Immunomodulatory treatment in postural tachycardia syndrome: a case series 2020

Mij · Jan 3, 2021

Abstract
Background
The postural tachycardia syndrome (POTS) is a form of autonomic dysfunction characterized by symptoms of orthostatic intolerance, often accompanied by sudomotor dysfunction and gastrointestinal dysmotility. Recently, evidence has accumulated that in a subset of patients, the pathogenesis of dysautonomia may be immune‐mediated. The aim of the current report was to evaluate the use of intravenous immunoglobulin (IVIG) treatment in patients with progressive and/or refractory immune‐mediated POTS.

Method
We retroactively assessed the effect and tolerance of monthly administered IVIG in 6 patients using autonomic function testing, standardized symptom questionnaires and patients’ symptom diaries each before and six months into IVIG treatment. Objective outcome measures included heart rate increase after 10 minutes of head‐up tilt as well as duration and anhidrotic area in a thermoregulatory sweat test. Subjective outcome measures were patient reports and symptom ratings from the symptom questionnaire.

Results
All patients responded to immunomodulatory treatment, regardless of disease duration. After six months of IVIG, symptom severity was reduced by nearly 40%. Autonomic function testing showed improved cardiovascular functioning by 50% and a reduction of anhidrotic areas by one third. Overall, tolerance of IVIG treatment was poor, but could be improved by a reduction in infusion rate, pre‐medication with steroids and additional i.v. hydration.

Conclusion
Using subjective but also standardized objective measures, the case series describes promising effects of IVIG treatment in POTS patients with immune‐mediated dysautonomia. By reducing the infusion rate, pre‐treatment with steroids and i.v. hydration tolerance could be improved and no patient had to discontinue the treatment.
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Jonathan Edwards · Jan 3, 2021

Do you have a source for this @Mij?

Mij · Jan 3, 2021

Yes, hold on I forgot to post it. I'm working on a very slow laptop today and I'm frustrated!

https://onlinelibrary.wiley.com/doi/10.1111/ene.14711

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Immunomodulatory treatment in postural tachycardia syndrome: a case series 2020

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Immunomodulatory treatment in postural tachycardia syndrome: a case series 2020

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Jonathan Edwards Senior Member (Voting Rights)

Mij Senior Member (Voting Rights)

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