Introduction
A case study of a 19 year-old female was diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS) and Ehlers Danlos Syndrome (EDS). Patient had been wheelchair bound for nearly 3 years due to severe joint pain, vertigo and dizziness making her unable to walk without falling. Her chief complaints were chronic vertigo, dizziness, fatigue, brain fog, lightheadedness and nausea.
Examination and Diagnosis
Neurological examination revealed a right vestibular deficit with a Dix Hallpike test to confirm geocentric nystagmus on patient’s right side. In addition to this, the examination revealed orthostatic intolerance, gaze instability, low vitamin D levels and raised cortisol levels in the evenings.
Treatment
The patient was initially treated two times per week for 60 minutes over 6 consecutive weeks then a re-examination on the final visit. In addition to this, the patient underwent 20 hours of hyperbaric oxygen therapy over the course of the 6 weeks. Visits included vestibular rehabilitation, orthostatic retraining, gaze stabilization therapy, somatosensory evoked potential therapy, core and knee stabilization exercises, Bemer therapy and red light/ near infrared therapy. While undergoing treatment, the patient began an at home regimen of individualized supplementation to address vitamin D and cortisol levels.
Results
After the initial course of treatment the patient was no longer experiencing vertigo or dizziness. Videonystagmography and Dix hallpike test revealed no vestibular deficit and improvement with gaze stability. The patient no longer requires a wheelchair to avoid falling, but does utilize a cane to provide support for her joints and minimize joint pain.
Patient continued a second course of treatment for 1x/week for 5 weeks to maintain progress and to improve upon brain fog and gaze instability. During this time a referral was made to a physical therapist who specializes in EDS to facilitate joint stability and strength with aims to increase biomechanical functionality and minimize pain. After the second course of treatment, the patient was given at-home exercises to continue improvement while completing physical therapy. Check-ins were made every 8-12 weeks with the patient to monitor progress.
Conclusion
Functional neurological care and hyperbaric oxygen therapy has been shown to be effective in the treatment of autonomic dysfunction. Every patient requires an individualized approach and targeted treatment to achieve optimal results. Please visit our Dysautonomia Program webpage for more information.