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Coelho FMS, de Carvalho Cremaschi RM, Novak P. Cerebral blood flow and end-tidal CO 2 predict lightheadedness during head-up tilt in patients with orthostatic intolerance. Neurol Sci 2024:10.1007/s10072-024-07673-8. [PMID: 38980457 DOI: 10.1007/s10072-024-07673-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/20/2024] [Indexed: 07/10/2024]
Abstract
Orthostatic intolerance (OI) is a common problem. Reliable markers of OI are missing, as orthostatic blood pressure and heart rate poorly correlate with orthostatic symptoms. The objective of this study was to assess the relationship between orthostatic lightheadedness and cerebral blood flow. In this retrospective study patients with OI were evaluated at the Autonomic Laboratory of the Department of Neurology, Brigham and Women's Faulkner Hospital, Boston. The 10-minute head-up tilt test was performed as a part of autonomic testing. Orthostatic lightheadedness was evaluated at every minute of the head-up tilt. Heart rate, blood pressure, capnography, and cerebral blood flow velocity (CBFv) in the middle cerebral artery using transcranial Doppler were measured. Repeated-measures design with a linear mixed-effects model was used to evaluate the relationship between orthostatic lightheadedness and hemodynamic variables. Correlation analyses were done by calculating Pearson's coefficient. Twenty-two patients with OI were compared to nineteen controls. Orthostatic CBFv and end-tidal CO2 decreased in OI patients compared to controls (p < 0.001) and predicted orthostatic lightheadedness. Orthostatic heart rate and blood pressure failed to predict orthostatic lightheadedness. The lightheadedness threshold, which marked the onset of lightheadedness, was equal to an average systolic CBFv decrease of 18.92% and end-tidal CO2 of 12.82%. The intensity of lightheadedness was proportional to the CBFv and end-tidal CO2 decline. Orthostatic lightheadedness correlated with systolic CBFv (r=-0.6, p < 0.001) and end-tidal CO2 (r=-0.33, p < 0.001) decline. In conclusion, orthostatic CBFv and end-tidal CO2 changes predict orthostatic lightheadedness and can be used as objective markers of OI.
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Affiliation(s)
- Fernando Morgadinho Santos Coelho
- Department of Neurology, Brigham and Women's Faulkner Hospital, 1153 Centre Street, Boston, MA, USA
- Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Renata Maria de Carvalho Cremaschi
- Department of Neurology, Brigham and Women's Faulkner Hospital, 1153 Centre Street, Boston, MA, USA
- Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Peter Novak
- Department of Neurology, Brigham and Women's Faulkner Hospital, 1153 Centre Street, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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2
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van Dijk JG, Bloem BR. A case report illustrating the 'hypotensive twilight zone' in Parkinson's disease; an under-recognised presentation of orthostatic hypotension. Clin Auton Res 2024; 34:307-310. [PMID: 38664335 DOI: 10.1007/s10286-024-01032-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/09/2024] [Indexed: 05/26/2024]
Affiliation(s)
- J Gert van Dijk
- Department of Neurology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Bastiaan R Bloem
- Department of Neurology (935), Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (935), Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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3
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Peebles KC, Jacobs C, Makaroff L, Pacey V. The use and effectiveness of exercise for managing postural orthostatic tachycardia syndrome in young adults with joint hypermobility and related conditions: A scoping review. Auton Neurosci 2024; 252:103156. [PMID: 38401460 DOI: 10.1016/j.autneu.2024.103156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia. It may occur in isolation, but frequently co-exists in individuals with hypermobile variants of Ehlers-Danlos Syndrome (EDS) and related conditions (chronic fatigue syndrome [CFS] and fibromyalgia). Exercise is recommended for non-pharmacological POTS management but needs to be individualised. This scoping review explores the current literature on use and effectiveness of exercise-based management for POTS, with specific focus on individuals with joint hypermobility and related conditions who experience hypermobility, and/or pain, and/or fatigue. METHODS A systematic search, to January 2023, of Medline, EMBASE, AMED, CINAHL and the Cochrane library was conducted. Studies that reported on adolescents and adults who had been diagnosed with POTS using standard criteria and underwent an exercise-based training intervention were included. RESULTS Following full-text screening, 10 articles were identified (2 randomised control trials, 4 comparative studies and 4 case reports). One comparative study reported a small subset of participants with EDS and one case report included an individual diagnosed with CFS; the remainder investigated a wider POTS population. Overall, 3 months of endurance followed by resistance exercise, graduating from the horizontal-to-upright position reduced POTS symptoms and improved quality-of-life. CONCLUSION The findings highlight a paucity of higher-level studies documenting exercise for POTS management in people with joint hypermobility and related conditions. Results from the wider POTS population demonstrate exercise is safe and effective. Large, well-designed clinical studies exploring exercise for POTS management adapting to meet the complex musculoskeletal and non-musculoskeletal features of symptomatic joint hypermobility are needed.
