Dataset Information

Post-Concussive Orthostatic Tachycardia is Distinct from Postural Orthostatic Tachycardia Syndrome (POTS) in Children and Adolescents.

ABSTRACT: Background: Orthostatic tachycardia (OT) affects some patients after concussion/mild traumatic brain injury (mTBI). In this study, we sought to identify the factors associated with increased risk for OT in patients with mTBI. Methods: We conducted a retrospective review of 268 patients (8-25 years) with mTBI/concussion to determine the prevalence of OT, defined as orthostatic heart rate change ≥40 bpm for those ≤19 years of age and ≥30 bpm on active standing test for those >19 years of age. Results: Among the study population, 7% (n = 19) exhibited post-concussive OT. The only significant difference between OT and non-OT groups was that history of prior concussion was more prevalent in the OT group. Conclusion: A substantial subset (7%) of concussion clinic patients exhibit OT. While POTS literature describes female and adolescent predominance, post-concussive OT had similar prevalence across age and gender groups in this study, suggesting that it may be distinct from POTS.

SUBMITTER: Pearson R

PROVIDER: S-EPMC9136088 | biostudies-literature | 2022 Jan-Dec

REPOSITORIES: biostudies-literature

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Post-Concussive Orthostatic Tachycardia is Distinct from Postural Orthostatic Tachycardia Syndrome (POTS) in Children and Adolescents.

Pearson Rachel R Sheridan Christopher A CA Kang Kaylee K Brown Anne A Baham Michael M Asarnow Robert R Giza Christopher C CC Choe Meeryo C MC

Child neurology open 20220101

<b>Background:</b> Orthostatic tachycardia (OT) affects some patients after concussion/mild traumatic brain injury (mTBI). In this study, we sought to identify the factors associated with increased risk for OT in patients with mTBI. <b>Methods:</b> We conducted a retrospective review of 268 patients (8-25 years) with mTBI/concussion to determine the prevalence of OT, defined as orthostatic heart rate change ≥40 bpm for those ≤19 years of age and ≥30 bpm on active standing test for those >19 year ...[more]

PMID: 35647216

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Project description:Postural orthostatic tachycardia syndrome (POTS) is a chronic neurological disorder of the autonomic nervous system (ANS) that is characterized by an excessive increase in heart rate upon orthostatic challenge. The symptoms of POTS are often debilitating, and it primarily affects young females. Even prior to coronavirus disease 2019 (COVID-19) pandemic, POTS was prevalent, affecting an estimated 0.5% to 1% of the entire population in the United States (US). Since the COVID-19 pandemic, the incidence of POTS has acutely risen, adding roughly 6-7 million POTS patients in the US alone. Despite its importance, there is currently no reliable serum biomarker for POTS. One of the major hurdles in identifying biomarkers of POTS is the heterogenous nature of the clinical syndrome. To address this challenge, we focused our analysis on patients from the recent increase in cases of post-COVID-19 onset POTS (PC-POTS). We hypothesized that PC-POTS represents a relatively homogeneous subgroup of POTS, likely triggered by the same pathogen, and presents with symptoms that are more pronounced compared to those in healthy controls. We identified 752 proteins from 18 serum proteome samples composed of 9 PC-POTS patients and 9 health control (HC) individuals, and 31 proteins showed a significant protein abundance difference in PC-POTS. Notably, the majority of the elevated proteins are associated with either actin filaments or immune functions/inflammation. The Weighted Gene Co-Expression Network Analysis (WGCNA) revealed that the module 7 (M7) most highly correlated with the diagnosis also exhibited strong correlations with various sample traits such as the Orthostatic Intolerance Score, Gastrointestinal Score, Pupillomotor Score, and the COMPASS-31 score. The proteins MTPN, TAGLN2, ADP-ribosylation factor 1, PDLIM1, PPIA, CNN2, LGALSL, TXN, TLN1, TUBA4A, IL4, TREML1, GP1BA, and GP6 were identified as common proteins overlapping in various sample traits. Cell-type enrichment analysis revealed that M7 is highly associated with immune and neuronal cells. The main pathways identified in this module include the integrin signaling pathway, blood coagulation, and glycolysis. This suggests that these proteins could potentially serve as biomarkers for PC-POTS. This study utilizes mass spectrometry-based proteomic analysis to identify serum biomarkers that differentiate patients with PC-POTS from HC individuals, thus establishing a foundation for further research and validation.

Project description:BackgroundNon-cephalgic symptoms including orthostatic intolerance, fatigue, and cognitive impairment, are common in patients with chronic headache disorders and may result from alterations in the autonomic nervous system. However, little is known about the function of autonomic reflexes, which regulate cardiovascular homeostasis and cerebral perfusion in patients with headache.MethodsAutonomic function testing data from patients with headache collected between January 2018 and April 2022 was retrospectively analyzed. Through review of EMR we determined headache pain chronicity and patient self-report of orthostatic intolerance, fatigue, and cognitive impairment. Composite Autonomic Severity Score (CASS), CASS subscale scores, and cardiovagal and adrenergic baroreflex sensitivities were used to quantify autonomic reflex dysfunction. Descriptive analyses (Mann-Whitney-U or χ2, as appropriate) determined associations between autonomic reflex dysfunction and POTS as well as chronic headache. Binomial logistic regression adjusted for age and sex. Spearman's rank correlation determined the association between the total CASS score and the number of painless symptoms reported by each participant.ResultsWe identified 34 patients meeting inclusion criteria, of whom there were 16 (47.0%) with orthostatic intolerance, 17 (50.0%) with fatigue, 11 (32.4%) with cognitive complaints, and 11 (32.4%) with Postural Orthostatic Tachycardia Syndrome (POTS). The majority of participants had migraine (n = 24, 70.6%), were female (n = 23, 67.6%) and had a chronic (>15 headache days in a month) headache disorder (n = 26, 76.5%). Reduced cardiovagal baroreflex sensitivity (BRS-V) independently predicted chronic headache [aOR: 18.59 (1.16, 297.05), p = 0.039] and POTS [aOR: 5.78 (1.0, 32.5), p = 0.047]. The total CASS was correlated with the total number of non-painful features in the expected direction (r = 0.46, p = 0.007).ConclusionAbnormal autonomic reflexes may play an important role in pain chronification and the development of POTS in patients with headache.

Dataset Information

Post-Concussive Orthostatic Tachycardia is Distinct from Postural Orthostatic Tachycardia Syndrome (POTS) in Children and Adolescents.

Publications

Post-Concussive Orthostatic Tachycardia is Distinct from Postural Orthostatic Tachycardia Syndrome (POTS) in Children and Adolescents.

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