Impact of the COVID-19 pandemic on clinical autonomic practice in Europe A survey of the European Academy of Neurology and(...), 2023, Fanciulli et al

[Wyva]

Full title:
Impact of the COVID-19 pandemic on clinical autonomic practice in Europe A survey of the European Academy of Neurology (EAN) and the European Federation of Autonomic Societies (EFAS)

Abstract

Objective
To investigate the impact of the coronavirus-disease-2019 (COVID-19) pandemic on European clinical autonomic practice.

Methods
Eighty-four neurology-driven or interdisciplinary autonomic centers in 22 European countries were invited to fill in a web-based survey between September and November 2021.

Results
Forty-six centers completed the survey (55%). During the first pandemic year, the number of performed tilt-table tests, autonomic outpatient and inpatient visits decreased respectively by 50%, 45% and 53%, and every-third center reported major adverse events due to postponed examinations or visits. The most frequent newly-diagnosed or worsened cardiovascular autonomic disorders after COVID-19 infection included postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension, and recurrent vasovagal syncope, deemed likely related to the infection by ≥50% of the responders. Forty-seven percent of the responders also reported about people with new-onset of orthostatic intolerance, but negative tilt-table findings, and 16% about people with psychogenic pseudosyncope after COVID-19. Most patients were treated non-pharmacologically and symptomatic recovery at follow-up was observed in ≥45% of cases.

By contrast, low frequencies of newly-diagnosed cardiovascular autonomic disorders following COVID-19 vaccination were reported, most frequently POTS and recurrent vasovagal syncope, and most of the responders judged a causal association unlikely. Non-pharmacological measures were the preferred treatment choice, with 50-100% recovery rates at follow-up.

Conclusions
Cardiovascular autonomic disorders may develop or worsen following a COVID-19 infection, while the association with COVID-19 vaccines remains controversial. Despite the severe pandemic impact on European clinical autonomic practice, a specialized diagnostic work-up was pivotal to identify non-autonomic disorders in people with post-COVID-19 orthostatic complaints.

Paywall: https://onlinelibrary.wiley.com/doi/10.1111/ene.15787

 

[SNT Gatchaman]

Seven responders reported altogether 45 cases of psychogenic pseudosyncope following COVID-19, in one-third of cases deemed to be related to the infection (Figure 3A).

Forty-eight percent (n=22/46) of responders also reported 135 cases with orthostatic complaints, but negative tilt-table findings (Figure 3A); six responders identified alternative causes of orthostatic intolerance in these patients, including physical deconditioning, polypharmacy, persistent postural-perceptual dizziness and pandemic-related psychological burden.

From Psychogenic Pseudosyncope: Real or Imaginary? Results from a Case-Control Study in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Patients (van Campen and Visser, 2022)

This study demonstrates that in patients suspected of having [psychogenic pseudosyncope], especially those with ME/CFS (patients, who are often being diagnosed with having conversion disorder), cerebral blood flow measurements at end-tilt show a large decline compared with a group of age-, gender- and disease-duration-matched ME/CFS patients. Therefore, cerebral hypoperfusion offers a clear-cut alternative explanation of the orthostatic intolerance complaints and syncopal spells in these patients. The abnormal cerebral blood flow reduction while being upright makes it clear, that the origin of the attacks might not be behavioral or psychogenic, but have a clear somatic pathophysiologic background.