Research highlights from the literature

Again, perusal of the literature was not dull at all. Recent publications give new insight in diagnosis and therapy of neurally mediated syncope. International guidelines advocate carotid massage as a diagnostic test in older syncope patients. Apparently, the false positive rate of this test is rather high, which may limit its clinical utility in unselected patients. Many syncope patients are treated with beta-adrenoreceptor blockers. Yet, in the largest placebo-controlled, double-blind study conducted to date, metoprolol was ineffective in preventing spontaneous syncope. Ingestion of honey from Rhododendron ponticum contains grayanotoxins. Ingestion of the “mad honey” causes bradycardia and hypotension, thus, mimicking neurally mediated syncope. How do cortical neurons accommodate the daunting task to run “vertebrate software”? A recent study introduces the concept that functional cooperation between sodium channels may fasten action potential onset in cortical neurons, which may improve the coding of fast nerve signals. Finally, two publications support the idea that manipulation of residual sympathetic nerves in autonomic failure patients may be a useful approach to alleviate orthostatic hypotension and supine hypertension. The approach may have distinct advantages compared with traditional treatment approaches.