Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-25T07:42:22.800Z Has data issue: false hasContentIssue false
  • English
  • Français

Therapy for fatigue and cognitive dysfunction in postural orthostatic tachycardia syndrome

Published online by Cambridge University Press:  10 September 2018

Jeffrey R. Boris Open the ORCID record for Jeffrey R. Boris [Opens in a new window]  and
Thomas Bernadzikowski
Jeffrey R. Boris*
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia and The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Thomas Bernadzikowski
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
*
Author for correspondence: J. R. Boris, MD, Division of Cardiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA. Tel: +215 590 3180; Fax: +267 426 5324; E-mail: borisj@email.chop.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Severe fatigue and cognitive dysfunction are frequent symptoms in patients with postural orthostatic tachycardia syndrome. They can be debilitating, and often do not resolve despite improvement in haemodynamic symptoms. Our analysis was intended to assess clinical outcomes of medication treatment for these symptoms in a large, single-centre paediatric programme.

Materials and Methods

We performed a retrospective review of patients treated for fatigue and cognitive dysfunction. Patients aged 18 years or younger at the time of initial diagnosis were included. Patients who had a specific medication ordered five or more times for these symptoms were confirmed by chart review for clinical improvement. Percentage of patients with clinical improvement for each medication and overall for all medications, as well as the number of medications per patient required to achieve improvement, were assessed. Data were analysed based on gender as well. t-Test and χ2 analyses were used to assess for differences between means in variables, or specific variables.

Results

A total of 708 patients met study criteria, of whom 517 were treated for fatigue or brain fog. Overall efficacy was 68.8%, with individual medication effectiveness ranging from 53.1 (methylphenidate) to 16.5% (atomoxetine). There was no significant difference in efficacy with respect to gender. The median number of medications used per patient was 2, without gender difference. Therapy was limited by side effects or lack of efficacy.

Discussion

Medications are effective in the improvement of fatigue and cognitive dysfunction in these patients. However, trials of multiple medications may be needed before achieving clinical improvement.

Keywords

Dysautonomiaadolescentbrain fog
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 12 , December 2018 , pp. 1415 - 1420
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Johnson, JN, Mack, KJ, Kuntz, NL, Brands, CK, Porter, CJ, Fischer, PR. Postural orthostatic tachycardia syndrome: a clinical review. Pediatr Neurol 2010; 42: 77–85.Google Scholar
2. Janjour, IT. Postural tachycardia syndrome in children and adolescents. Semin Pediatr Neurol 2013; 20: 18–26.Google Scholar
3. Li, J, Zhang, Q, Hao, H, Jin, H, Du, J. Clinical features and management of postural tachycardia syndrome in children: a single-center experience. Chin Med J 2014; 127: 3684–3689.Google Scholar
4. Boris, JR, Bernadzikowski, T. Demographics of a large paediatric postural orthostatic tachycardia syndrome program. Cardiol Young 2018; 28: 668–674.Google Scholar
5. George, SA, Bivens, TB, Howden, EJ, et al. The International POTS Registry: evaluating the efficacy of an exercise training intervention in a community setting. Heart Rhythm 2016; 13: 943–950.Google Scholar
6. Kanjwal, K, Saeed, B, Karabin, B, Kanjwal, Y, Grubb, BP. Use of methylphenidate in the treatment of patients suffering from refractory postural tachycardia syndrome. Am J Ther 2012; 19: 2–6.Google Scholar
7. Green, EA, Raj, V, Shibao, CA, et al. Effects of norepinephrine reuptake inhibition on postural tachycardia syndrome. J Am Heart Assoc 2013; 2: e000395.Google Scholar
8. Kpaeyeh, J Jr, Mar, PL, Raj, V, et al. Hemodynamic profiles and tolerability of modafinil in the treatment of postural tachycardia syndrome: a randomized, placebo-controlled trial. J Clin Psychopharmacol 2014; 34: 738–741.Google Scholar
9. Benarroch, EE. Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clin Proc 2012; 87: 1214–1225.Google Scholar
10. Karas, B, Grubb, BP, Boehm, K, Kip, K. The postural orthostatic tachycardia syndrome: a potentially treatable cause of chronic fatigue, exercise intolerance, and cognitive impairment in adolescents. Pacing Clin Electrophysiol 2000; 23: 344–351.Google Scholar
11. Ross, AJ, Medow, MS, Rowe, PC, Stewart, JM. What is brain fog? An evaluation of the symptom in postural tachycardia syndrome. Clin Auton Res 2013; 23: 305–311.Google Scholar
12. Kizibash, SJ, Ahrens, SP, Bruce, BK, et al. Adolescent fatigue, POTS, and recovery: a guide for clinicians. Curr Probl Pediatr Adolesc Health Care 2014; 44: 108–133.Google Scholar
13. Sharma, A, Couture, J. A review of the pathophysiology, etiology, and treatment of Attention-Deficit Hyperactivity Disorder (ADHD). Ann Pharmacother 2014; 48: 209–225.Google Scholar
14. Garland, EM, Celedonio, JE, Raj, SR. Postural tachycardia syndrome: beyond orthostatic intolerance. Curr Neurol Neurosci Rep 2015; 15: 60.Google Scholar
15. Norvik, TS, Hervas, A, Ralston, SJ, et al. Influence of gender on Attention-Deficit/Hyperactivity Disorder in Europe – ADORE. Eur Child Adolesc Psychiatry 2006; 15 (Suppl 1): I/15–I/24.Google Scholar