Heyer Geoffrey L, Fischer Anastasia, Wilson Julie, MacDonald James, Cribbs Sarah, Ravindran Reno, Pommering Thomas L, Cuff Steven
*Division of Pediatric Neurology, Nationwide Children's Hospital, Columbus, Ohio; †Department of Neurology, The Ohio State University, Columbus, Ohio; ‡Division of Sports Medicine, Nationwide Children's Hospital, Columbus, Ohio; §Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado; and ‖Departments of Pediatrics and Orthopedics, Children's of Alabama, Birmingham, Alabama.
Clin J Sport Med. 2016 Jan;26(1):40-5. doi: 10.1097/JSM.0000000000000183.
To explore head-upright tilt table (HUT) signs of autonomic dysfunction in a cohort of youth with persistent postconcussion symptoms (PCSs) that include light-headedness and to correlate repeat tilt table results with symptom improvements for those patients found to have postural tachycardia syndrome (POTS) on initial testing.
Prospective cohort design.
Nationwide Children's Hospital, Neurology Clinic.
Thirty-four patients (13-18 years of age) with persistent PCSs.
All patients underwent at least 1 tilt table test. The PCS Interview (PCS-I) and patient ratings of light-headedness and vertigo were used to measure symptom burden. Patients found to have POTS were asked to repeat tilt table testing when PCSs improved or 3 to 6 months after the initial test if symptoms persisted.
Twenty-four of the 34 (70.6%) patients had abnormal tilt table results with patients categorized as normal (n = 10), isolated syncope (n = 10), and POTS (n = 14). Patients with POTS had higher PCS-I scores than normal patients (P < 0.001) and higher ratings of light-headedness than both normal patients (P = 0.015) and syncope patients (P = 0.04). Twelve POTS patients underwent repeat tilt table testing, and 9 of 12 (75%) no longer met POTS diagnostic criteria. All patients with resolution of POTS had corresponding improvements in PCSs, including light-headedness and vertigo.
Our study demonstrates a high rate of tilt table abnormalities among youth with persistent PCSs. Several patients with POTS had normalization of tilt table testing when PCSs improved. These findings warrant further research of autonomic dysfunction related to concussion.
Our study is the first to prospectively characterize autonomic dysfunction in patients with persistent PCSs using HUT testing and to show that the tilt test abnormalities normalize in some patients as PCSs improve.
探讨一组有持续性脑震荡后症状（PCS）（包括头晕）的青少年自主神经功能障碍的直立倾斜试验（HUT）体征，并将那些初次检查发现有姿势性心动过速综合征（POTS）的患者的重复倾斜试验结果与症状改善情况进行关联分析。
前瞻性队列研究设计。
全国儿童医院神经科门诊。
34例年龄在13至18岁之间的持续性PCS患者。
所有患者均接受至少1次倾斜试验。使用PCS访谈（PCS-I）以及患者对头晕和眩晕的评分来衡量症状负担。初次检查发现有POTS的患者，当PCS改善时或初次检查后3至6个月症状仍持续时，被要求重复进行倾斜试验。
34例患者中有24例（70.6%）倾斜试验结果异常，患者被分为正常组（n = 10）、单纯晕厥组（n = 10）和POTS组（n = 14）。POTS患者的PCS-I评分高于正常患者（P < 0.001），头晕评分高于正常患者（P = 0.015）和晕厥患者（P = 0.04）。12例POTS患者接受了重复倾斜试验，12例中有9例（75%）不再符合POTS诊断标准。所有POTS症状消失的患者，其PCS（包括头晕和眩晕）都有相应改善。
我们的研究表明，持续性PCS的青少年中倾斜试验异常的发生率很高。一些POTS患者在PCS改善时倾斜试验结果恢复正常。这些发现值得对与脑震荡相关的自主神经功能障碍进行进一步研究。
我们的研究首次使用HUT试验对持续性PCS患者的自主神经功能障碍进行前瞻性特征描述，并表明随着PCS改善，一些患者的倾斜试验异常恢复正常。
