Research in Review

• Is home orthostatic self-training effective in preventing neurally mediated syncope?
• Autonomic dysfunction, allergy and the upper airway
• Panayiotopoulos syndrome: diagnosis and management
• Blood volume perturbations in the postural tachycardia syndrome

Pacing Clin Electrophysiol. 2007 May;30(5):638-43

Is home orthostatic self-training effective in preventing neurally mediated syncope?

On YK, Park J, Huh J, Kim JS.

Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea.

BACKGROUND: Repeated orthostatic stress may prove to be of benefit in the regulation of neurally mediated syncope. But the role of home orthostatic self-training is not established to prevent symptoms in patients with neurally mediated syncope. We performed a prospective and randomized study to evaluate the effectiveness of repeated home orthostatic self-training in preventing tilt-induced neurally mediated syncope.

METHODS AND RESULTS: Fourty-two consecutive patients (24 males and 18 females, mean age 39 years, 16-68 years) with recurrent neurally mediated syncope were randomized into the tilt training and control groups. The home orthostatic self-training program consisted of daily sessions for 7 days a week for 4 weeks.

In order to determine the effects of home orthostatic self-training, we repeated the head-up tilt test in both groups 4 weeks later. Among the tilt-training group, 9 of 16 patients (56%) had a positive response on follow-up head-up tilt test. Among the untreated control group, 9 of 17 patients (53%) had a positive response on follow-up head-up tilt test. In subgroup analyses according to the number of tilt-training sessions or the classified type, we found no differences in the follow-up head-up tilt test responses. Spontaneous syncope or presyncope over mean follow-up of 16.9 months were observed in 42.9% versus 47.1% in the tilt-training and control group, respectively.

CONCLUSIONS: Home orthostatic self-training was ineffective in reducing the positive response rate of head-up tilt test in patients with recurrent neurally mediated syncope.

PMID: 17461874

Curr Opin Otolaryngol Head Neck Surg. 2007 Aug;15(4):264-7.

Autonomic dysfunction, allergy and the upper airway.

Loehrl TA.

Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Medical College of Wisconsin/Zablocki VA Medical Center, Milwaukee, Wisconsin, USA.

PURPOSE OF REVIEW: The autonomic nervous system has been implicated in the pathophysiology of chronic upper airway inflammatory disease for decades. We discuss the most recent literature with regard to autonomic nervous system dysfunction and chronic upper airway disease.

RECENT FINDINGS: Recently, state of the art autonomic nervous system testing has demonstrated autonomic nervous system dysfunction in patients with chronic upper airway inflammatory disease. This dysfunction has been characterized as hypoadrenergic.

SUMMARY: Autonomic nervous system dysfunction likely plays a role in chronic upper airway inflammatory disease. Further investigation may lead to a better understanding of the role of autonomic nervous system dysfunction in these disorders and, hence, opportunities for novel therapeutic modalities.

PMID: 17620901

Neurol Sci. 2007 Apr;28(2):72-9.

Panayiotopoulos syndrome: diagnosis and management.

Parisi P, Villa MP, Pelliccia A, Rollo VC, Chiarelli F, Verrotti A.

Child Neurology and Paediatric Sleep Centre, La Sapienza University c/o Sant'Andrea Hospital, Rome, Italy.

Panayiotopoulos syndrome is a relatively frequent and benign epileptic syndrome, characterised by predominantly autonomic symptoms and/or simple motor focal seizures followed or not by impairment of consciousness. Interictal EEG shows occipital spikes although multifocal spikes with high amplitude sharp-slow wave complexes at various locations can be present. This syndrome can imitate gastroenteritis, encephalitis, syncope, migraine, sleep disorders or metabolic diseases. The peculiar aspects should be known not only by epileptologists but also by general doctors because a correct diagnosis would avoid aggressive interventions and concerns on account of its benign outcome. This review focuses on the main clinical and EEG features of this epilepsy underlining its typical and atypical symptoms and its management.

PMID: 17464469

Am J Med Sci. 2007 Jul;334(1):57-60.

Blood volume perturbations in the postural tachycardia syndrome.

Raj SR, Robertson D.

From the Autonomic Dysfunction Center, Division of Clinical Pharmacology, Departments of Medicine (srr, dr), Pharmacology (srr, dr), and Neurology (dr), Vanderbilt University School of Medicine, Nashville, Tennessee.

The postural tachycardia syndrome (POTS) is characterized by excessive orthostatic tachycardia with chronic symptoms that are associated with upright posture. These chronic symptoms (of at least 6 months' duration) include tachycardia, exercise intolerance, lightheadedness, extreme fatigue, headache, and mental clouding. Patients with POTS demonstrate an increase in heart rate of at least 30 beats/min within 5 to 30 minutes of assuming an upright posture, in the absence of orthostatic hypotension (a fall in blood pressure >20/10 mm Hg) and in the absence of other medical disorders that might cause tachycardia. POTS can be associated with a high degree of functional disability. The blood volume has been found to be low in many patients with POTS. This article will review some of the data regarding blood volume perturbations in POTS, blood volume regulation in POTS, and potential treatment approaches.

PMID: 17630594

Research abstracts obtained from PubMed.

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