nerve activity in humans during exposure to emotionally-charged images

The sympathetic innervation of the skin primarily subserves thermoregulation, but the system has also been commandeered as a means of expressing emotion. While it is known that the level of skin sympathetic nerve activity (SSNA) is affected by anxiety, the majority of emotional studies have utilized the galvanic skin response as a means of inferring increases in SSNA. The purpose of the present study was to characterize the changes in SSNA when showing subjects neutral or emotionally charged images from the International Affective Picture System (IAPS). SSNA was recorded via tungsten microelectrodes inserted into cutaneous fascicles of the common peroneal nerve in ten subjects. Neutral images, positively charged images (erotica) or negatively charged images (mutilation) were presented in blocks of fifteen images of a specific type, each block lasting 2 min. Images of erotica or mutilation were presented in a quasi-random fashion, each block following a block of neutral images. Both images of erotica or images of mutilation caused significant increases in SSNA, but the increases in SSNA were greater for mutilation. The increases in SSNA were often coupled with sweat release and cutaneous vasoconstriction; however, these markers were not always consistent with the SSNA increases. We conclude that SSNA, comprising cutaneous vasoconstrictor and sudomotor activity, increases with both positively charged and negatively charged emotional images. Measurement of SSNA provides a more comprehensive assessment of sympathetic outflow to the skin than does the use of sweat release alone as a marker of emotional processing.

Real-time imaging of cortical areas involved in the generation of increases in skin sympathetic nerve activity when viewing emotionally charged images.

The sympathetic innervation of the skin not only primarily subserves thermoregulation, but has also been commandeered as a means of emotional expression. While the majority of brain imaging studies of emotion have utilised the galvanic skin response as a means of inferring changes in skin sympathetic nerve activity (SSNA), spontaneous fluctuations in the galvanic skin response bear little relation to spontaneous fluctuations in SSNA. To improve our understanding of the central neural processes involved in the generation of autonomic emotional markers, we recorded SSNA concurrently with brain functional magnetic resonance imaging in 13 subjects. Emotional changes were evoked by presentation of positively-charged (erotica) or negatively-charged (mutilation) images from the International Affective Picture System. Positive and negative emotionally-charged images evoked significant increases in total SSNA and signal intensity in the orbital, dorsolateral and ventromedial prefrontal cortices, amygdala, nucleus accumbens and anterior insula. Increases in signal intensity during increases in SSNA occurred in a number of brain regions, including the central and lateral amygdala, dorsolateral pons, thalamus, nucleus accumbens, and cerebellar cortex. Signal intensity decreases during SSNA increases occurred in the left orbitofrontal, frontal and right precuneus cortices. These data reveal for the first time, cortical and subcortical sites involved in generating SSNA changes during emotions.

Selective activation of muscle and skin nociceptors does not trigger exaggerated sympathetic responses in spinal-injured subjects.

Study design:Measurement of sympathetic effector organ responses to selective activation of muscle and skin nociceptors below lesion in spinal cord-injured (SCI) subjects.Objectives:To test whether selective noxious stimulation below lesion causes exaggerated sympathetic responses in human SCI.Setting:Prince of Wales Medical Research Institute, Australia.Methods:Twelve subjects (C5-T10, ASIA A-C), none of whom had sensation below the lesion, were included in the study. Selective stimulation of muscle or cutaneous nociceptors was produced by bolus injection of hypertonic (5%) saline into the tibialis anterior muscle or overlying skin and compared with non-noxious electrical stimulation of the abdominal wall. Cutaneous vasoconstrictor (photoelectric plethysmography) and sudomotor (skin conductance) responses, in addition to respiration, heart rate and continuous arterial pressure were monitored.Results:Electrical stimulation of the abdominal wall caused a significant increase in arterial pressure (31.8±6.1%). Conversely, intramuscular or subcutaneous injection of hypertonic saline caused no significant changes in blood pressure (−3.0±2.4%; −1.4±3.4%) heart rate, skin blood flow or sweat release.Conclusions:While hypertonic saline injected into muscle or skin induces strong pain, cutaneous vasoconstriction and sweat release in able-bodied subjects, we saw no evidence of exaggerated sympathoexcitation when these same noxious stimuli were delivered below lesion in subjects with SCI. This suggests that certain types of somatic noxious input may not trigger autonomic dysreflexia, and questions the concept that any painful stimuli originating below lesion can reliably trigger dysreflexia.

Assessing the integrity of sympathetic pathways in spinal cord injury.