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Affiliation(s)
- Karen C Peebles
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Charl Jacobs
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Logan Makaroff
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Verity Pacey
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Novak P, Systrom DM, Marciano SP, Knief A, Felsenstein D, Giannetti MP, Hamilton MJ, Nicoloro-SantaBarbara J, Saco TV, Castells M, Farhad K, Pilgrim DM, Mullally WJ. Mismatch between subjective and objective dysautonomia. Sci Rep 2024; 14:2513. [PMID: 38291116 PMCID: PMC10828385 DOI: 10.1038/s41598-024-52368-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
Autonomic symptom questionnaires are frequently used to assess dysautonomia. It is unknown whether subjective dysautonomia obtained from autonomic questionnaires correlates with objective dysautonomia measured by quantitative autonomic testing. The objective of our study was to determine correlations between subjective and objective measures of dysautonomia. This was a retrospective cross-sectional study conducted at Brigham and Women's Faulkner Hospital Autonomic Laboratory between 2017 and 2023 evaluating the patients who completed autonomic testing. Analyses included validated autonomic questionnaires [Survey of Autonomic Symptoms (SAS), Composite Autonomic Symptom Score 31 (Compass-31)] and standardized autonomic tests (Valsalva maneuver, deep breathing, sudomotor, and tilt test). The autonomic testing results were graded by a Quantitative scale for grading of cardiovascular reflexes, sudomotor tests and skin biopsies (QASAT), and Composite Autonomic Severity Score (CASS). Autonomic testing, QASAT, CASS, and SAS were obtained in 2627 patients, and Compass-31 in 564 patients. The correlation was strong between subjective instruments (SAS vs. Compass-31, r = 0.74, p < 0.001) and between objective instruments (QASAT vs. CASS, r = 0.81, p < 0.001). There were no correlations between SAS and QASAT nor between Compass-31 and CASS. There continued to be no correlations between subjective and objective instruments for selected diagnoses (post-acute sequelae of COVID-19, n = 61; postural tachycardia syndrome, 211; peripheral autonomic neuropathy, 463; myalgic encephalomyelitis/chronic fatigue syndrome, 95; preload failure, 120; post-treatment Lyme disease syndrome, 163; hypermobile Ehlers-Danlos syndrome, 213; neurogenic orthostatic hypotension, 86; diabetes type II, 71, mast cell activation syndrome, 172; hereditary alpha tryptasemia, 45). The lack of correlation between subjective and objective instruments highlights the limitations of the commonly used questionnaires with some patients overestimating and some underestimating true autonomic deficit. The diagnosis-independent subjective-objective mismatch further signifies the unmet need for reliable screening surveys. Patients who overestimate the symptom burden may represent a population with idiosyncratic autonomic-like symptomatology, which needs further study. At this time, the use of autonomic questionnaires as a replacement of autonomic testing cannot be recommended.
