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Has anyone failed a TTT but had their QSART return back normal?

Has anyone failed a TTT, had their QSART return back normal, and still be diagnosed with POTS?

I've yet to have a QSART yet but I'm assuming this would be necessary in verifying whether or not your autonomic system is functioning correctly.

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I had a positive TTT with a negative QSART. So I have POTS but not Peripheral neuropathy. That is what the QSART tests.

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Well, for one thing, you would have burning and pain, pins and needles feelings in your hands and feet, although it's different for everybody. I have both.

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I have had 3 abnormal tilts and 2 normal QSARTS. Yet, I have pronounced parasthesias (tingling, numbness, burning, ice cold, feelings) both centrally and peripherally. And, I have lost my ability to sweat normally. So I full expected to have abnormal QSARTS. Funny thing I that it seems I have so many neuro issues I was surprised this was normal. Also, all myl autonomic reflexes are intact. Well I should restate that- my reflexes are exaggerated so I have the hyperadrenergic form of POTS confirmed by elevated NE levels.

According to Dr. Biaggioni at Vanderbilt approx 1/3 of POTS patients have normal QSARTS which means that about 2/3rds have small fiber neuropathy as stated above. Neuropathic POTS is one subtype of POTS that describes those that have POTS that also have small fiber nerve involvement. Patients can have multiple subtypes.

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I think it just means that I don't have nerve involvement, which I believe is good. It means my Autonomic nervous system isn't functioning 100% (POTS) but it isn't to the nerve level. That is how I understand it.

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You can throw the Valsalva test in too. According to my POTS neuro, my valsalva results indicate autonomic neuropathy. I had "sudomotor" testing done, which I think was the QSART? and those results were normal, but a skin biopsy showed significant denervation and I was diagnosed with SFN based on that. A repeat skin biopsy did not show SFN, yet the first results were double checked and deemed accurate. I don't care what the tests said, I know based on the horrible burning in my feet that I have at least sensory neuropathy. I've also heard the other way around - of people having normal skin biopsies and abnormal QSARTS. I don't think testing can always give definitive results on this one. If you have the symptoms, I don't think a negative test result necessarily rules it out. I think the whole point of determining whether there is nerve involvement is because it can be another clue into what's causing the dysautonomia. Once I had the positive skin biopsy, my Doctor started thinking about things that could cause small fiber neuropathy (which might be causing the POTS symptoms) and tested me for a bunch of things he would not have otherwise. Unfortunately, we still haven't found the underlying cause for the SFN.

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The QSART is basically a test to see if you have issues with the peripheral autonomic nervous system signalling to your legs and arms - basically, do you have small fiber neuropathy? The reason they test for it is twofold: first, it is an easy test, and second, many of the causes of SFN, even autonomic SFN, are treatable (diabetes, HIV/AIDS, vitamin issues) so it's a good call to rule it out. In my case both TTT and QSART were positive, though the QSART weakly so; we did a ton of bloodwork and ruled out all the usual causes of SFN, so it's just "idiopathic" (due to no obvious reason). A non-significant QSART doesn't mean much about whether you have POTS/dysautonomia or not, it just suggests whether you might have issues with nervous signaling in your legs and arms that influences autonomic functioning in those areas.

If you have the autonomic workup done at UWMC, they test QSART as well as Valsalva.

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Hi, I can also speak to this. TTT, Qsart and the gold standard - skin biopsy, are all test that prove autonomic dysfunction. If autonomic neuropathy is found from any of these tests, then further testing is done to determine if there is underlying cause.

In my case ttt showed several forms of dysautonomia which included pots, hyperandregenic rise in blood pressure, and with that rise eventual syncope. In real life I get near syncopes that suddenly drop me to the ground without loosing conscienceness. Once the ttt results are done skin biopsy along with qsart are good tests to do, which then can lead to pointing in what direction to go next.

My neuro does both qsart and skin biopsy for sfn. SFN can be spotty or patchy so doing both tests gives one a better chance of catching it. I did not end up needing qsart as both my skin biopsies a year a part showed denervation to my sfns which include both sensory and autonomic nerves. In my case my autonomic nerves that constrict blood vessels, control temperature, moisture product/sweat, hr/bp, gi motility and pain sensation/numbness were effected.

Upon these results my neuro tested me for many causitive conditions including stiff persons and carcinoid, some rarer causes, of which we have several members here that have had those diagnosies made. I turned out to have a defective immune system with several autoimmune diseases including hashimoto, a lupus/sjogren like undefined one, and lichen planus a tissue one, along with a depressed immune system low in igg and igm that does not allow my body to fight off certain types of infections effectively. I am also homozygous for the mthfr gene.

With treatment my symptoms are slowly improving, but will require life long managment. I'm good with that, though it can be challenging at times. I remember and still deal with the struggles of seeking proper diagnosis, effective testing and finding a doctor that can actually see the forest, instead of just the trees. Wouldn't want to go back to the begining of this process for anything it took decades.

I tell you this, so you perserve through this difficult part of the process. Trust your gut, move on if you are not getting what you need, and you will eventually figure out what is wrong.

Remember that this is a dysautonomia website providing information and support for all who present with several types of autonomic intolerance and pots alone is not always the only or end answer to getting treatment. While we list several types on our website, often dysautonomia's are a result of a secondary cause. One test alone does not prove or disprove anything. Sometimes tests need to be redone as many times these states of illness are progressive and a normal may become abnormal. So normals should be rechecked from time to time, especially if symptoms get worse.

Take care all and I wish you a faster journey to health then I.

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