The excitatory:inhibitory ratio model (EIR model):: An integrative explanation of acute autonomic overactivity syndromes
The excitatory:inhibitory ratio model (EIR model):: An integrative explanation of acute autonomic overactivity syndromes
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DOI：
10.1016/j.mehy.2007.04.037
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发表时间：
2008-01-01
影响因子：
4.7
通讯作者：
Baguley, Ian J.
中科院分区：
文献类型：
--
作者：
Baguley, Ian J.
许多医疗条件目前与急性和严重的自主神经和肌肉过度活跃。这些综合征包括抗精神病药恶性综合征、血清素综合征、获得性脑损伤后的自主神经功能障碍（或阵发性交感神经风暴）、自主神经反射障碍、帕金森-高热综合征、恶性紧张症、鞘内巴氯芬戒断、恶性高热、僵人综合征和伊鲁康吉综合征。在最坏的情况下，这些综合征中的每一种都相对罕见，由不同的医学专业治疗，并显示出广泛不同的病理生理学。大多数被认为是医疗紧急情况，死亡率很高。以前的作者已经注意到这些疾病之间的相似性，提示一个单一的共同机制可能是其临床表现的基础。然而，这样一个综合模型的发展还没有发生。本文提出了一个简短的审查的临床症状，分组的病理和作用机制的位置。在此背景下，提出了一个称为兴奋：抑制比（EIR）模型的综合框架。EIR模型由在脊髓和脑干水平上操作的两个相互关联的网络组成。该模型根据临床前科学研究、已知途径、每种疾病的病理生理学（已知）和可变严重程度进行评估，并用于解释当前治疗方案疗效背后的原因。恶性高热的扩大病因的间接证据提供和一些其他条件的通用治疗策略的建议。最后，对该模型的微小修改为开始解释不太严重的区域性“重叠”综合征提供了基础。(C)2007爱思唯尔有限公司保留所有权利。
Numerous medical conditions present with acute and severe autonomic and muscular overactivity. These syndromes include Neuroleptic Malignant Syndrome, Serotonin Syndrome, Dysautonomia (or paroxysmal sympathetic storms) following acquired brain injury, Autonomic Dysreflexia, Parkinsonian-Hyperpyrexia Syndrome, Malignant Catatonia, intrathecal baclofen withdrawal, Malignant Hyperthermia, Stiff Man Syndrome and Irukandji Syndrome. In their worst forms, each of these syndromes are relatively rare, are treated by different medical specialties and show widely varying pathophysiology. Most are considered to be medical emergencies and share significant mortality rates. Previous authors have noted similarities between some of these conditions, prompting the suggestion that a single common mechanism may underlie their clinical presentation. However, the development of such an integrative model has not occurred.This paper presents a short review of the clinical syndromes, grouped by the location of pathology and mechanism of action. From this background, an integrative framework termed the excitatory: inhibitory ratio (EIR) model is presented. The EIR model consists of two inter-retated networks operating at spinal and brainstem levels. The model is evaluated against pre-clinical scientific research, known pathways, each disorder's pathophysiology (where this is known) and variable severity, and used to explain the reasons behind the efficacy of current treatment regimes. Circumstantial evidence for an expanded aetiology for Malignant Hyperthermia is provided and generic treatment strategies for a number of other conditions are suggested. Finally, minor modifications to this model provide a basis to begin to explain less severe, regional "overlap" syndromes. (C) 2007 Elsevier Ltd. All rights reserved.