title: Orthostatic Intolerance and Autonomic Dysfunction in Youth With Persistent Postconcussion Symptoms: A Head-Upright Tilt Table Study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective cohort design.
  
  
  METHODS
  Nationwide Children's Hospital, Neurology Clinic.
  
  
  METHODS
  Thirty-four patients (13-18 years of age) with persistent PCSs.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: *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.
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Heyer
authors.forename: Anastasia
authors.initials: A
authors.lastname: Fischer
authors.forename: Julie
authors.initials: J
authors.lastname: Wilson
authors.forename: James
authors.initials: J
authors.lastname: MacDonald
authors.forename: Sarah
authors.initials: S
authors.lastname: Cribbs
authors.forename: Reno
authors.initials: R
authors.lastname: Ravindran
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Pommering
authors.forename: Steven
authors.initials: S
authors.lastname: Cuff
mesh_terms: D000293:Adolescent; D004244:Dizziness / Q000209:etiology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D038223:Post-Concussion Syndrome / Q000150:complications* / Q000503:physiopathology; D054972:Postural Orthostatic Tachycardia Syndrome / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D063189:Symptom Assessment; D013575:Syncope / Q000209:etiology; D018667:Tilt-Table Test; D014717:Vertigo / Q000209:etiology