Dysautonomia/POTS
Dysautonomia is a condition where the autonomic nervous system (ANS) is disordered. The ANS is the part of the nervous system that functions mostly without conscious control, of which heart rate, breathing, digestion and the fight or flight response are among the most important functions. Dysautonomia is caused by damage to the nerves carrying information from the brain and spinal cord to the heart, blood vessels, bladder, intestines, sweat glands and pupils, parts of the body which we expect to function normally without us thinking about them.
In MS, the focus is on the symptoms caused to the somatic nervous system, which serves the sensory organs and the muscles that are under voluntary control. Of interest to people with MS is that MS can also affect the ANS, and the symptoms of dysautonomia can include sleep disturbance, excessive fatigue, exercise intolerance, weakness, spasticity, orthostatic intolerance (inability to remain upright), light-headedness or dizziness, brain fog, mood swings, anxiety, headache, noise and light sensitivity, difficulty concentrating, hypersensitivity to sensory stimulation, rapid or slowed heart rate, palpitations, difficulty breathing or swallowing, blurry vision, neurogenic bladder, constipation, and heat intolerance.
Dysautonomia can be a feature in MS and is one cause of serious disability that may be treatable to a certain extent http://www.medsci.org/v07p0062.htm
If the ANS can’t keep the automatic body systems functioning optimally, then progressively, damage to the various organs may occur, and a spiral of incapacity may develop. Damage that worsens over time essentially describes progression, and the symptoms of dysautonomia are coincidentally some of the most severe symptoms of advancing MS. Vigilance is required in people with MS so that autonomic dysfunction can be detected early and treatment commenced as soon as possible.
POTS (Postural Orthostatic Tachycardia Syndrome) is a type of dysautonomia where movement from a reclining position to an upright or standing position causes an unusually large jump in heart rate without a drop in blood pressure, and may also be accompanied by palpitations, light headedness, dizziness, weakness, discomfort in the chest, and blurry vision.
Diagnosis:
POTS was not properly named and framed until 1993, although it was known and identified by numerous names before that date. Due to the recent identification of the disorder, many doctors and specialists may not be up to date, or switched onto linking the diverse array of symptoms with this diagnosis, so patients may need to inform themselves thoroughly before approaching their medical professional.
In adults, POTS is diagnosed when a person moves from the supine position to the upright position and their heart rate increases by 30 beats per minute, or by more than 120 beats per minute within ten minutes of standing, and in the absence of decreased blood pressure http://www.potsuk.org/
If a person suspects they may have POTS, an initial self-assessment could assist, but irrespective of any self-assessment their concerns should be discussed with their doctor. A pulse oximeter is a small electronic device that is placed on a finger and measures blood oxygen and heart rate. These can be purchased relatively inexpensively and a self-test conducted. The heart rate can be measured in the supine position and then the standing position, and if it becomes elevated by the required amount within ten minutes, the results can be discussed with the family doctor and a referral made to an appropriate specialist in their area.
Treatment:
Treatment for dysautonomia/POTS is by a combination of care giving, lifestyle approaches, management strategies, and medication. Treatment will need to be overseen by a specialist who can diagnose the type of dysautonomia and any associated illness, and monitor a treatment plan.
Of interest to people with MS, is that POTS can cause many of the most debilitating symptoms of MS in people who clearly do not have multiple sclerosis. In fact, POTS can be so disabling that people who do not have MS, but do have POTS, are unable to complete crucial activities of daily living such as standing, sitting, walking, bathing, toileting, doing housework or gardening, cooking, attending work, driving, or using public transport and so on. It can readily be seen therefore how seriously someone with MS lesions (which it is acknowledged cannot be correlated to disability) and who also suffers from POTS, could be affected by the disorder.
