The relation between disequilibrium and orthostatic intolerance in patients with MECFS

[Murph]

J Cardiol. 2018 Mar 24. pii: S0914-5087(18)30058-3. doi: 10.1016/j.jjcc.2018.02.010. [Epub ahead of print]
The etiologic relation between disequilibrium and orthostatic intolerance in patients with myalgic encephalomyelitis (chronic fatigue syndrome).
Miwa K1, Inoue Y2.
Author information
Abstract
BACKGROUND:
Orthostatic intolerance (OI) causes a marked reduction in the activities of daily living in patients with myalgic encephalomyelitis (ME) or chronic fatigue syndrome. Most symptoms of OI are thought to be related to cerebral hypo-perfusion and sympathetic activation. Because postural stability is an essential element of orthostatic tolerance, disequilibrium may be involved in the etiology of OI.

METHODS AND RESULTS:
The study comprised 44 patients with ME (men, 11 and women, 33; mean age, 37±9 years), who underwent neurological examinations and 10-min standing and sitting tests. Symptoms of OI were detected in 40 (91%) patients and those of sitting intolerance were detected in 30 (68%). Among the 40 patients with OI, disequilibrium with instability on standing with their feet together and eyes shut, was detected in 13 (32.5%) patients and hemodynamic dysfunction during the standing test was detected in 19 (47.5%); both of these were detected in 7 (17.5%) patients. Compared with 31 patients without disequilibrium, 13 (30%) patients with disequilibrium more prevalently reported symptoms during both standing (100% vs. 87%, p=0.43) and sitting (92% vs. 58%, p=0.06) tests. Several (46% vs. 3%, p<0.01) patients failed to complete the 10-min standing test, and some (15% vs. 0%, p=0.15) failed to complete the 10-min sitting test. Among the seven patients with both hemodynamic dysfunction during the standing test and disequilibrium, three (43%) failed to complete the standing test. Among the 6 patients with disequilibrium only, 3 (50%) failed while among the 12 patients with hemodynamic dysfunction only, including 8 patients with postural orthostatic tachycardia, none (0%, p=0.02) failed.

CONCLUSIONS:
Patients with ME and disequilibrium reported not only OI but also sitting intolerance. Disequilibrium should be recognized as an important cause of OI and appears to be a more influential cause for OI than postural orthostatic tachycardia in patients with ME.

https://www.ncbi.nlm.nih.gov/pubmed/29588088

 

[Murph]

Great to see research out of Japan published in English.

Haven't seen the term sitting intolerance before.

 

[CFS_for_19_years]

Great to see research out of Japan published in English.

Haven't seen the term sitting intolerance before.

Full text: http://sci-hub.la/10.1016/j.jjcc.2018.02.010

Methods
[...]
Sitting test

Patients were asked to keep the sitting position on the center of the side of a bed without cushions for 10 min after lying in the recumbent position for 5 min. Postural sitting tachycardia was diagnosed as an increase in the heart rate of > 20 and/or > 90 beats/min during the sitting test. Sitting hypotension was diagnosed as a decrease in the systolic blood pressure of >20 and/or <90 mmHg or diastolic blood pressure of >10 mmHg.
[...]
Results
During the sitting test, patients with disequilibrium reported various symptoms including faintness, nausea, dyspnea, palpitation, and severe fatigue (92% vs. 58%, p = 0.06) and had postural sway (38% vs. 6%,p = 0.03) more prevalently than those without disequilibrium. Some (15%) patients with disequilibrium were unable to complete the 10-min sitting test, whereas none (0%) of the patients without disequilibrium failed to complete it. Postural sitting tachycardia (heart rate 90/min) was noted in 3 (23%) patients with disequilibrium and in 9 (29%) without disequilibrium (p = 0.97).

 

[Sushi]

Because postural stability is an essential element of orthostatic tolerance, disequilibrium may be involved in the etiology of OI.

How many of us with OI can "walk a straight line," heel, toe, heel toe--with ease? I can't.

 

[rel8ted]

How many of us with OI can "walk a straight line," heel, toe, heel toe--with ease? I can't.

Not a chance!


I was very interested in the sitting test. i have been noticing for the last 6 months or so that if I have to sit for any length of time, my heart rate is shooting up after a few minutes. the only relief is to semi-recline (like putting the seat partially back when riding in the car).