From the Research
Introduction to Postural Orthostatic Tachycardia Syndrome (POTS)
POTS is a complex disorder characterized by orthostatic intolerance and orthostatic tachycardia without hypotension, often accompanied by a range of disabling symptoms 1. The pathophysiology of POTS remains incompletely understood, involving multiple potential mechanisms including peripheral denervation, hypovolemia, venous pooling, beta-receptor supersensitivity, and psychologic factors 2.
Association with Seizures
There is evidence to suggest that individuals with POTS may experience seizures, although this is not a universal finding. A case report describes a patient with temporal lobe epilepsy and POTS, where the patient's palpitations were found to be due to episodes of marked sinus tachycardia secondary to POTS 3. This highlights the importance of considering POTS in the differential diagnosis of patients with epilepsy.
Diagnosis and Treatment
Diagnosis of POTS typically involves a detailed medical history, physical examination, and orthostatic vital signs or brief tilt table test 4. Treatment may include a high salt diet, copious fluids, postural training, beta-receptor antagonists in small doses, and low-dose vasoconstrictors 2. In some cases, treatment of underlying conditions such as epilepsy may also be necessary.
Clinical Considerations
POTS is a heterogeneous clinical syndrome, and its presentation can overlap with other conditions, making diagnosis and treatment challenging 4. Additionally, the lack of awareness and education among physicians can contribute to suboptimal care for patients with POTS 1. A comprehensive approach to diagnosis and treatment, taking into account the individual patient's symptoms and underlying pathophysiology, is essential for effective management of POTS.
Caveats and Future Directions
Further research is needed to improve our understanding of the pathophysiology of POTS and to develop effective treatments 1. A national POTS research consortium could facilitate well-controlled multidisciplinary clinical research studies and therapeutic trials, ultimately leading to better outcomes for patients with POTS.