STUDY DESIGN Measurement of cutaneous sympathetic reflexes and hemodynamic responses to brief electrical stimuli applied above (forehead) and below (abdominal wall) a spinal lesion. OBJECTIVE To assess the validity of using cutaneous vasoconstriction as a sensitive indicator of increases in sympathetic activity in spinal cord injury. SETTING Prince of Wales Medical Research Institute, Australia. SUBJECTS Twenty spinal cord injured subjects with injuries ranging from C3-T11 and nine able-bodied controls. METHOD Cutaneous electrical stimulation was applied to the forehead and abdominal wall to subjects at unexpected times. Sudomotor and vasomotor responses, as well as continuous arterial pressure, heart rate and respiration were monitored. RESULTS Sudomotor (electrodermal) responses to forehead stimulation were scarce in spinal cord injured subjects, whereas cutaneous vasoconstrictor responses (photoelectric pulse plethysmography) provided a sensitive indicator of any remaining central control of sympathetic function below the lesion. Electrical stimulation applied to the abdominal wall evoked vasoconstrictor reflexes below the lesion in the majority of spinal cord injured subjects, whereas only a limited number of electrodermal responses were observed. That these cutaneous vasoconstrictor responses could reflect parallel increases in muscle and splanchnic vasoconstrictor activity was indicated by the increases in blood pressure; patients lacking vasoconstrictor responses rarely showed stimulus-induced blood pressure increases. CONCLUSION Our findings show that skin vasomotor responses to somatosensory stimulation provide a more sensitive tool than electrodermal responses for evaluation of sympathetic function below a spinal cord lesion. STATEMENT OF ETHICS: We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research, and all experiments were conducted with the understanding and consent of each subject.

Cutaneous vasoconstriction as a measure of incipient autonomic dysreflexia during penile vibratory stimulation in spinal cord injury

Study design:Measurement of haemodynamic responses, cutaneous blood flow and sweat release during penile vibratory stimulation (PVS) in spinal cord-injured men.Objective:To assess the validity of using markers of sympathetic activity (cutaneous blood flow and sweat release) as a measure of incipient autonomic dysreflexia during PVS in spinal cord-injured men.Setting:Prince of Wales Medical Research Institute, Australia.Subjects:Ten spinal cord-injured men with injuries ranging from C3 to T6.Methods:Continuous arterial pressure, intermittent auscultation, heart rate (HR), respiration, cutaneous blood flow and sweat release from both finger and toe were recorded during PVS.Results:Vibration of the penis caused immediate cutaneous vasoconstriction, but negligible sweat release, in the hands and feet of the quadriplegics and the feet of the paraplegics. Systolic blood pressure (BP) increased by up to 90 mm Hg, and a compensatory vagal bradycardia was observed in five of the six quadriplegics and two of the four paraplegic subjects.Conclusion:Given that there was—in general—an inverse relationship between BP and skin blood flow, we conclude that continuous measurements of skin blood flow above and below the lesion can provide important information on the state of the sympathetic nervous system and early identification of reflexly evoked increases in sympathetic vasoconstrictor drive, below a spinal lesion. Coupled with a decrease in HR, this cutaneous vasoconstriction infers an increased BP.

Increases in muscle sympathetic nerve activity, heart rate, respiration, and skin blood flow during passive viewing of exercise

The cardiovascular and respiratory effects of exercise have been widely studied, as have the autonomic effects of imagined and observed exercise. However, the effects of observed exercise in the first person have not been documented, nor have direct recordings of muscle sympathetic nerve activity (MSNA) been obtained during observed or imagined exercise. The aim of the current study was to measure blood pressure, heart rate, respiration, skin blood flow, sweat release, and MSNA (via microelectrodes inserted into the common peroneal nerve), during observation of exercise from the first person point of view. It was hypothesized that the moving stimuli would produce robust compensatory increases in the above-mentioned parameters as effectively as those generated by mental imagery and—to a lesser extent—actual exercise. Nine subjects watched a first-person running video, allowing them to view the action from the perspective of the runner rather than viewing someone else perform the exercise. On average, statistically significant increases from baseline during the running phase were seen in heart rate, respiratory rate, skin blood flow, and burst amplitude of MSNA. These results suggest that observation of exercise in the first person is a strong enough stimulus to evoke “physiologically appropriate” autonomic responses that have a purely psychogenic origin.

Inter-Individual Responses to Experimental Muscle Pain: Baseline Physiological Parameters Do Not Determine Whether Muscle Sympathetic Nerve Activity Increases or Decreases During Pain.

We have previously reported that there are inter-individual differences in the cardiovascular responses to experimental muscle pain, which are consistent over time: intramuscular infusion of hypertonic saline, causing pain lasting ~60 min, increases muscle sympathetic nerve activity (MSNA)—as well as blood pressure and heart rate—in certain subjects, but decrease it in others. Here, we tested the hypothesis that baseline physiological parameters (resting MSNA, heart rate, blood pressure, heart rate variability) determine the cardiovascular responses to long-lasting muscle pain. MSNA was recorded from the common peroneal nerve, together with heart rate and blood pressure, during a 45-min intramuscular infusion of hypertonic saline solution into the tibialis anterior of 50 awake human subjects (25 females and 25 males). Twenty-four subjects showed a sustained increase in mean amplitude of MSNA (160.9 ± 7.3%), while 26 showed a sustained decrease (55.1 ± 3.5%). Between the increasing and decreasing groups there were no differences in baseline MSNA (19.0 ± 1.5 vs. 18.9 ± 1.2 bursts/min), mean BP (88.1 ± 5.2 vs. 88.0 ± 3.8 mmHg), HR (74.7 ± 2.0 vs. 72.8 ± 1.8 beats/min) or heart rate variability (LF/HF 1.8 ± 0.2 vs. 2.2 ± 0.3). Furthermore, neither sex nor body mass index had any effect on whether MSNA increased or decreased during tonic muscle pain. We conclude that the measured baseline physiological parameters cannot account for the divergent sympathetic responses during tonic muscle pain.

