Case Study: Dysautonomia: 27-Year-Old Female

A 27-year-old female presented to the clinic with pre syncope, dizziness, fatigue, tremors, shortness of breath, difficulty regulating temperature, exercise intolerance, tachycardia, and morning nausea. She was officially diagnosed with Dysautonomia following EKG, Holter monitor, and Tilt Table testing in August of 2023 and her cardiologist placed her on Ondansetron for nausea and Midodrine to help maintain steady blood pressure. Her main goal was to be able to discontinue all of her medications.

Examination and Diagnosis

Physical examination and diagnostic testing identified a significant (43bpm) increase in heart rate from lying to standing that was maintained at one minute, a physiological tremor, decreased balance and stability, convergence excess, vertical nystagmus, hypometric saccades, decreased gain of smooth pursuits in all directions, abnormal pupillary light reflex, and excessive sweating of extremities. Salivary cortisol testing revealed elevated cortisol levels throughout the day. These findings were consistent with her previous diagnosis of Dysautonomia and suggested both neurological and endocrine concomitants. 

Treatment

The patient was initially treated for 12 visits over the course of 6 weeks. The initial course of treatment consisted of diaphragmatic breathing exercises, cranial nerve neuromodulation, transcutaneous vagus nerve stimulation, oculomotor exercises, vestibular rehabilitation, interactive metronome training, Go/No-Go activities, Eye-Hand activities, Red/NIR light therapy, and Bemer pEMF therapy. Lifestyle modifications surrounding diet and circadian rhythm regulation were recommended, and supplementation was utilized to aid in cortisol regulation. 

A re-examination was performed and the patient was instructed on a home exercise plan. The patient then continued treatment at a frequency of 1 visit per week for 8 more visits. 

Results

Following the completion of the initial course of treatment the patient reported a 50% overall subjective improvement in symptoms with near complete resolution in pre syncope and significant reduction in tachycardia, fatigue, exercise intolerance, tremors, and shortness of breath. She reported continued difficulties with morning nausea. 

Following additional dietary changes during the second phase of treatment, nausea was almost completely eliminated. Working with her cardiologist, the patient was able to completely discontinue her medications. 

Re-examination revealed improvement in heart rate increase from lying to standing (20bpm) that completely recovered within one minute, amelioration of tremor, improved balance and stability scores, improvements in accuracy of saccades and gain of smooth pursuits, elimination of convergence excess, and appropriate sweat production of all extremities.  

Conclusion

Functional neurological rehabilitation has been shown to be effective in the management and treatment of dysautonomia. An individualized plan of care and targeted treatment strategies are necessary to achieve optimal outcomes. Please contact us to learn more or schedule a consultation.