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Affiliation(s)
- Peter Novak
- Autonomic Laboratory, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Neurology, Brigham and Women's Faulkner Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - David M Systrom
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Sadie P Marciano
- Department of Neurology, Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Alexandra Knief
- Department of Neurology, Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Donna Felsenstein
- Harvard Medical School, Boston, MA, USA
- Department of Infectious Disease and Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew P Giannetti
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Mastocytosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew J Hamilton
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Mastocytosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Tara V Saco
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Mastocytosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Mariana Castells
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Mastocytosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Khosro Farhad
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - David M Pilgrim
- Department of Neurology, Brigham and Women's Faulkner Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - William J Mullally
- Department of Neurology, Brigham and Women's Faulkner Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Knoop I, Jones ASK, Gall N, Chilcot J, Pascoe W, Moss-Morris R. Validation of symptom measures in patients under investigation for postural orthostatic tachycardia syndrome (POTS): The Orthostatic Grading Scale (OGS) and the Symptom Screen for Small-fiber Polyneuropathy (SSS). Auton Neurosci 2023; 250:103130. [PMID: 37976608 DOI: 10.1016/j.autneu.2023.103130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/20/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Postural Orthostatic Tachycardia Syndrome (POTS) presents with a range of poorly delineated symptoms across several domains. There is an urgent need for standardized symptom reporting in POTS, but a lack of validated symptom burden instruments. Our aim was to evaluate the psychometric properties of two symptom burden measures: the Orthostatic Grading Scale (OGS) and the Symptom Screen for Small-Fiber Polyneuropathy (SSS), in patients under investigation for suspected POTS. DESIGN Psychometric validation study. METHODS Confirmatory factor analysis (CFA) tested the factor structure of the SSS and OGS completed by 149 patients under investigation for POTS. Scale reliability and validity were assessed. The uni-dimensionality of the SSS was assessed through principal component analysis (PCA). RESULTS CFA of the OGS revealed that a 1-factor structure had adequate fit. CFA of the SSS revealed that a 5-factor structure had generally appropriate fit supporting the originally proposed 5 factors (1: Gastrointestinal, 2: Somatosensory, 3: Miscellaneous, 4: Microvascular, and 5: Urological). In addition, the SSS demonstrated sufficient uni-dimensionality in the PCA, warranting use of a single total score. Omega coefficients of both measures indicated satisfactory internal reliability (0.668-0.931). Correlations with related constructs (distress (K10 score), r = 0.317-0.404, p < 0.001) and heart rate indices (with the OGS, r = 0.211-0.294, p < 0.05) suggested sound convergent and divergent validity. CONCLUSIONS Initial evidence suggests that the OGS and SSS have good psychometric properties for use in populations with suspected and confirmed POTS.
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Affiliation(s)
- Iris Knoop
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Annie S K Jones
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Nicholas Gall
- Cardiology Department, King's College Hospital, London, United Kingdom
| | - Joseph Chilcot
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - William Pascoe
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
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Devigili G, Straccia G, Cereda E, Garavaglia B, Fedeli A, Elia AE, Piacentini SHMJ, Prioni S, Amami P, Invernizzi F, Andreasi NG, Romito LM, Eleopra R, Cilia R. Unraveling Autonomic Dysfunction in GBA-Related Parkinson's Disease. Mov Disord Clin Pract 2023; 10:1620-1638. [PMID: 38026514 PMCID: PMC10654845 DOI: 10.1002/mdc3.13892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/13/2023] [Accepted: 09/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Patients with Parkinson's disease (PD) and GBA gene mutations (GBA-PD) develop nonmotor complications more frequently than noncarriers. However, an objective characterization of both cardiovascular and sudomotor autonomic dysfunction using extensive clinical and instrumental measures has never been provided so far. Survival is reduced in GBA-PD regardless of age and dementia, suggesting that other hitherto unrecognized factors are involved. Objectives To provide instrumental measures of pattern and severity of autonomic dysfunction in GBA-PD and explore their correlation with other non-motor symptoms and implications for clinical practice. Methods In this cross-sectional study, 21 GBA-PD and 24 matched PD noncarriers underwent extensive assessment of motor and non-motor features, including neuropsychological testing. Cardiovascular autonomic function was explored through a comprehensive battery of indexes, including power spectral analysis of the R-R intervals and blood pressure short-term variability during resting state and active maneuvers. Dynamic Sweat Test was used to assess post-ganglionic sudomotor dysfunction. Results Despite minimal or absent clinical correlates, cardiovagal and sympathetic indexes, heart rate variability parameters and sudomotor postganglionic function were more severely impaired in GBA-PD than noncarriers (overcoming relatively preserved compensatory peripheral sympathetic function), suggesting more prominent cardiac sympatho-vagal demodulation, efferent baroreflex failure and peripheral sympathetic dysfunction in GBA-PD. Cardiovascular dysautonomia showed marginal correlations with cognitive impairment. Conclusions Compared to PD noncarriers, GBA-PD display more severe instrumental autonomic abnormalities, which may be underestimated by purely clinical measures, despite their relevance on morbidity and mortality. This supports the necessity of implementing instrumental autonomic assessment in all GBA-PD, regardless of clinically overt symptoms.
