Advertisement

Autonomic function testing in long-COVID syndrome patients with orthostatic intolerance

  • Ahmed M. Eldokla
    Correspondence
    Corresponding author at: 6620 Fly Road, Suite 302, East Syracuse, NY 13057, USA.
    Affiliations
    Department of Neurology, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA

    Department of Pathology, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA
    Search for articles by this author
  • Sara T. Ali
    Affiliations
    Department of Neurology, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA
    Search for articles by this author

      Abstract

      The association between dysautonomia and long-COVID syndrome has gained considerable interest. This study retrospectively characterized the findings of autonomic reflex screen (ARS) in long-COVID patients presenting with orthostatic intolerance (OI). Fourteen patients were identified. All patients had normal cardiovagal function and 2 patients had abnormal sudomotor function. The head-up tilt table (HUTT) was significantly abnormal in 3 patients showing postural orthostatic tachycardia syndrome (POTS). CASS ranged from 0 to 2. The most common clinical scenario was symptoms of orthostatic intolerance without demonstrable HUTT orthostatic tachycardia or orthostatic hypotension (OH) (n = 8, 57 %). In our case series, most long-COVID patients presenting to our laboratory with OI had no significant HUTT abnormalities; only 3 patients met the criteria for POTS.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Autonomic Neuroscience: Basic and Clinical
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cheshire Jr., W.P.
        • Goldstein D.S.
        Autonomic uprising: the tilt table test in autonomic medicine.
        Clin. Auton. Res. 2019; 29 (Apr): 215-230https://doi.org/10.1007/s10286-019-00598-9
        • Cheshire W.P.
        • Freeman R.
        • Gibbons C.H.
        • et al.
        Electrodiagnostic assessment of the autonomic nervous system: a consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology.
        Clin. Neurophysiol. 2021; 132 (Feb): 666-682https://doi.org/10.1016/j.clinph.2020.11.024
        • Dani M.
        • Dirksen A.
        • Taraborrelli P.
        • et al.
        Autonomic dysfunction in 'long COVID': rationale, physiology and management strategies.
        Clin. Med. (Lond.). 2021; 21 (Jan): e63-e67https://doi.org/10.7861/clinmed.2020-0896
        • Eldokla A.M.
        • Mohamed-Hussein A.A.
        • Fouad A.M.
        • et al.
        Prevalence and patterns of symptoms of dysautonomia in patients with long-COVID syndrome: a cross-sectional study.
        Ann. Clin. Transl. Neurol. 2022; (Apr 8)https://doi.org/10.1002/acn3.51557
        • Fudim M.
        • Qadri Y.J.
        • Ghadimi K.
        • et al.
        Implications for neuromodulation therapy to control inflammation and related organ dysfunction in COVID-19.
        J. Cardiovasc. Transl. Res. 2020; 13 (Dec): 894-899https://doi.org/10.1007/s12265-020-10031-6
        • Goldstein D.S.
        • Cheshire Jr., W.P.
        The autonomic medical history.
        Clin. Auton. Res. 2017; 27 (Aug): 223-233https://doi.org/10.1007/s10286-017-0425-7
        • Guedj E.
        • Million M.
        • Dudouet P.
        • et al.
        (18)F-FDG brain PET hypometabolism in post-SARS-CoV-2 infection: substrate for persistent/delayed disorders?.
        Eur. J. Nucl. Med. Mol. Imaging. 2021; 48 (Feb): 592-595https://doi.org/10.1007/s00259-020-04973-x
        • Huang C.
        • Huang L.
        • Wang Y.
        • et al.
        6-Month consequences of COVID-19 in patients discharged from hospital: a cohort study.
        Lancet. 2021; 397: 220-232https://doi.org/10.1016/s0140-6736(20)32656-8
        • Larsen N.W.
        • Stiles L.E.
        • Miglis M.G.
        Preparing for the long-haul: autonomic complications of COVID-19.
        Auton. Neurosci. 2021; 235 (Jul 3)102841https://doi.org/10.1016/j.autneu.2021.102841
        • Lopez-Leon S.
        • Wegman-Ostrosky T.
        • Perelman C.
        • et al.
        More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. medRxiv.
        2021https://doi.org/10.1101/2021.01.27.21250617 (Jan 30)
        • Low P.A.
        Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure.
        Mayo Clin. Proc. 1993; 68 (Aug): 748-752https://doi.org/10.1016/s0025-6196(12)60631-4
        • National Institute for Health and Care Excellence (NICE)
        COVID-19 rapid guideline: managing the long-term effects of COVID-19.
        (Accessed 26 Nov 2021)
        • Raj S.R.
        • Arnold A.C.
        • Barboi A.
        • et al.
        Long-COVID postural tachycardia syndrome: an American Autonomic Society statement.
        Clin. Auton. Res. 2021; 31 (Jun): 365-368https://doi.org/10.1007/s10286-021-00798-2
        • Rass V.
        • Beer R.
        • Schiefecker A.J.
        • et al.
        Neurological outcome and quality of life 3 months after COVID-19: a prospective observational cohort study.
        Eur. J. Neurol. 2021; 28 (Oct): 3348-3359https://doi.org/10.1111/ene.14803
        • Schondorf R.
        • Low P.A.
        Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?.
        Neurology. 1993; 43 (Jan): 132-137https://doi.org/10.1212/wnl.43.1_part_1.132
        • Shouman K.
        • Vanichkachorn G.
        • Cheshire W.P.
        • et al.
        Autonomic dysfunction following COVID-19 infection: an early experience.
        Clin. Auton. Res. 2021; 31 (Jun): 385-394https://doi.org/10.1007/s10286-021-00803-8
        • Stewart J.M.
        • Boris J.R.
        • Chelimsky G.
        • et al.
        Pediatric disorders of orthostatic intolerance.
        Pediatrics. 2018; 141 (Jan): 1https://doi.org/10.1542/peds.2017-1673
        • Thijs R.D.
        • Brignole M.
        • Falup-Pecurariu C.
        • et al.
        Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness: consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN).
        Clin. Auton. Res. 2021; 31 (Jun): 369-384https://doi.org/10.1007/s10286-020-00738-6
        • Ulloa L.
        The vagus nerve and the nicotinic anti-inflammatory pathway.
        Nat. Rev. Drug Discov. 2005; 4 (Aug): 673-684https://doi.org/10.1038/nrd1797
        • Umapathi T.
        • Poh M.Q.W.
        • Fan B.E.
        • Li K.F.C.
        • George J.
        • Tan J.Y.L.
        Acute hyperhidrosis and postural tachycardia in a COVID-19 patient.
        Clin. Auton. Res. 2020; 30 (Dec): 571-573https://doi.org/10.1007/s10286-020-00733-x