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崔 雅, 杜 军, 张 清, 廖 莹, 刘 平, 王 瑜, 齐 建, 闫 辉, 徐 文, 刘 雪, 孙 燕, 孙 楚, 张 春, 陈 永, 金 红. [A 10-year retrospective analysis of spectrums and treatment options of orthostatic intolerance and sitting intolerance in children]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:954-960. [PMID: 36241239 PMCID: PMC9568388 DOI: 10.19723/j.issn.1671-167x.2022.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To analyze the disease spectrums underlying orthostatic intolerance (OI) and sitting intolerance (SI) in Chinese children, and to understand the clinical empirical treatment options. METHODS The medical records including history, physical examination, laboratory examination, and imagological examination of children were retrospectively studied in Peking University First Hospital from 2012 to 2021. All the children who met the diagnostic criteria of OI and SI were enrolled in the study. The disease spectrums underlying OI and SI and treatment options during the last 10 years were analyzed. RESULTS A total of 2 110 cases of OI and SI patients were collected in the last 10 years, including 943 males (44.69%) and 1 167 females (55.31%) aged 4-18 years, with an average of (11.34±2.84) years. The overall case number was in an increasing trend over the year. In the OI spectrum, postural tachycardia syndrome (POTS) accounted for 826 cases (39.15%), followed by vasovagal syncope (VVS) (634 cases, 30.05%). The highest proportion of SI spectrum was sitting tachycardia (STS) (8 cases, 0.38%), followed by sitting hypertension (SHT) (2 cases, 0.09%). The most common comorbidity of OI and SI was POTS coexisting with STS (36 cases, 1.71%). The highest proportion of treatment options was autonomic nerve function exercise (757 cases, 35.88%), followed by oral rehydration salts (ORS) (687 cases, 32.56%), metoprolol (307 cases, 14.55%), midodrine (142 cases, 6.73%), ORS plus metoprolol (138 cases, 6.54%), and ORS plus midodrine (79 cases, 3.74%). The patients with POTS coexisting with VVS were more likely to receive pharmacological intervention than the patients with POTS and the patients with VVS (41.95% vs. 30.51% vs. 28.08%, χ2= 20.319, P < 0.01), but there was no significant difference in the proportion of treatment options between the patients with POTS and the patients with VVS. CONCLUSION POTS and VVS in children are the main underlying diseases of OI, while SI is a new disease discovered recently. The number of children with OI and SI showed an increasing trend. The main treatment methods are autonomic nerve function exercise and ORS. Children with VVS coexisting with POTS were more likely to take pharmacological treatments than those with VVS or POTS only.
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Affiliation(s)
- 雅茜 崔
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - 军保 杜
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
- 教育部分子心血管学重点实验室, 北京 100191Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing 100191, China
| | - 清友 张
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - 莹 廖
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - 平 刘
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - 瑜丽 王
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - 建光 齐
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - 辉 闫
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - 文瑞 徐
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - 雪芹 刘
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - 燕 孙
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - 楚凡 孙
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - 春雨 张
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - 永红 陈
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - 红芳 金
- 北京大学第一医院儿科, 北京 100034Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
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Ray JC, Pham X, Foster E, Cheema S, Corcoran SJ, Matharu MS, Hutton EJ. The prevalence of headache disorders in Postural Tachycardia Syndrome: A systematic review and meta-analysis of the literature. Cephalalgia 2022; 42:1274-1287. [PMID: 35469447 DOI: 10.1177/03331024221095153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Headache is a common presentation of postural tachycardia syndrome, yet robust prevalence data is lacking. OBJECTIVES To undertake a systematic review and meta-analysis to estimate the prevalence of headache disorders in postural tachycardia syndrome, and to explore the potential shared pathophysiological mechanisms that underpin these conditions as well as treatment options. METHODS Three databases were searched for publications evaluating prevalence of migraine (primary outcome) and general and orthostatic headache (secondary outcomes) in patients with postural tachycardia syndrome. Two independent reviewers selected studies and extracted data. A random-effects meta-analysis calculated the pooled prevalence of migraine in postural tachycardia syndrome. A narrative literature review explored the pathophysiology and treatment options for concurrent headache disorders and postural tachycardia syndrome. RESULTS Twenty-three articles met inclusion criteria. Estimated pooled prevalence of migraine in postural tachycardia syndrome was 36.8% (95% CI 2.9-70.7%). Various shared pathophysiological pathways for these conditions, as well as proposed treatment strategies, were identified.Limitations: Heterogeneity of study design, populations, and methodology for identifying headache disorders and postural tachycardia syndrome limited the generalisability of results. CONCLUSIONS Migraine is a commonly reported comorbidity in POTS, however the true prevalence cannot be determined from the current literature. Further studies are required to assess this comorbidity and investigate the underlying mechanisms, as well as identify effective treatment strategies.
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Affiliation(s)
- Jason C Ray
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Xiuxian Pham
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Emma Foster
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Sanjay Cheema
- Headache and Facial Pain Group, University College London Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Susan J Corcoran
- Department of Cardiology, Alfred Hospital, Melbourne Victoria, Australia
| | - Manjit S Matharu
- Headache and Facial Pain Group, University College London Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Elspeth J Hutton
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
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Chen G, Du J, Jin H, Huang Y. Postural Tachycardia Syndrome in Children and Adolescents: Pathophysiology and Clinical Management. Front Pediatr 2020; 8:474. [PMID: 32974246 PMCID: PMC7468430 DOI: 10.3389/fped.2020.00474] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/06/2020] [Indexed: 12/21/2022] Open
Abstract
Postural tachycardia syndrome (POTS), characterized by chronic (≥6 months) orthostatic intolerance symptoms with a sustained and excessive heart rate increase while standing without postural hypotension, is common in children and adolescents. Despite the unclear pathogenesis of POTS, the present opinion is that POTS is a heterogeneous and multifactorial disorder that includes altered central blood volume, abnormal autonomic reflexes, "hyperadrenergic" status, damaged skeletal muscle pump activity, abnormal local vascular tension and vasoactive factor release, mast cell activation, iron insufficiency, and autoimmune dysfunction. A number of pediatric POTS patients are affected by more than one of these pathophysiological mechanisms. Therefore, individualized treatment strategies are initiated in the management of POTS, including basal non-pharmacological approaches (e.g., health education, the avoidance of triggers, exercise, or supplementation with water and salt) and special pharmacological therapies (e.g., oral rehydration salts, midodrine hydrochloride, and metoprolol). As such, the recent progress in the pathogenesis, management strategies, and therapeutic response predictors of pediatric POTS are reviewed here.
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Affiliation(s)
- Guozhen Chen
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Department of Pediatrics, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Science, The Ministry of Education, Beijing, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yaqian Huang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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Abstract
The concept of orthostatic hypertension in children was first proposed in 2012. The pathogenesis is not clear by now. Orthostatic hypertension is one of the important causes of orthostatic intolerance in children and is related to the development of essential hypertension in the future. It is commonly seen in older children, with dizziness and syncope as their main clinical manifestations. Non-drug therapy is the commonly used treatment strategy, which is effective to improve the orthostatic intolerance symptoms. In this paper, we reviewed the clinical studies on the pathogenesis, clinical characteristics, diagnostic criteria, and treatment of orthostatic hypertension in children, aiming to provide new insights for the future studies on pediatric orthostatic hypertension.
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Affiliation(s)
- Yang Hu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Key Laboratory of Cardiovascular Sciences, Ministry of Education, Beijing, China
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