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Affiliation(s)
- Grazia Devigili
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders UnitMilanItaly
| | - Giulia Straccia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders UnitMilanItaly
- Neurology and Stroke UnitC.T.O. Hospital, A.O.R.N Ospedali dei ColliNaplesItaly
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics UnitFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Barbara Garavaglia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Unit of Medical Genetics and NeurogeneticsMilanItaly
| | - Alessandro Fedeli
- Neuropsychology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Antonio Emanuele Elia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders UnitMilanItaly
| | | | - Sara Prioni
- Neuropsychology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Paolo Amami
- Neuropsychology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Federica Invernizzi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Unit of Medical Genetics and NeurogeneticsMilanItaly
| | - Nico Golfrè Andreasi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders UnitMilanItaly
| | - Luigi Michele Romito
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders UnitMilanItaly
| | - Roberto Eleopra
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders UnitMilanItaly
| | - Roberto Cilia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders UnitMilanItaly
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Shevets V, Sherstiuk L, Bumeister V, Lychko V, Korenkov O, Ivakhnyuk T, Sotnikov D, Brizhata I. Cardiovascular Reaction to Orthostatic Test Among Non-functional Overreaching Athletes with Vegetative Disorders (The Physical Therapist Perspective). ACTA BALNEOLOGICA 2023. [DOI: 10.36740/abal202301107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Aim: The non-functional overreaching requires a deeper study because its diagnosing is not based on conventional methods. Orthostatic and clinostatic tests make it easy and quick to detect health problems. The purpose of this research is defining orthostatic reactions among 68 athletes with and without signs of non-functional overreaching.
Materials and Methods: Our research comprises 2 groups of 68 athletes subdivided by presence of non-functional overreaching. The first group includes 27 persons with vegetative disorder signs. The second group covers 41 individuals without non-functional overreaching. For all of them, we conducted orthostatic tests to record blood pressure and heart rate horizontally and vertically.
Results: The research showed that 9 athletes (33.3% of the O+ group) had unsatisfactory results after body tests in horizontal and vertical positions. All athletes revealed the orthostatic tolerance disorder. For 5 sportsmen, the latter was accompanied by the clinostatic overreaction. Resting heart rate did not vary considerably between both groups (р=0.412). However, orthostatic tests reflected the sharp index rise among 9 individuals. For non-functional overreaching athletes, the mean value (р<0.001) exceeded the corresponding one in the O- group more than twofold.
Conclusions: Although today it is possible to differentiate orthostatic-clinostatic tolerance from vegetative dysfunction, further research must be conducted to clarify this syndrome types and to improve physical recovery for non-functional overreaching athletes.
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Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies. Auton Neurosci 2023; 244:103052. [PMID: 36525900 DOI: 10.1016/j.autneu.2022.103052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/27/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Postural Orthostatic Tachycardia Syndrome (POTS) is a chronic health condition affecting mostly women of childbearing age, and significantly impacting their health and quality of life. It is currently poorly understood with no approved licensed treatments. The aim of this systematic review was to contextualize the symptom burden of POTS, and review factors associated with this burden that may guide future treatments. The specific questions were (1) How does symptom burden in POTS compare to the burden in other long term conditions (LTCs), (2) Which factors are associated with POTS symptom burden, and (3) Which interventions show promise in reducing symptom burden in POTS. DATABASES AND DATA TREATMENT Electronic databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, APA PsycArticles, OpenGrey) were searched from inception to January 2022 for observational studies reporting on the association between any biological, psychological or social factors and symptom burden, and randomized controlled trials reporting on interventions for symptom burden in adults with POTS. Two reviewers independently conducted eligibility screening, data extraction and quality assessment. A narrative synthesis was undertaken. RESULTS/CONCLUSION 5159 entries were screened for eligibility. Twenty-nine studies were included (1372 participants with POTS of a total sample size of 2314, 17 High-, 12 Medium-quality), seventeen were observational and twelve were randomized controlled experimental and intervention trials. Overall methodological quality of the evidence was medium-high but heterogeneity was high and sample sizes modest, allowing moderately robust conclusions. Orthostatic symptom burden was higher in POTS than other LTCs. Serum activity against adrenergic α1 receptors, physical functioning, depression, catastrophizing, prolonged cognitive stress testing and anxiety were significantly associated with symptom burden in medium-high quality studies. Preliminary medium-high quality evidence from predominantly proof-of-concept (n = 11) studies and one 3-month 2 × 2 factorial design trial suggest that compression garments, propranolol, pyridostigmine, desmopressin, and bisoprolol may hold promise in reducing symptom burden. Directions for future research include investigating associated factors over time, the development of complex interventions which address both biological and psychosocial factors associated with symptom burden, and effectiveness trials of these interventions. SIGNIFICANCE POTS symptom burden is high, particularly in relation to orthostatic intolerance when compared to other long-term conditions (LTCs). Despite this burden, there are no effectiveness randomized controlled trials of treatment to reduce symptoms in POTS. This review provides a starting point to understanding researched biological and psychosocial factors associated with this burden. There was however inconsistency in the measurement of symptom burden, lowering the confidence of cross-study inferences. A coherent definition of POTS symptom range, severity and impact along with a validated and reliable POTS-specific instrument is currently lacking. A standardized questionnaire to assess POTS symptom burden as a core outcome measure will help clarify future research and clinical practice.
