Book Review

As originally published in The Physiologist
Volume 45, Number 3, June 2002, page 164-165

Books Received

The Autonomic Nervous System in Health and Disease
David S. Goldstein
Marcel Decker, Inc., New York, 2001

    The volume written by Dr. David Goldstein represents an ambitious review of the literature concerning the function of the varied components of the autonomic nervous system in health and disease states. It provides a reasonable overview of autonomic neuronal control of the internal milieu, focusing in particular on how the internal nervous system remodels in the presence of specific pathologies.

    The author introduces his volume with a short, but excellent summary of the major contributors to our understanding of the anatomy and function of the autonomic nervous system. Major ‘milestones’ in the evolution of current understanding of this nervous system are presented in a succinct and logical fashion. The author pays particular attention to the concepts developed by Bernard, Oliver, and Schaefer, Langley as well as Cannon and von Euler. The author also emphasizes the importance of Neurocardiology for the field of integrative medicine, something that is timely. 

    This is followed by a discussion of the various components of the autonomic nervous system (chapter 2). A good overview of catecholamine release and re-uptake mechanisms at sympathetic efferent nerve terminals is provided, along with data about adrenergic receptor subtypes. The author also provides brief descriptions of the role of epinephrine release from the adrenal glands, as well as non-cholinergic, non-adrenergic neurotransmission, along with dopaminergic mechanisms, are presented.

    Chapter 3 is devoted to the role that central autonomic neurons play in maintaining adequate internal organ function. The complex neuroanatomy of central autonomic neurons is treated in a rather superficial manner, which may be appropriate given the presumed general audience of such a volume. The author categorizes central autonomic interneuronal interactions, the concept of pacemaker neurons regulating sympathetic efferent neuronal outflow via “coupled oscillators” is presented to explain sympathetic efferent preganglionic neuronal rhythmic activity (page 139). The outflow of parasympathetic efferent preganglionic neurons is treated in an equally cursory fashion (c.f., page 182-183). The complex integration that occurs among neurons within the spinal column is simplified beyond reason. On the other hand, the author does a credible job discussing interactions among autonomic neurons in the medulla, pons, midbrain and hypothalamus. 

    With this background information, the author then proceeds to discuss how the organism copes with stress (chapter 4). The “central command” thesis that purportedly “regulates sympathetically-mediated vasoconstrictor tone” (page 226) is discussed. The complex interneuronal interactions that occur within the central neuronal components of the ANS are barely touched upon. The author presents the concept that “arteriosclerotic cardiovascular walls splint baroreceptors” to prevent (not modify) sympathetic efferent reflex activation, surely a simplistic approach to the complex field of altered cardiovascular control. The author also states that angiotensin II exerts little direct effect on the heart. He states that, if anything, angiotensin II causes bradycardia despite recent experimental evidence indicates that angiotensin modifies populations of intrinsic cardiac neurons to induce cardioaugmentor effects.

    In chapter 5, autonomic neuronal responses to stressors are presented in a very conventional manner. Concepts presented in this chapter may generate debate. For instance, the author states that BOTH efferent limbs of the autonomic nervous system are activated after adrenal medullar function. That the sympathetic efferent neurons function in exclusion of “housekeeping system” while the adrenal gland functions as a “distress system” is a concept without scientific foundation. Epinephrine does exert significant effects on total vascular resistance, but not by deceasing arteriolar resistance (page 303). 

    In the chapter entitled Clinical Evaluation (chapter 6), a reasoned attempt is made to depict alterations in autonomic neuronal control in the format of the history, physical examination and scientific analysis of monitored indices. It is unfortunate that the entire GI system is dealt with in a cursor fashion (in tow lines at the onset of this chapter and briefly on pages 355-356) since the importance of the ANS to its function is enormous. With respect to cardiovascular reflexes, the author places too much emphasis on unreliable responses elicited by the Valsalva maneuver. Power spectral analysis, another limited concept when applied to neuronal control of heart rate, is presented in a clear, but wholly uncritical manner. The author also presents the thesis that “high pressure baroreceptors (mechanosensory neurons associated with major arteries) only regulate mean arterial pressure (blood flow to the brain) while low-pressure baroreflex” (mechanosensory neurons associated with vessels with low pressure presumably) regulate “central venous pressure, cardiac output and filling and extracellular fluid volume”? This represents another example of misinformation presented in this text. 

