Abstract
We evaluated plasma noradrenaline (NA) levels at rest and during head-up tilt test in 20 patients with sporadic amyotrophic lateral sclerosis (ALS). Their fasting plasma NA levels ranged from 195 to 4227 pg/ml. The average plasma NA level was 483 pg/ml in five ambulatory patients, 341 in two wheelchair-bound patients, 1264 in 11 bedridden patients, and 208 in two respirator-dependent patients whose disability grading was the worst among the four groups. Arterial carbon dioxide (PCO2) was evaluated as a measure of respiratory function. The coefficient of correlation between PCO2 and plasma NA wasr=0.654 (p<0.01). Either respiratory failure or lower motor neuron dysfunction may relate to the elevation of plasma NA levels. In the two bedridden patients, plasma NA levels and heart rate at rest increased significantly as the disease progressed. Cardiovascular responses to head-up tilting were normal. These data suggest that the elevation of plasma NA levels may be related to progression of respiratory failure and lower motor neuron dysfunction. In conclusion, sympathetic hyperactivity in ALS is considered to be not primary, but secondary to somatic motor disabilities and respiratory failure.
Similar content being viewed by others
References
Toyokura Y. Amyotrophic lateral sclerosis. A clinical and pathological study on the ‘negative features’ of the disease.Jpn J Med 1977;16: 269–273.
Chida K, Sakamaki S, Takasu T. Alteration in autonomic function and cardiovascular regulation in amyotrophic lateral sclerosis.J Neurol 1989;236: 127–130.
Shindo K, Tsunoda S, Shiozawa Z. Microneurographic analysis of muscle sympathetic nerve activity in amyotrophic lateral sclerosis.Clin Auton Res 1993;3: 131–135.
Shimizu T, Hayashi H, Kato S, Hayashi M, Tanabe H, Oda M. Circulatory collapse and sudden death in respirator-dependent amyotrophic lateral sclerosis.J Neurol Sci 1994;124: 45–55.
Ziegler MG, Brooks BR, Lake CR, Wood JH, Enna SJ. Norepinephrine and gamma-aminobutyric acid in amyotrophic lateral sclerosis.Neurology 1980;30: 98–101.
Tamura N, Shimazu K, Oh-iwa K, Kim H, Hamaguchi K. Increased sympathetic nervous activity in motor neuron disease — a hemodynamic study.Clin Neurol (Tokyo) 1983;23: 152–158 (in Japanese).
Tamura N. Autonomic nervous disorder in motor neuron disease.Clin Neurol (Tokyo) 1984;24: 1242–1245 (in Japanese).
Sachs C, Conradi S, Kaijser L. Autonomic function in amyotrophic lateral sclerosis: a study of cardiovascular responses.Acta Neurol Scand 1985;71: 373–378.
Bogucki A, Salvesen R. Sympathetic iris function in amyotrophic lateral sclerosis.J Neurol 1987;234: 185–186.
Hattori T, Hirayama K, Yasuda K, Shimazaki J. Disturbance of micturition in amyotrophic lateral sclerosis.Clin Neurol (Tokyo) 1983;23: 224–227 (in Japanese).
Shindo K, Tsunoda S, Shiozawa Z, Togashi S, Nagasaka T. Muscle sympathetic nerve activity in a long-term survival amyotrophic lateral sclerosis patient.Auton Nerv Syst (Tokyo) 1995;32: 378–383 (in Japanese).
Kennedy PGE, Duchen LW. A quantitative study of intermediolateral column cells in motor neuron disease and the Shy-Drager syndrome.J Neurol Neurosurg Psychiatry 1985;48: 1103–1106.
Brooks BR. El Escorial World Federation of Neurology Criteria for the diagnosis of amyotrophic lateral sclerosis.J Neurol Sci 1994;124 (Suppl.): 96–107.
Brooke MH. Diagnostic criteria in clinical trials.Neurology 1996;47 (Suppl. 2): S67-S70.
Pryse-Phillips W. Amyotrophic lateral screlosis. In:Companion to Clinical Neurology, 1st edn. Boston: Little, Brown and Co., 1995; 43.
Senda Y, Koike Y, Oiso Y, Matuoka Y, Takahashi A. Plasma vasopressin responses to orthostasis and hypertonic saline infusion in progressive autonomic failure.Clin Neurol (Tokyo) 1988;28: 1282–1289 (in Japanese).
Shepherd RFJ, Shepherd JT. Control of blood pressure and the circulation in man. In: Bannister R, Mathias CJ, eds.,Autonomic Failure, a Textbook of Clinical Disorders of the Autonomic Nervous System, 3rd edn. Oxford: Oxford University Press, 1992; 78–93.
Morris ME, Millar RA. Blood pH/plasma catecholamine relationships: respiratory acidosis.Br J Anaesth 1962;34: 672–681.
Mills CA, Flacke JW, Miller JD, Davis LJ, Bloor BC, Flacke WE. Cardiovascular effects of fentanyl reversal by naloxone at varying arterial carbon dioxide tensions in dogs.Anesth Analg (Cleve) 1988;67: 730–736.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Yamashita, A., Koike, Y., Takahashi, A. et al. Relationship between respiratory failure and plasma noradrenaline levels in amyotrophic lateral sclerosis. Clinical Autonomic Research 7, 173–177 (1997). https://doi.org/10.1007/BF02267978
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02267978