Children with chronic nausea and a condition known as orthostatic intolerance (OI) (dizziness when standing up) exhibit brain connectivity changes in areas related to sensory external and internal awareness resulting in over self-monitoring, according to a study published in the journal Neurogastroenterology & Motility.
One of the common manifestations of OI is a condition known as postural orthostatic tachycardia syndrome (POTS). While it is still unclear if these changes are the cause or effect of their symptoms, the findings provide important validation for patients’ symptoms, underscoring that this debilitating condition should be taken seriously, despite oftentimes normal results during routine evaluation. Chronic nausea with dizziness impacts up to 10 percent of adolescents.
“Our results clearly demonstrate that these patients have altered brain connectivity that doesn’t support optimal regulation of stimuli. This very often manifests as hyper self-awareness of bodily states, often accompanied by heightened anxiety,” said lead author John Fortunato, Jr, MD, Director of Neurointestinal and Motility Program at Ann & Robert H. Lurie Children’s Hospital of Chicago, and Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “This is a powerful validation of the need to assess the interplay among multiple chronic symptoms towards better understanding disease processes. The whole is oftentimes greater than the sum of its parts. Unfortunately, many symptoms that appear vague or difficult to objectively measure are often dismissed, even though the quality of life of these patients is severely diminished.”
Fortunato and colleagues compared results of functional MRI of three regions of the brain in healthy children and in patients with chronic nausea who have dizziness when standing up. They noted marked differences in the parts of the brain associated with central autonomic control.
“This is the first time we see objective evidence of changes in brain processing associated with this combination of GI and autonomic symptoms,” said Fortunato. “Our findings strongly point to the need for a biopsychosocial model of care with a more holistic approach to the management of these patients.”
