Orthostatic Intolerance in Adolescent Chronic Fatigue Syndrome

Stewart, Julian M.; Gewitz, Michael H.; Weldon, Amy; Arlievsky, Nina; Li, Karl; Muñoz, José

doi:10.1542/peds.103.1.116

Cited by 134 publications

(98 citation statements)

References 21 publications

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“…34 There are also studies supporting the similarity of the autonomic dysfunctions observed in CFS and POTS. 35,36 Hägglöf 37 in 2000 and Björkegren 38 in 1999 demonstrated that CFS could be treated with vitamin B 12 .…”

Section: Discussionmentioning

confidence: 99%

Postural Orthostatic Tachycardia Syndrome (POTS) and Vitamin B12 Deficiency in Adolescents

et al. 2014

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OBJECTIVE: Vitamin B12 is involved in the production of adrenaline from noradrenaline. It is the cofactor involved in catecholamine degradation and plays a role in myelin synthesis. The current study aimed to investigate the association between vitamin B12 levels and postural orthostatic tachycardia syndrome (POTS) during adolescence when accelerated myelin synthesis increases the vitamin B12 need. METHODS: One hundred twenty-five patients (mean age 11.1 ± 2.3 years; 60% female) reporting short-term loss of consciousness and diagnosed with vasovagal syncope based on anamnesis with a normal distribution and 50 control subjects (mean age 10.94 ± 2.5 years, 62% female) were included in this study. Serum vitamin B12, folic acid, and ferritin levels were measured prospectively in addition to other tests. We defined vitamin B12 deficiency as a serum level <300 pg/mL.1–4 RESULTS: Vitamin B12 levels were significantly lower in the patient group compared with the control group (47.2% vs 18%, P < .001). In the patient group, children with the POTS pattern had significantly lower vitamin B12 levels compared with children without the POTS response (P = .03). CONCLUSIONS: Vitamin B12 deficiency in patients with POTS may lead to sympathetic nervous system baroreceptor dysfunction.

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Section: Discussionmentioning

confidence: 99%

Postural Orthostatic Tachycardia Syndrome (POTS) and Vitamin B12 Deficiency in Adolescents

et al. 2014

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“…Similar to the adult experience, orthostatic intolerance in adolescents with CFS is consistent with POTS. 118,121 CFS may represent a severe form of POTS in adolescents, and the autonomic findings may be related to circulatory abnormalities at rest and during orthostasis. Stewart et al 121 have demonstrated loss of heart rate variability consistent with vagal withdrawal, increased blood pressure variability consistent with enhanced modulation of sympathetic tone, and impaired baroreflex.…”

Section: Functional Abdominal Painmentioning

confidence: 99%

Pediatric Autonomic Disorders

2006

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The scope of pediatric autonomic disorders is not well recognized. The goal of this review is to increase awareness of the expanding spectrum of pediatric autonomic disorders by providing an overview of the autonomic nervous system, including the roles of its various components and its pervasive influence, as well as its intimate relationship with sensory function. To illustrate further the breadth and complexities of autonomic dysfunction, some pediatric disorders are described, concentrating on those that present at birth or appear in early childhood.www.pediatrics.org/cgi

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“…POTS is operationally defined by the presence of symptoms of orthostatic intolerance associated with an increase in sinus heart rate of Ͼ30 beats/min or to a rate of Ͼ120 beats/min during the first 10 min of HUT table testing (2). Previous work, including our own, has suggested that adolescent patients with CFS often have findings of POTS during HUT (3)(4)(5)(6). Conversely, patients with POTS often have fatigue as a prominent clinical feature (2,7).…”

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confidence: 99%

Autonomic Nervous System Dysfunction in Adolescents with Postural Orthostatic Tachycardia Syndrome and Chronic Fatigue Syndrome Is Characterized by Attenuated Vagal Baroreflex and Potentiated Sympathetic Vasomotion

2000

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The objective was to determine the nature of autonomic and vasomotor changes in adolescent patients with orthostatic tachycardia associated with the chronic fatigue syndrome (CFS) and the postural orthostatic tachycardia syndrome (POTS). Continuous electrocardiography and arterial tonometry was used to investigate the heart rate and blood pressure responses before and 3-5 min after head-up tilt in 22 adolescents with POTS and 14 adolescents with CFS, compared with control subjects comprising 10 healthy adolescents and 20 patients with simple faint. Heart rate and blood pressure variability, determined baroreceptor function using transfer function analysis, and measured cardiac vagal and adrenergic autonomic responses were calculated using timed breathing and the quantitative Valsalva maneuver. Two of 10 healthy controls and 14 of 20 simple faint patients experienced vasovagal syncope during head-up tilt. By design, all CFS and POTS patients experienced orthostatic tachycardia, often associated with hypotension. R-R interval and heart rate variability were decreased in CFS and POTS patients compared with control subjects and remained decreased with head-up tilt. Low-frequency (0.05-0.15 Hz) blood pressure variability reflecting vasomotion was increased in CFS and POTS patients compared with control subjects and increased further with head-up tilt. This was associated with depressed baroreflex transfer indicating baroreceptor attenuation through defective vagal efferent response. Only the sympathetic response remained. Heart rate variability declined progressively from normal healthy control subjects through syncope to POTS to CFS patients. Timed breathing and Valsalva maneuver were most often normal in CFS and POTS patients, although abnormalities in select individuals were found. Heart rate and blood pressure regulation in POTS and CFS patients are similar and indicate attenuated efferent vagal baroreflex associated with increased vasomotor tone. Loss of beat-to-beat heart rate control may contribute to a destabilized blood pressure resulting in orthostatic intolerance. The dysautonomia of orthostatic intolerance in POTS and in chronic fatigue are similar. Abbreviations CFS, chronic fatigue syndrome POTS, postural orthostatic tachycardia syndrome HUT, head-up tilt CDC, Centers for Disease Control and Prevention BP, blood pressure LF, low frequency HF, high frequency VLF, very low frequency HRV, heart rate variability Orthostatic intolerance is defined by the inability to remain upright without severe signs and symptoms such as hypotension, tachycardia, lightheadedness, pallor, fatigue, weakness, and nausea. Orthostatic intolerance appears in many guises including overt dysautonomia, vasovagal syncope, and orthostatic tachycardia (1). POTS is operationally defined by the presence of symptoms of orthostatic intolerance associated with an increase in sinus heart rate of Ͼ30 beats/min or to a rate of Ͼ120 beats/min during the first 10 min of HUT table testing (2). Previous work, including our own, has suggested that...

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Orthostatic Intolerance in Adolescent Chronic Fatigue Syndrome

Cited by 134 publications

References 21 publications

Postural Orthostatic Tachycardia Syndrome (POTS) and Vitamin B12 Deficiency in Adolescents

Postural Orthostatic Tachycardia Syndrome (POTS) and Vitamin B12 Deficiency in Adolescents

Pediatric Autonomic Disorders

Autonomic Nervous System Dysfunction in Adolescents with Postural Orthostatic Tachycardia Syndrome and Chronic Fatigue Syndrome Is Characterized by Attenuated Vagal Baroreflex and Potentiated Sympathetic Vasomotion

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