title: Botulism: heart rate variation, sympathetic skin responses, and plasma norepinephrine.
abstract: BACKGROUND
  Botulism may involve the autonomic nervous system.
  
  
  METHODS
  We assessed the autonomic function of 6 botulism patients with heart rate variations, sympathetic skin responses, and plasma norepinephrine.
  
  
  RESULTS
  Two weeks after onset, all the patients had absent sympathetic skin response in the palm and sole. Compared with controls, the heart rate variation of botulism patients was significantly decreased at rest (3.1 +/- 1.2% vs. 20.9 +/- 2.0%, p = 0.0018) and during deep breathing (4.3 +/- 2.3% vs. 29.7 +/- 2.6%, p = 0.0018). The botulism patients had significantly lower plasma norepinephrine levels (supine 29.2 +/- 10.1 pg/ml vs. 257.5 +/- 65.8 pg/ml, p = 0.0018; standing 40.3 +/- 13.1 pg/ml vs. 498.5 +/- 85.6 pg/ml, p = 0.0018). The heart rate variation and sympathetic skin response was greatly improved 6 months after onset.
  
  
  CONCLUSIONS
  Heart rate variation, absence of sympathetic skin response, and low plasma norepinephrine are all manifestations of autonomic dysfunction in botulism patients.
authors.affiliation: Department of Neurology, Veterans General Hospital-Taipei, Taiwan, R.O.C.
authors.forename: J T
authors.initials: JT
authors.lastname: Chen
authors.forename: C C
authors.initials: CC
authors.lastname: Chen
authors.forename: K P
authors.initials: KP
authors.lastname: Lin
authors.forename: S J
authors.initials: SJ
authors.lastname: Wang
authors.forename: Z A
authors.initials: ZA
authors.lastname: Wu
authors.forename: K K
authors.initials: KK
authors.lastname: Liao
mesh_terms: D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D001906:Botulism / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D004558:Electric Stimulation; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood*; D012867:Skin / Q000294:innervation
chemical_list: D015415:Biomarkers; D009638:Norepinephrine