IMPROVEMENT IN POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME IN A PATIENT WITH EHLERS-DANLOS SYNDROME, MAST CELL ACTIVATION SYNDROME AND CADISIL FOLLOWING A PROGRAM OF MULTIMODAL NEUROREHABILITATION
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1
Brain, Spine & Sport, United States
Background: A 40 year old female presented to a private clinic with multiple conditions and a history of Lyme’s Disease, immune deficiency and autoimmune disease diagnosed previously by multiple medical specialists. The patient had complaints of cognitive decline, pain, neuropathy, dizziness and fatigue. The dizziness and lightheadedness was brought on by positional changes with no Benign Paroxysmal Positional Vertigo (BPPV) present at the time of presentation.
Methods: neurological examination revealed a drop in blood pressure (BP) on the right during supine to standing testing. Heart rate (HR) elevated abnormally with an increase of 32 beats per minute (bpm). This confirmed a diagnosis of Postural Orthostatic Tachycardia Syndrome (POTS) which was also diagnosed previously. Finger to nose (FTN) testing on the left was dysmetric. Alternating hand movements on the left were dysdiadochokinetic (DDK). Pupillary reaction to light was sluggish bilaterally. Saccodometry testing of 100 saccades to 20 degree targets were hypermetric bilaterally. An imbalance in velocity was revealed with slower saccades to the left. Computerized Dynamic Posturography (CDP) revealed an increase in fatigue ratios with eyes closed on a firm surface. There was a decrease in stability with the head rotated to the left and the head in flexion. There was more stability with the head in extension than flexion. A program of multimodal neurorehabilitation was initiated that included active and passive vestibular canal stimulation, gaze stability exercises, eye movement exercises that included combinations of saccades and pursuits, repositioning maneuvers, autonomic training in various gravitational/postural positions to address rise in HR, acupuncture, low level laser therapy (LLLT), and transcutaneous vagal nerve stimulation.
Results: the signs of POTS resolved with elevations of HR reduced to 15-18 bpm from supine to standing. FTN testing normalized. DDK on the left normalized. Pupillary reactions to light normalized. Repeat CDP revealed an improvement in fatigue ratios, normalization of stability with head rotated to the left and an improvement of stability with the head in flexion. Saccodometry revealed an improvement in hypermetria. Velocity of saccades remained slower towards leftward targets. The patient claims improvement of dizziness symptoms and pain.
Conclusion: this author recommends further investigation into the treatment of POTS with multimodal neurorehabilitation.
Keywords:
dysautonomia,
Postural Orthostatic Tachycardia Syndrome,
Dizziness,
Vertigo,
Mast cell activation syndrome,
Ehlers-Danlos Syndrome,
Autoimmunity,
Neurorehabilitation,
Vestibular Rehabilitation,
Low level laser Therapy,
Acupuncture,
Lyme Disease,
CADASIL,
Fatigue,
cognitive decline,
Gaze stabilization
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Schiller
D
(2018). IMPROVEMENT IN POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME IN A PATIENT WITH EHLERS-DANLOS SYNDROME, MAST CELL ACTIVATION SYNDROME AND CADISIL FOLLOWING A PROGRAM OF MULTIMODAL NEUROREHABILITATION
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Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00118
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Received:
02 Apr 2018;
Published Online:
14 Dec 2018.
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Correspondence:
Dr. David Schiller, Brain, Spine & Sport, Avon, Connecticut, 06001, United States, drschiller@comcast.net