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Xiao Y, Wu J, Min L, Dong X. The correlation between serum 25-hydroxyvitamin D and parathyroid hormone levels and orthostatic intolerance in children. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Habek M, Andabaka M, Fanciulli A, Jakob GB, Drulović J, Leys F, Di Pauli F, Hegen H, Auer M, Pekmezović T, Mesaroš Š, Jovičević V, Junaković A, Wenning GK, Deisenhammer F, Gabelić T, Barun B, Adamec I, Krbot Skorić M. Sudomotor dysfunction in people with neuromyelitis optica spectrum disorders. Eur J Neurol 2022; 29:2772-2780. [DOI: 10.1111/ene.15413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/22/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Mario Habek
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Marko Andabaka
- Faculty of Medicine University of Belgrade Belgrade Serbia
| | | | - Gregor Brecl Jakob
- University Medical Centre Ljubljana Department of Neurology Ljubljana Slovenia
| | - Jelena Drulović
- Faculty of Medicine University of Belgrade Belgrade Serbia
- University Clinical Center of Serbia, Clinic of Neurology Belgrade Serbia
| | - Fabian Leys
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | - Franziska Di Pauli
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | - Harald Hegen
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | - Michael Auer
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | | | - Šarlota Mesaroš
- Faculty of Medicine University of Belgrade Belgrade Serbia
- University Clinical Center of Serbia, Clinic of Neurology Belgrade Serbia
| | - Vanja Jovičević
- University Clinical Center of Serbia, Clinic of Neurology Belgrade Serbia
| | - Anamari Junaković
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
| | - Gregor K. Wenning
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | | | - Tereza Gabelić
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Barbara Barun
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Ivan Adamec
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Magdalena Krbot Skorić
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- Faculty of Electrical Engineering and Computing University of Zagreb Zagreb Croatia
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11
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Peebles KC, Tan I, Butlin M, Collins F, Tofts L, Avolio AP, Pacey V. The prevalence and impact of orthostatic intolerance in young women across the hypermobility spectrum. Am J Med Genet A 2022; 188:1761-1776. [PMID: 35224842 PMCID: PMC9305471 DOI: 10.1002/ajmg.a.62705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/16/2022] [Accepted: 02/08/2022] [Indexed: 11/10/2022]
Abstract
Orthostatic intolerance (OI) is frequently reported in young women with generalized hypermobility spectrum disorder (G-HSD) and hypermobile EDS (hEDS). However, it remains currently unclear whether OI is a comorbidity or fundamental part of the pathophysiology of G-HSD or hEDS. This study investigated the prevalence and impact of OI in young women across the hypermobility spectrum. Forty-five women (14-30 years, 15 controls, 15 G-HSD, and 15 hEDS) undertook a head-up tilt (HUT) and active stand test. Postural Orthostatic Tachycardia Syndrome (POTS) and Orthostatic Hypotension (OH) were assessed using age-related criteria. Autonomic dysfunction and quality-of-life questionnaires were also completed. The prevalence of POTS was higher in women with G-HSD than hEDS and control groups during HUT (43% vs. 7% and 7%, respectively, p < 0.05), but similar between groups during the active stand (47%, 27%, and 13% for G-HSD, hEDS, and control, respectively). No participants had OH. hEDS and G-HSD participants reported more severe orthostatic symptoms and poorer quality of life than controls. Although POTS was observed in hypermobile participants, there is no conclusive evidence that its prevalence differed between groups due to differences between the HUT and active stand assessments. Nevertheless, OI and broader autonomic dysfunction impacted on their quality of life.