Just like those with progressive MS, POTS patients can be so debilitated that they are confined to wheelchairs or bedridden. For those with MS who still have capacity to move their limbs, but become rapidly exhausted on standing and attempting to walk, could POTS be playing a part, and would they benefit from a diagnostic examination, and treatment if they are found to have POTS or another form of dysautonomia?
Links:
A comprehensive site for just about everything relating to POTS http://www.potsuk.org/
Another comprehensive site for just about everything relating to dysautonomia. This is their POTS home page, and numerous other pages relating to POTS are listed on the left http://www.dysautonomiainternational.org/page.php?ID=30
Yet another comprehensive site, this time focusing on younger people with dysautonomia http://www.dynainc.org/dysautonomia/symptoms
A patient’s perspective on what it feels like to live with POTS http://dysautonomia.weebly.com/if-you-know-someone-with-dysautonomia.html
… and why it feels like that http://dysautonomia.weebly.com/effects-of-dysautonomia.html
A broad discussion of autonomic disorders in MS: http://www.hindawi.com/journals/ad/2011/803841/
Article relating autonomic dysfunction to disease progression in MS http://www.ncbi.nlm.nih.gov/pubmed/11724449
Study showing an association with MS and POTS http://www.ncbi.nlm.nih.gov/pubmed/23246200
Another study noting that autonomic dysfunction is common in MS, and showing an association with MS and POTS http://www.ncbi.nlm.nih.gov/pubmed/20309394
Another study noting that autonomic dysfunction is common in MS, and theorising why POTS may develop in MS http://www.neurology-asia.org/articles/neuroasia-2012-17%282%29-155.pdf
A broad discussion of POTS and whether it is primary (not associated with another illness) or secondary (when it is associated with another illness). It also lists the associated illnesses (MS is listed) and discusses treatment and prognosis, as well as how POTS can debilitate the patient to the point of being incapacitated http://www.dysautonomiainternational.org/page.php?ID=30
This page discusses some of the symptoms of dysautonomia and explains why balloon angioplasty for CCSVI may assist http://autonomicspecialists.com/symptoms/
Vitamin D
Dysautonomia is a condition where the autonomic nervous system (ANS) is disordered. The ANS is the part of the nervous system that functions mostly without conscious control, of which heart rate, breathing, digestion and the fight or flight response are among the most important functions. Dysautonomia is caused by damage to the nerves carrying information from the brain and spinal cord to the heart, blood vessels, bladder, intestines, sweat glands and pupils, parts of the body which we expect to function normally without us thinking about them.
In MS, the focus is on the symptoms caused to the somatic nervous system, which serves the sensory organs and the muscles that are under voluntary control. Of interest to people with MS is that MS can also affect the ANS, and the symptoms of dysautonomia can include sleep disturbance, excessive fatigue, exercise intolerance, weakness, spasticity, orthostatic intolerance (inability to remain upright), light-headedness or dizziness, brain fog, mood swings, anxiety, headache, noise and light sensitivity, difficulty concentrating, hypersensitivity to sensory stimulation, rapid or slowed heart rate, palpitations, difficulty breathing or swallowing, blurry vision, neurogenic bladder, constipation, and heat intolerance.
Dysautonomia can be a feature in MS and is one cause of serious disability that may be treatable to a certain extent http://www.medsci.org/v07p0062.htm
If the ANS can’t keep the automatic body systems functioning optimally, then progressively, damage to the various organs may occur, and a spiral of incapacity may develop. Damage that worsens over time essentially describes progression, and the symptoms of dysautonomia are coincidentally some of the most severe symptoms of advancing MS. Vigilance is required in people with MS so that autonomic dysfunction can be detected early and treatment commenced as soon as possible.
POTS (Postural Orthostatic Tachycardia Syndrome) is a type of dysautonomia where movement from a reclining position to an upright or standing position causes an unusually large jump in heart rate without a drop in blood pressure, and may also be accompanied by palpitations, light headedness, dizziness, weakness, discomfort in the chest, and blurry vision.
