The use of ULF-TENS is at the center of Neuromuscular Dentistry as practiced by members of ICCMO treating TMD
Does the ULF-TENS affect the Trigeminal Cardiac Reflex?
A A Pract
. 2025 Jan 2;19(1):e01889. doi: 10.1213/XAA.0000000000001889. eCollection 2025 Jan 1.
Prolonged Treatment of Inappropriate Sinus Tachycardia with Continuous Stellate Ganglion Blockade: A Case Report
Rebecca Christensen 1, Emily O Burzynski 2, Sarah R Vincze 3, Edan Bashkin 1, Priyanka Shetty 1, Pranjali Kainkaryam 3, Kevin Finkel 3
Affiliations Expand
PMID: 39745291 DOI: 10.1213/XAA.0000000000001889
Abstract
Inappropriate sinus tachycardia (IST) presents challenges in diagnosis and treatment due to its unclear etiology and limited therapeutic options. This case report explores the use of Continuous Stellate Ganglion Block (CSGB) as a potential treatment avenue. A 23-year-old woman with refractory IST underwent several CSGB placements, resulting in prolonged symptom relief and decreased median heart rate. Despite the eventual recurrence of symptoms, the sustained effects of CSGB suggest its efficacy in managing IST. This report underscores the potential of CSGB as a promising therapeutic approach for IST, offering longer-lasting symptom control compared to single-injection Stellate Ganglion Block (SGB) interventions.
The Autonomic nervous system often presents a conundrum about the mechanisms of action. As a large Sympathetic Ganglion it may makes sense that blocking the Stellate Ganglion would decrease Sympathetic activity and help in the treatment of Sinus Tachycardia. However, we also know that blocking the Stellate Ganglion can sometimes “CURE” PTSD or Post Traumatic Stress Disorder with a single shot. This would seem to be a Parasympathetic not a Sympathetic reflex.
What is the mechanism of these actions?
Typically, the nervous system is divided into Afferent and Efferent components. When we consider the Autonomic Nervous System (ANS) our focus is usually on efferent or outbound effects. When it comes to the General Visceral Afferent (GVA), our knowledge has gaping holes.
Historically, no one has successfully tracked or tried to separate GVA fibers into Sympathetic Afferent and Parasympathetic Afferent or trace these afferent nerves back to a specific target in the CNS.
The Oculocardiac Reflex or Trigeminal Cardiac Reflex might explain a mechanism of action. A quick AI Overview of the Reflex is presented below for reference.
AI Overview
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The Oculocardiac Reflex: A Rare but Significant …
The trigeminal vagal reflex, also known as the oculocardiac reflex (OCR) or Aschner reflex, is a reflex that reduces heart rate when pressure is applied to the eye. It’s a result of the connection between the trigeminal nerve and the vagus nerve.
How it works
Pressure is applied to the eye, globe, or extraocular muscles
The ophthalmic branch of the trigeminal nerve is stimulated
The vagus nerve is stimulated, causing a decrease in heart rate
When it occurs
During ophthalmologic procedures, such as strabismus surgery
During facial trauma
During regional anesthetic nerve blocks
During mechanical stimulation
During severe bruxism
During surgical procedures involving the head, neck, and face
What it can cause bradycardia, arrhythmias, cardiac arrest, hypotension, and gastric hypermotility.
Treatments
Cervical neck collars
Cervical traction
Physical therapy
Nonsteroidal anti-inflammatory drugs
Muscle relaxants
Surgery
“The trigeminal cardiac reflex (TCR) is a unique brainstem reflex that manifests as typical hemodynamic perturbations including sudden lowering of heart rate (HR), mean arterial blood pressure (MABP), cardiac arrhythmias, asystole, and other autonomic reactions such as apnea and gastric hypermotility.” The information comes from an excellent article, the abstract is presented here:
Medicine (Baltimore). 2015 Feb 6;94(5):e484. doi: 10.1097/MD.0000000000000484
Trigeminal Cardiac Reflex: New Thinking Model About the Definition Based on a Literature Review
C Meuwly 1, E Golanov 1, T Chowdhury 1, P Erne 1, B Schaller 1
Editor: Salvatore Patanè1
Abstract
Trigeminocardiac reflex (TCR) is a brainstem reflex that manifests as sudden onset of hemodynamic perturbation in blood pressure (MABP) and heart rate (HR), as apnea and as gastric hypermotility during stimulation of any branches of the trigeminal nerve. The molecular and clinical knowledge about the TCR is in a constant growth since 1999, what implies a current need of a review about its definition in this changing context.
Relevant literature was identified through searching in PubMed (MEDLINE) and Google scholar database for the terms TCR, oculocardiac reflex, diving reflex, vasovagale response.
The definition of the TCR varies in clinical as well as in research studies. The main difference applies the required change of MABP and sometimes also HR, which most varies between 10% and 20%. Due to this definition problem, we defined, related to actual literature, 2 major (plausibility, reversibility) and 2 minor criteria (repetition, prevention) for a more proper identification of the TCR in a clinical or research setting. Latest research implies that there is a need for a more extended classification with 2 additional subgroups, considering also the diving reflex and the brainstem reflex.