Excessive parasympathetic responses to sympathetic challenges: a treatable, hidden, dynamic autonomic imbalance

Abstract

Background: A common assumption with autonomic assessment is that one branch opposes the other. With independent measures of parasympathetic (P) and sympathetic (S) activity, based on concurrent time-frequency analysis of respiratory activity and heart rate variability, this assumption has been challenged. Clinical observations of unprovoked P-excess during S-stimulation have been associated with treatable, abnormal responses. Method: Serial autonomic profiling of 12,967 patients was performed using the P&S method (ANX-3.0 Autonomic Monitor by ANSAR Medical Technologies, Inc., Philadelphia, PA) over a five-year period. Treatment protocols are very low-dose and depend on patient history. For cardiovascular disease patients, Carvedilol was prescribed. For non-CVD patients, Nortriptyline was prescribed. In some cases where end-organ effects were not yet presented or relieved, patients were weaned of therapy once PE was relieved. Alternative therapies included Specific Chiropractic Adjustment, better known in the literature as Chiropractic Manipulative Therapy and intensive zero-impact, cardiovascular exercise. Results: PE patients present with normal HR and BP and no other apparent symptoms at rest. However, they reported symptoms of: sleep difficulties, palpitations, poor peripheral circulation, general malaise, depression (often with anxiety or ADD-like symptoms), frequent headache or migraines, menopause difficulties in women, hypothyroidism, cognitive difficulties, gastrointestinal upset, persistent weight-gain, and dizziness after standing. Conclusion: Normalizing PE, regardless of method, stabilizes the patient, relieves symptoms, improves quality of life, and improves patient outcomes.

Keywords

• Parasympathetic excess
• Sympathetic stimulation
• Diagnosis
• Therapy