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Affiliation(s)
- Karen C Peebles
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Isabella Tan
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Mark Butlin
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Felicity Collins
- Department of Medical Genomics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Louise Tofts
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Narrabeen Sports and Exercise Medicine Centre, Sydney, Australia
| | - Alberto P Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Verity Pacey
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Abstract
SUMMARY This review recapitulates the head-up tilt test, which is commonly used for evaluation of orthostatic syndromes and dysautonomia. Tilt test evaluates autonomic system responses to orthostatic stress. Established tilt testing includes monitoring of heart rate and blood pressure; adding capnography and cerebral blood flow monitoring expands its diagnostic yield and allows assessing cerebral blood flow regulation. Common syndromes detectable by the tilt test are neurally mediated syncope (vasodepressor, cardiovagal, or mixed), orthostatic hypotension, postural orthostatic tachycardia syndrome, hypocapnic cerebral hypoperfusion, and orthostatic cerebral hypoperfusion syndrome. This review describes relevant physiology, tilt test protocols, diagnostic criteria for orthostatic syndromes, grading test results, diagnostic accuracy, limitations of the tilt test, and safety considerations.
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Chouksey D, Rathi P, Sodani A, Jain R, Ishar HS. Postural orthostatic tachycardia syndrome in patients of orthostatic intolerance symptoms: an ambispective study. AIMS Neurosci 2021; 8:74-85. [PMID: 33490373 PMCID: PMC7815479 DOI: 10.3934/neuroscience.2021004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022] Open
Abstract
Background A Postural orthostatic tachycardia syndrome (POTS) is infrequently diagnosed in routine practice because of the variable range of symptoms that could be seen in cardiac rhythm disorders, vertigo, chronic fatigue syndrome and anxiety panic disorder. POTS is a chronic debilitating condition that affects day to day efficient working of an individual. We have planned a study to look for POTS in patients who are having orthostatic intolerance symptoms and underwent a head-up tilt table test (HUTT). Aim To study the prevalence of POTS in patients of orthostatic intolerance (OI) symptoms and to analyze symptomatology, its association with neurocardiogenic syncope (NCS), and its outcome. Methods We reviewed the medical records of 246 patients presented with symptoms of OI seen at our centre from January 2010 till March 2019. Out of them, 40 patients included, those qualifying the criteria for POTS on HUTT. Results The mean age of the cohort was 25.90 ± 10.33 years with a range of 15 to 55 years, and males comprised 52.5% (21/40) of total patients. The most frequent presenting orthostatic symptoms of POTS patients are loss of consciousness (77.5%), lightheadedness (75%), and palpitation (67.5%). A total of 18 patients (45%) had coexisting neurocardiogenic syncope. Conclusion POTS is a prevalent condition and have a significant impact on the quality of life, and the majority of patients may not present with OI symptoms during HUTT. We have to keep this possibility in young patients of transient loss of consciousness because it may coexist with NCS.