Skin sympathetic nerve activity in humans during exposure to emotionally-charged images: sex differences

While it is known that anxiety or emotional arousal affects skin sympathetic nerve activity (SSNA), the galvanic skin response (GSR) is the most widely used parameter to infer increases in SSNA during stress or emotional studies. We recently showed that SSNA provides a more sensitive measure of emotional state than effector-organ responses. The aim of the present study was to assess whether there are gender differences in the responses of SSNA and other physiological parameters such as blood pressure, heart rate, skin blood flow and sweat release, while subjects viewed neutral or emotionally-charged images from the International Affective Picture System (IAPS). Changes in SSNA were assessed using microneurography in 20 subjects (10 male and 10 female). Blocks of positively-charged (erotica) or negatively-charge images (mutilation) were presented in a quasi-random fashion, following a block of neutral images, with each block containing 15 images and lasting 2 min. Images of both erotica and mutilation caused significant increases in SSNA, with increases being greater for males viewing erotica and greater for females viewing mutilation. The increases in SSNA were often coupled with sweat release and cutaneous vasoconstriction; however, these markers were not significantly different than those produced by viewing neutral images and were not always consistent with the SSNA increases. We conclude that SSNA increases with both positively-charged and negatively-charged emotional images, yet sex differences are present.

Assessing the capacity of the sympathetic nervous system to respond to a cardiovascular challenge in human spinal cord injury.

Study design:Measurement of haemodynamic responses and cutaneous blood flow during an inspiratory-capacity apnoea following spinal cord injury (SCI).Objective:To assess the capacity of the sympathetic nervous system to respond to a cardiovascular challenge following SCI.Setting:Prince of Wales Medical Research Institute, Australia.Subjects:Thirteen spinal cord injured subjects with injuries ranging from C5-T8 and eight able-bodied control subjects.Methods:Continuous blood pressure, an electrocardiogram, respiration and cutaneous blood flow were recorded during a static maximum inspiratory breath-hold for 40 s.Results:On average, systolic blood pressure decreased 26% from baseline in the spinal group during the breath-hold and remained below baseline throughout the entire apnoeic period. Heart rate in this group had an initial decrease from baseline but quickly increased throughout the breath-hold, being 17% above baseline in the recovery period. Systolic pressure in the control group decreased 12% from baseline at the beginning of the breath-hold but quickly stabilized for the remainder of the apnoea, with heart rate initially decreasing 22% and remaining below baseline throughout the breath-hold.Conclusion:A maximal inspiratory breath-hold, which is known to cause a sustained increase in muscle sympathetic nerve activity, is a simple test to perform in supine spinal cord-injured subjects, and provides information on the capacity of muscle and splanchnic vasoconstrictor activity to increase blood pressure in SCI. A sustained decrease in blood pressure, coupled with an increase in heart rate, infers interruption of sympathetic vasoconstrictor pathways to muscle and splanchnic vascular beds.

Mal de Debarquement Syndrome: a survey on subtypes, misdiagnoses, onset and associated psychological features

IntroductionMal de Debarquement Syndrome (MdDS) is a neurological condition typically characterized by a sensation of motion, that persists longer than a month following exposure to passive motion (e.g., cruise, flight, etc.). The most common form of MdDS is motion triggered (MT). However, recently it has been acknowledged that some patients develop typical MdDS symptoms without an apparent motion trigger. These cases are identified here as spontaneous or other onset (SO) MdDS. This study aimed to address similarities and differences between the MdDS subtypes. Diagnostic procedures were compared and extensive diagnostic guidelines were proposed. Second, potential triggers and associated psychological components of MdDS were revealed.MethodsThis was a retrospective online survey study for MT and SO MdDS patients. Participants were required to respond to a set of comprehensive questions regarding epidemiological details, as well as the diagnostic procedures and onset triggers.ResultsThere were 370 patients who participated in the surveys. It is indicated that MdDS is often misdiagnosed; more so for the SO group. In addition to the apparent self-motion, both groups reported associated levels of stress, anxiety and depression.DiscussionIt appears at present that both MdDS subtypes are still poorly recognised. This was the first attempt to evaluate the diagnostic differences between MdDS subtypes and to propose a set of comprehensive diagnostic guidelines for both MdDS subtypes. In addition, the current research addressed that associated symptoms such as stress, anxiety and depression should also be considered when treating patients. We hope this study will help the medical community to broaden their awareness and diagnostic knowledge of this condition.