Autonomic Dysfunction Presenting as Postural Orthostatic Tachycardia Syndrome in Patients with Multiple Sclerosis

Abstract

Background: Autonomic dysfunction is common in patients suffering from multiple sclerosis (MS) and orthostatic dizziness occurs in almost 50% of these patients. However, there have been no reports on postural orthostatic tachycardia syndrome (POTS) in patients suffering from MS.Methods: The patients were included for analysis in this study if they had POTS with either a prior history of MS or having developed MS while being followed for POTS. Postural orthostatic tachycardia (POTS) is defined as symptoms of orthostatic intolerance(>6months) accompanied by a heart rate increase of at least 30 beats/min (or a rate that exceeds 120 beats/min) that occurs in the first 10 minutes of upright posture or head up tilt test (HUTT) occurring in the absence of other chronic debilitating disorders. We identified nine patients with POTS who were suffering from MS as well. Each of these patients had been referred from various other centers for second opinions.Results: The mean age at the time of diagnosis of POTS was 49±9 years and eight of the 9 patients were women. Five patients (55%) had hyperlipidemia, 3 (33%) migraine and 2 (22%) patients had coronary artery disease and diabetes each. Fatigue and palpitations (on assuming upright posture) were the most common finding in our patients (9/9). All patients also had orthostatic dizziness. Syncope was seen in 5/9(55%) of patients. Four patients (44%), who did not have clear syncope, were having episodes of near syncope. The presence of POTS in our study population resulted in substantial limitation of daily activities. Following recognition and treatment of POTS, 6/9(66%), patients were able to resume daily activities of living. Their symptoms (especially fatigue and orthostatic intolerance) improved. The frequency and severity of syncope also improved. Three (33%) patients failed to show a good response to treatment.Conclusion: Patients suffering from MS may manifest autonomic dysfunction by developing POTS. Early recognition and proper management may help improve the symptoms of POTS.

Autonomic dysfunction in multiple sclerosis presenting with postural orthostatic tachycardia

“…Despite this, POTS has rarely been reported in MS [2,3] One series described 9 MS patients with POTS, 2 patients developed MS after the diagnosis of POTS, and 7 patients developed POTS sometime after the diagnosis of MS [3]. Authors of this study did not find any correlation between MS symptoms or relapses with POTS.…”

Autonomic dysfunction in multiple sclerosis

“…POTS has been reported to occur frequently in MS and the connection of the two entities is explained by the presence of demyelinating brainstem and hemispheral lesions disrupting the physiological heart rate variability modulation [10,14]. Almost half of POTS patients complain of fatigue and the concomitant appearance of POTS and MS aggravates the dire sense of fatigue that MS patients often experience [15].…”

“…Orthostatic intolerance occurs in up to 50% of MS patients [10]. It is characterized by symptoms such as dizziness, nausea and palpitations when assuming upright position or prolonged standing or sitting.…”

Postural orthostatic tachycardia syndrome associated with multiple sclerosis

“…On the other hand, autonomic dysfunction has been related to MRI findings of cervical spinal cord atrophy rather than the presence of hyperintensive lesions in that region postulating that it results not solely from demyelination but from axonal loss as well (de Seze et al 2001). POTS has been reported occurring in MS patients and their connection is explained by the presence of demyelinating brainstem and hemispheral lesions which disrupt the physiological heart rate variability modulation (Kanjwal et al 2010). …”

“…Although orthostatic dizziness has been commonly seen in multiple sclerosis (MS) patients (Vita et al 1993), there have been no studies demonstrating the occurrence of POTS in patients with MS. One study described clinical characteristics of 9 patients with MS and POTS, emphasizing that MS patients may manifest autonomic dysfunction by developing POTS (Kanjwal et al 2010).…”