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Affiliation(s)
- Dinesh Chouksey
- Department of Neurology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, M.P. India
| | - Pankaj Rathi
- Department of Neurology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, M.P. India
| | - Ajoy Sodani
- Department of Neurology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, M.P. India
| | - Rahul Jain
- Department of Neurology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, M.P. India
| | - Hashash Singh Ishar
- Department of Neurology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, M.P. India
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14
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Delta plot analysis of cardiovascular and cardiorespiratory interactions in young women with orthostatic intolerance. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.101892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Prevalence and factors related to orthostatic syndromes in recently diagnosed, drug-naïve patients with Parkinson disease. Clin Auton Res 2019; 30:265-271. [DOI: 10.1007/s10286-019-00652-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/02/2019] [Indexed: 12/15/2022]
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16
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Charleston-Villalobos S, Reulecke S, Voss A, Azimi-Sadjadi MR, González-Camarena R, Gaitán-González MJ, González-Hermosillo JA, Hernández-Pacheco G, Schulz S, Aljama-Corrales T. Time-Frequency Analysis of Cardiovascular and Cardiorespiratory Interactions During Orthostatic Stress by Extended Partial Directed Coherence. ENTROPY (BASEL, SWITZERLAND) 2019; 21:e21050468. [PMID: 33267182 PMCID: PMC7514957 DOI: 10.3390/e21050468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 06/12/2023]
Abstract
In this study, the linear method of extended partial directed coherence (ePDC) was applied to establish the temporal dynamic behavior of cardiovascular and cardiorespiratory interactions during orthostatic stress at a 70° head-up tilt (HUT) test on young age-matched healthy subjects and patients with orthostatic intolerance (OI), both male and female. Twenty 5-min windows were used to analyze the minute-wise progression of interactions from 5 min in a supine position (baseline, BL) until 18 min of the orthostatic phase (OP) without including pre-syncopal phases. Gender differences in controls were present in cardiorespiratory interactions during OP without compromised autonomic regulation. However in patients, analysis by ePDC revealed considerable dynamic alterations within cardiovascular and cardiorespiratory interactions over the temporal course during the HUT test. Considering the young female patients with OI, the information flow from heart rate to systolic blood pressure (mechanical modulation) was already increased before the tilt-up, the information flow from systolic blood pressure to heart rate (neural baroreflex) increased during OP, while the information flow from respiration to heart rate (respiratory sinus arrhythmia) decreased during the complete HUT test. Findings revealed impaired cardiovascular interactions in patients with orthostatic intolerance and confirmed the usefulness of ePDC for causality analysis.
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Affiliation(s)
| | - Sina Reulecke
- Department of Electrical Engineering, Universidad Autónoma Metropolitana, Mexico City 09340, Mexico
| | - Andreas Voss
- Institute of Innovative Health Technologies, Ernst-Abbe-Hochschule Jena, 07745 Jena, Germany
| | - Mahmood R. Azimi-Sadjadi
- Department of Electrical and Computer Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | | | | | | | | | - Steffen Schulz
- Institute of Innovative Health Technologies, Ernst-Abbe-Hochschule Jena, 07745 Jena, Germany
| | - Tomás Aljama-Corrales
- Department of Electrical Engineering, Universidad Autónoma Metropolitana, Mexico City 09340, Mexico
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17
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Naschitz JE. Blood pressure management in older people: balancing the risks. Postgrad Med J 2018; 94:348-353. [PMID: 29555655 DOI: 10.1136/postgradmedj-2017-135493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/31/2018] [Accepted: 02/12/2018] [Indexed: 12/17/2022]
Abstract
Guidelines of arterial hypertension treatment based on individualised expected outcomes are not available for frail older persons. In this paper, we review the evidence, concerning management of arterial blood pressure (BP) in frail older patients. We focused on the best affordable methods for BP measurement; the age-related optimum BP; specific BP goals in agreement with the patients' general heath, frailty status, orthostatic and postprandial hypotension; balancing the benefits against risks of antihypertensive treatment. Lenient BP goals are generally recommended for older persons with moderate or severe frailty, multimorbidity and limited life expectancy. To this aim, there may be a need for deintensification of antihypertensive treatment.
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Affiliation(s)
- Jochanan E Naschitz
- Bait Balev Nesher and The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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18
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Merola A, Romagnolo A, Rosso M, Suri R, Berndt Z, Maule S, Lopiano L, Espay AJ. Autonomic dysfunction in Parkinson's disease: A prospective cohort study. Mov Disord 2017; 33:391-397. [DOI: 10.1002/mds.27268] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/09/2017] [Accepted: 11/19/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Aristide Merola
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology; University of Cincinnati; Cincinnati Ohio USA
| | - Alberto Romagnolo
- Department of Neuroscience “Rita Levi Montalcini”; University of Turin; Torino Italy
| | - Michela Rosso
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology; University of Cincinnati; Cincinnati Ohio USA
| | - Ritika Suri
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology; University of Cincinnati; Cincinnati Ohio USA
| | - Zoe Berndt
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology; University of Cincinnati; Cincinnati Ohio USA
| | - Simona Maule
- Department of Medical Sciences, Autonomic Unit and Hypertension Unit; University of Turin; Torino Italy
| | - Leonardo Lopiano
- Department of Neuroscience “Rita Levi Montalcini”; University of Turin; Torino Italy
| | - Alberto J. Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology; University of Cincinnati; Cincinnati Ohio USA
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