Thursday, May 31, 2012

Update on the Dysautonomias: POTS and MSA

Several research articles are of note. All can be located at the NIH website, as listed below on the link to one article. Two articles are on Postural Orthostatic Tachycardia Syndrome (POTS), and one is on Multiple System Atrophy (MSA).  POTS and MSA may be associated with symptoms that one should watch out for, and a new drug is reviewed in relation to POTS treatment. Please talk to your doctor if you feel you have any associated symptoms listed here. Patients can be their own best advocates.

Two articles are hot off the press on POTS and MSA; they just came out May 3 and March 19, 2012 respectively. There may be an association between Joint Hypermobility Syndrome and POTS, so take care if you have the listed symptoms, and ask your doctor if you have further questions. And instead of waiting until Multiple System Atrophy sets in during the late stages, please be advised of the listed symptoms as now one does not have to 'wait' until motor problems occur. Instead, the diagnosis can be made earlier. It is novel that DDAVP, an endocrine hormone analog of the posterior pituitary gland, shows promise in helping both symptoms and tachycardia associated with POTS. This article has been out since 2010, but we thought it was relevant for education and awareness. Please read below for further information.

Joint Hypermobility Syndrome (JHS) is associated with POTS.  In this Editorial on a research article  from India, Bohora suggests that all young women presenting with migraine or syncope and symptomatic POTS be screened for JHS (Bohora et al). There is no known reason why POTS and JHS may be related, although up to 70 percent of patients with JHS may have a dysautonomia component. The usual culprits of female hormones, genes, and environmental factors have been tangentially implicated.

Recently, Jecmenica-Lukic et al. describe premotor signs of Multiple System Atrophy (MSA) that may be regarded as potentially amenable to neuroprotective agent therapy (Jecmenica-Lukic M., et al). So instead of waiting for the classic motor signs of ataxia and parkinsonism, the following symptoms are viewed as being early indicators of possible MSA: autonomic failure, sleep disturbances, and respiratory problems. This notable article is from the Clinic of Neurology, School of Medicine, University of Belgrade, Serbia.

For POTS, there may be a role for DDVAP, or desmopressin, as a drug therapy due to its ability to provide volume expansion in a low-blood-volume state. Today, DDAVP is widely used in the standard protocol for Advanced Cardiac Life Support (ACLS), and most American doctors are required to carry regular, updated certification in the emergency use of DDAVP. Coffin et al. are to be commended for the novel application of this drug to the study of POTS and dysautonomia. This study showed that DDAVP resolved tachycardia upon standing, and improved complaints for 30 patients with POTS, versus controls (Coffin St, et al). They recommend a follow-up study to determine safety on a larger population subset. These researchers are located at the Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, in Nashville, Tennessee.

While we can not touch on all the latest advances, we hope that these research articles are of interest to you. Researchers, keep on researching! Patients, keep on participating! Together, we can make important strides.

Bohora S. Joint hypermobility syndrome and dysautonomia: expanding the spectrum of disease presentation and manifestation. Indian Pacing and Electrophysiol J, 2010; 10:158-161.  
Coffin ST, et al. Desmopressin acutely decreases tachycardia and improves symptoms in postural tachycardia syndrome. Heart rhythm; 2012, May 3.

Jecmenica-Lukic M., et al. Premotor signs and symptoms of multiple system atrophy. Lancet Neurol, 2012; Apr 11(4):261-368; Epub March 19, 2012. 

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