65 YOF with Supraventricular Tachycardia Episodes and Chronic Pain Symptoms Improve with Neuro-Rehabilitation
-
1
Missouri Functional Neurology and Chiropractic, LLC, United States
Background:
65 YOF presents with a history of Supraventricular Tachycardia (SVT) episodes and chronic pain. She states any pathological cardiovascular issues have been cleared by the hospitals numerous times. Patient states the episodes usually occur in the morning or after eating breakfast but has started happening during lunch and dinner recently. She states that walking around will sometimes help with her symptoms. She states she had the same kind of episodes in July of 2014. She describes the episodes as feeling a pounding in her head and around her temples with increased anxiety. Patient states she does get headaches located to the base of her skull starting about 4 weeks ago when she was working in her garden for a few days in a row. She states overexertion, or minor injuries will bring on her symptoms. Patient states she does have constant pain on the left side of her body in random spots of her shoulder and back. Patient states she had tremors of her arms and the left side of her back a couple days ago at night. She states she has had a stress test done and went to a Cardiologist who wanted to give her blood pressure medicine which she refuses to take. She states a few days ago when she went to the nearby clinic she did have high blood pressure but refused to take the blood pressure meds, so they gave her the Valsalva maneuver which has helped. She states normally her blood pressure is around 130/70. She states she has numerous food sensitivities and has to be very strict with her diet to prevent the episodes. She states her last group of episodes in July of 2014, she ended up having a Staph infection in her nose.
Methods:
Neurological testing was performed which included Btracks modified Clinical Test of Sensory Integration and Balance (mCTSIB), the Rand short form health questionnaire intake form (SF-36), NeurA’s version of Trails A and B, CogEval’s version of Digit-Symbol matching, and blood pressure and heart rate measurements. mCTSIB testing results showed patient scoring 31st percentile with eyes open on a firm surface, 21st percentile with eyes closed on a firm surface, 54th percentile with eyes open on a perturbed surface, and 81st percentile with eyes closed on a perturbed surface, SF-36 questionnaire revealed Physical Function at the 30th percentile, Role Physical at the 0 percentile, Body Pain at the 0 percentile, General Health at the 25th percentile, Vitality at the 15th percentile, Social Functioning at the 12th percentile, Role Emotional at the 33rd percentile, and Mental Health at the 56th percentile, Trails A testing was completed in 27.8 seconds which is above average, Trails B testing completed in 131.3 seconds which is deficient, Digit-Symbol matching completed 27 in 2 minutes for a -1.25 z-score, laying blood pressure 160/80, heart rate 106, standing blood pressure 180/90, heart rate 110. The bedside neurological examination revealed left palatal sagging, left tongue deviation, decreased gain of slow vestibular ocular reflex testing bilaterally, positive rightward head impulse testing for decreased gain, decreased gain of eye pursuits in the horizontal plane, vertical plane, and diagonal planes, decreased gain of head following in all directions with poor neck motor control, left convergence insufficiency, left pendular patellar reflex, finger-tapping positive for mirroring bilaterally, dysdiadochokinesia of the left arm during rapid alternating movement, dysrhythmia during left heel to shin tapping, dual tasking during gait decreased bilateral arm swing, decreased stride length, and hesitations were present, positive tandem gait for instability and falling leftward, unable to perform single leg stance on the left leg.
Treatment consisted of 10-30 minute visits over the course of 7 weeks and began with laying resisted cervical spine isometrics in left/right rotation and left/right lateral flexion, laying passive horizontal gaze stability on a single dot, laying passive left arm/leg distraction, and repetitive peripheral somatosensory (RPSS) stimulation to the ophthalmic and maxillary distributions of the trigeminal nerve, after 5-30 minute treatment sessions the patient’s heart rate had stabilized to 75 laying down and 84 standing up. The next 5 treatment sessions consisted of seated active figure-8 movements of the left arm, right arm, then left arm, gaze stability on a single dot, cervical spine rotation and lateral flexion resisted isometrics, the Clam exercise, and Mckenzie side glide exercise.
At-home exercise prescribed at the end of the 10 visits included seated and standing figure-8 movements of the left arm, right arm, then left arm, gaze stability on a single dot, cervical spine rotation and lateral flexion isometrics, the Clam exercise, and Mckenzie side glide exercise. At 2 weeks post treatment the patient was asked to return for follow-up diagnostics.
Outcome:
Follow-up Diagnostics:
SF-36 questionnaire showed Physical Function at the 25th percentile, Role Physical at the 0 percentile, Body Pain at the 52nd percentile, General Health at the 42nd percentile, Vitality at the 35th percentile, Social Functioning at the 25th percentile, Role Emotional at the 66th percentile, Mental Health at the 72nd percentile. Btracks mCTSIB testing results showed with eyes open on a firm surface at the 71st percentile, eyes closed on a firm surface at the 66th percentile, eyes open on a perturbed surface at the 45th percentile, eyes closed on a perturbed surface at the 33rd percentile, Trails A testing completed in 29.5 seconds which is above average, Trails B testing completed in 84.8 seconds, which is average, Digit-Symbol matching completed 40 in 2 minutes for a -0.03 z-score, laying blood pressure 140/80, heart rate 80, standing blood pressure 140/80, heart rate 85
Patient states she is now able to eat an entire breakfast without getting the SVT episodes and hasn’t had an episode since our last treatment session. Patient states she also hasn’t had any left sided tremors or pain since our last treatment session.
Conclusion:
At the time of the follow-up diagnostics the patients Btracks mCTSIB scoring improved for scores on a firm surface. The SF-36 questionnaire showed improvements in Body Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health categories. Trails B testing and Digit-Symbol matching tasks improved significantly. There was also significant improvement in patient blood pressure and heart rate measures. The current case supports multimodal neurological rehabilitation as an effective treatment for Supraventricular tachycardia (SVT) episodes and chronic pain. Further research needs to be conducted and investigated in this field.
References
Zhang XY, Wang JJ, Zhu JN. Cerebellar fastigial nucleus: from anatomic construction to physiological functions. Cerebellum Ataxias. 2016;3:9. Published 2016 May 3. doi:10.1186/s40673-016-0047-1
Keywords:
Supraventricular tachycardia (SVT),
Chronic Pain,
Clinical Neuroscience,
Neurorehabilitation,
Tachycardia
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Schmidt
M
(2019). 65 YOF with Supraventricular Tachycardia Episodes and Chronic Pain Symptoms Improve with Neuro-Rehabilitation.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00058
Copyright:
The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers.
They are made available through the Frontiers publishing platform as a service to conference organizers and presenters.
The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated.
Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed.
For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions.
Received:
11 Mar 2019;
Published Online:
27 Sep 2019.
*
Correspondence:
Dr. Michael Schmidt, Missouri Functional Neurology and Chiropractic, LLC, Centralia, United States, mofuncneuro@gmail.com