Diagnosis:
POTS was not properly named and framed until 1993, although it was known and identified by numerous names before that date. Due to the recent identification of the disorder, many doctors and specialists may not be up to date, or switched onto linking the diverse array of symptoms with this diagnosis, so patients may need to inform themselves thoroughly before approaching their medical professional.
In adults, POTS is diagnosed when a person moves from the supine position to the upright position and their heart rate increases by 30 beats per minute, or by more than 120 beats per minute within ten minutes of standing, and in the absence of decreased blood pressure http://www.potsuk.org/
If a person suspects they may have POTS, an initial self-assessment could assist, but irrespective of any self-assessment their concerns should be discussed with their doctor. A pulse oximeter is a small electronic device that is placed on a finger and measures blood oxygen and heart rate. These can be purchased relatively inexpensively and a self-test conducted. The heart rate can be measured in the supine position and then the standing position, and if it becomes elevated by the required amount within ten minutes, the results can be discussed with the family doctor and a referral made to an appropriate specialist in their area.
Treatment:
Treatment for dysautonomia/POTS is by a combination of care giving, lifestyle approaches, management strategies, and medication. Treatment will need to be overseen by a specialist who can diagnose the type of dysautonomia and any associated illness, and monitor a treatment plan.
Of interest to people with MS, is that POTS can cause many of the most debilitating symptoms of MS in people who clearly do not have multiple sclerosis. In fact, POTS can be so disabling that people who do not have MS, but do have POTS, are unable to complete crucial activities of daily living such as standing, sitting, walking, bathing, toileting, doing housework or gardening, cooking, attending work, driving, or using public transport and so on. It can readily be seen therefore how seriously someone with MS lesions (which it is acknowledged cannot be correlated to disability) and who also suffers from POTS, could be affected by the disorder.
Just like those with progressive MS, POTS patients can be so debilitated that they are confined to wheelchairs or bedridden. For those with MS who still have capacity to move their limbs, but become rapidly exhausted on standing and attempting to walk, could POTS be playing a part, and would they benefit from a diagnostic examination, and treatment if they are found to have POTS or another form of dysautonomia?
Links:
A comprehensive site for just about everything relating to POTS http://www.potsuk.org/
Another comprehensive site for just about everything relating to dysautonomia. This is their POTS home page, and numerous other pages relating to POTS are listed on the left http://www.dysautonomiainternational.org/page.php?ID=30
Yet another comprehensive site, this time focusing on younger people with dysautonomia http://www.dynainc.org/dysautonomia/symptoms
A patient’s perspective on what it feels like to live with POTS http://dysautonomia.weebly.com/if-you-know-someone-with-dysautonomia.html
… and why it feels like that http://dysautonomia.weebly.com/effects-of-dysautonomia.html
A broad discussion of autonomic disorders in MS: http://www.hindawi.com/journals/ad/2011/803841/
Article relating autonomic dysfunction to disease progression in MS http://www.ncbi.nlm.nih.gov/pubmed/11724449
Study showing an association with MS and POTS http://www.ncbi.nlm.nih.gov/pubmed/23246200
Another study noting that autonomic dysfunction is common in MS, and showing an association with MS and POTS http://www.ncbi.nlm.nih.gov/pubmed/20309394
Another study noting that autonomic dysfunction is common in MS, and theorising why POTS may develop in MS http://www.neurology-asia.org/articles/neuroasia-2012-17%282%29-155.pdf
A broad discussion of POTS and whether it is primary (not associated with another illness) or secondary (when it is associated with another illness). It also lists the associated illnesses (MS is listed) and discusses treatment and prognosis, as well as how POTS can debilitate the patient to the point of being incapacitated http://www.dysautonomiainternational.org/page.php?ID=30
This page discusses some of the symptoms of dysautonomia and explains why balloon angioplasty for CCSVI may assist http://autonomicspecialists.com/symptoms/
Vitamin D