    The technique of sympathetic microneurography, the presumed quantification of activity generated by sympathetic efferent postganglionic axons in a particular peripheral (assessable) nerve, is also dealt with in a superficial manner. So are other tests currently employed to study altered ANS status, such as lower body negative pressure. Recent research delineating ventricular interstitial catecholamine content puts much of the literature concerning the quantification of catecholamine AV differences “across the heart” into doubt. The author imaging techniques are presented as though they are sensitive enough to detect alterations in, for instance, the activity generated by sympathetic efferent postganglionic neurons innervating a particular organ. 
The next three chapters deal with autonomic failure, essential hypertension and cardiac necrosis, among other topics. Varied and sometimes fanciful conclusions are presented when discussing the role of the ANS in such pathologies. For instance, the author states that coronary artery occlusion does not lead to ventricular fibrillation if psychological stress is minimized (page 427). If the mass of ventricular tissue involved in an infarct is large enough, psychological status of the patient will likely not be a primary determinant of infarct size or any associated ventricular electrical instability. A transmural ventricular infarction does not modify the capacity of axons traversing the infarct to influence regional mechanics (i.e., it does not cause regional denervation). 
Chapter 8 (“Disorders in which abnormal catecholaminergic function is etiologic”) presents data in a more reasoned fashion. The author summarizes autonomic failure in the absence or presence of central neuronal degeneration. The author compares autonomic degeneration in disease states such as Parkinson’s disease and Shy-Drager syndrome with clarity, pointing out that central as well as peripheral autonomic neurons can be involved. The effects of significant emotional distress and the resultant excessive activation of sympathetic efferent neurons on selective target organs (specifically the heart: page 490-1) are presented clearly. This is followed (chapter 9) by an excellent overview of the limited amount of data concerning ANS function in neurasthenia, chronic fatigue syndrome, fibromyalgia, post-traumatic stress disorder and essential hypertension. The author is very successful in presenting information about “coronary prone” behavior and job stress as related to autonomic dysfunction. The final chapter presents the authors concepts about the importance of “integrative medicine,” a term used to denote a return to thinking in integrative terms when assessing internal organ diseases. Comparisons between “reductionism” (linear logic) versus “homeostasis” thinking are somewhat overdrawn as surely both approaches are required in order to understand syndromes like heart failure from an autonomic nervous system perspective.

    In sum, this volume presents a plethora of data concerning peripheral and central autonomic neuronal function in normal and specific pathologies. After reading this volume, one might consult more specialized texts in order to gain an adequate understanding of autonomic neuronal regulation of specific organs in normal and pathological states. 

Books Received

Endurance Exercise and Adipose Tissue.
Barbara Nicklas (Editor).
CRC Series in Exercise Physiology.
Boca Raton, FL: CRC, 2001, 176 pp., illus., index, $89.95.
ISBN: 0-8493-0460-1.

Proteinase and Peptidase Inhibition: Recent Potential Targets for Drug Development.
H. John Smith and Claire Simons (Editors).
New York: Taylor & Francis, 2002, 420 pp., illus., index, $95.00.
ISBN: 0-415-27349-8. 

The Somatosensory System: Deciphering the Brain’s Own Body Image.
Randall J. Nelson (Editor).
Methods & New Frontiers in Neuroscience.
Boca Raton, FL: CRC, 2001, 399 pp., illus., index, $119.95.
ISBN: 0-8493-2336-3.

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