title: Use of an allostatic neurotechnology by adolescents with postural orthostatic tachycardia syndrome (POTS) is associated with improvements in heart rate variability and changes in temporal lobe electrical activity.
abstract: Autonomic dysregulation and heterogeneous symptoms characterize postural orthostatic tachycardia syndrome (POTS). This study evaluated the effect of high-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM(®)), a noninvasive, allostatic neurotechnology for relaxation and auto-calibration of neural oscillations, on heart rate variability, brain asymmetry, and autonomic symptoms, in adolescents with POTS. Seven subjects with POTS (three males, ages 15-18) underwent a median of 14 (10-16) HIRREM sessions over 13 (8-17) days. Autonomic function was assessed from 10-min continuous heart rate and blood pressure recordings, pre- and post-HIRREM. One-minute epochs of temporal high-frequency (23-36 Hz) brain electrical activity data (T3 and T4, eyes closed) were analyzed from baseline HIRREM assessment and subsequent sessions. Subjects rated autonomic symptoms before and after HIRREM. Four of seven were on fludrocortisone, which was stopped before or during their sessions. Heart rate variability in the time domain (standard deviation of the beat-to-beat interval) increased post-HIRREM (mean increase 51%, range 10-143, p = 0.03), as did baroreflex sensitivity (mean increase in high-frequency alpha 65%, range -6 to 180, p = 0.05). Baseline temporal electrical asymmetry negatively correlated with change in asymmetry from assessment to the final HIRREM session (p = 0.01). Summed high-frequency amplitudes at left and right temporal lobes decreased a median of 3.8 μV (p = 0.02). There was a trend for improvements in self-reported symptoms related to the autonomic nervous system. Use of HIRREM was associated with reduced sympathetic bias in autonomic cardiovascular regulation, greater symmetry and reduced amplitudes in temporal lobe high-frequency electrical activity, and a trend for reduced autonomic symptoms. Data suggest the potential for allostatic neurotechnology to facilitate increased flexibility in autonomic cardiovascular regulation, possibly through more balanced activity at regions of the neocortex responsible for autonomic management. Clinical trial registry "Tilt Table with Suspected postural orthostatic tachycardia syndrome (POTS) Subjects," Protocol Record: WFUBAHA01.
authors.affiliation: Virginia Commonwealth University, Richmond, VA, USA. john.fortunato@vcuhealth.org.|Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA. john.fortunato@vcuhealth.org.
authors.forename: John E
authors.initials: JE
authors.lastname: Fortunato
authors.affiliation: Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Tegeler
authors.affiliation: Brain State Technologies LLC, Scottsdale, AZ, 85260, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Gerdes
authors.affiliation: Brain State Technologies LLC, Scottsdale, AZ, 85260, USA.
authors.forename: Sung W
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Pajewski
authors.affiliation: Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Franco
authors.affiliation: Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Jared F
authors.initials: JF
authors.lastname: Cook
authors.affiliation: Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA.|Departments of Obstetrics and Gynecology and General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Hossam A
authors.initials: HA
authors.lastname: Shaltout
authors.affiliation: Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Tegeler
mesh_terms: D000161:Acoustic Stimulation / Q000379:methods; D000293:Adolescent; D052636:Allostasis / Q000502:physiology*; D017704:Baroreflex / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D054972:Postural Orthostatic Tachycardia Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D011187:Posture / Q000502:physiology; D013702:Temporal Lobe / Q000502:physiology*; D018667:Tilt-Table Test / Q000379:methods*
keywords: Allostasis; Autonomic dysregulation; Hemispheric asymmetry; Nausea; Neurotechnology; POTS