Use of an allostatic neurotechnology by adolescents with postural orthostatic tachycardia syndrome (POTS) is associated with improvements in heart rate variability and changes in temporal lobe electrical activity

John E Fortunato, Catherine L Tegeler, Lee Gerdes, Sung W Lee, Nicholas M Pajewski, Meghan E Franco, Jared F Cook, Hossam A Shaltout, Charles H Tegeler, John E Fortunato, Catherine L Tegeler, Lee Gerdes, Sung W Lee, Nicholas M Pajewski, Meghan E Franco, Jared F Cook, Hossam A Shaltout, Charles H Tegeler

Abstract

Autonomic dysregulation and heterogeneous symptoms characterize postural orthostatic tachycardia syndrome (POTS). This study evaluated the effect of high-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM(®)), a noninvasive, allostatic neurotechnology for relaxation and auto-calibration of neural oscillations, on heart rate variability, brain asymmetry, and autonomic symptoms, in adolescents with POTS. Seven subjects with POTS (three males, ages 15-18) underwent a median of 14 (10-16) HIRREM sessions over 13 (8-17) days. Autonomic function was assessed from 10-min continuous heart rate and blood pressure recordings, pre- and post-HIRREM. One-minute epochs of temporal high-frequency (23-36 Hz) brain electrical activity data (T3 and T4, eyes closed) were analyzed from baseline HIRREM assessment and subsequent sessions. Subjects rated autonomic symptoms before and after HIRREM. Four of seven were on fludrocortisone, which was stopped before or during their sessions. Heart rate variability in the time domain (standard deviation of the beat-to-beat interval) increased post-HIRREM (mean increase 51%, range 10-143, p = 0.03), as did baroreflex sensitivity (mean increase in high-frequency alpha 65%, range -6 to 180, p = 0.05). Baseline temporal electrical asymmetry negatively correlated with change in asymmetry from assessment to the final HIRREM session (p = 0.01). Summed high-frequency amplitudes at left and right temporal lobes decreased a median of 3.8 μV (p = 0.02). There was a trend for improvements in self-reported symptoms related to the autonomic nervous system. Use of HIRREM was associated with reduced sympathetic bias in autonomic cardiovascular regulation, greater symmetry and reduced amplitudes in temporal lobe high-frequency electrical activity, and a trend for reduced autonomic symptoms. Data suggest the potential for allostatic neurotechnology to facilitate increased flexibility in autonomic cardiovascular regulation, possibly through more balanced activity at regions of the neocortex responsible for autonomic management. Clinical trial registry "Tilt Table with Suspected postural orthostatic tachycardia syndrome (POTS) Subjects," Protocol Record: WFUBAHA01.

Keywords: Allostasis; Autonomic dysregulation; Hemispheric asymmetry; Nausea; Neurotechnology; POTS.

Figures

Fig. 1
Fig. 1
a, b FFT spectral display of electroencephalic data with frequency (Hertz, Hz, central Y axis) plotted against transformed amplitude (microvolts, µV, X axis). These graphs from a study subject represent 1 min of data from the T3/T4 montage with eyes closed (EC) at the baseline assessment (a) and at the penultimate minute of the penultimate session (b). Columns to the left and right denote ten frequency bands of aggregated data (00: <1.0 Hz; 10: 1.0–3.0 Hz; 20: 3.0–5.5 Hz; 30: 5.5–7.5 Hz; 40: 7.5–10.0 Hz; 50: 10.0–12.0 Hz; 60: 12.0–15.0 Hz; 70: 15.0–23.0 Hz; 80: 23.0–36.0 Hz; and 90: 36.0–48.0 Hz) and numerical values for averages in those ranges. Amplitudes in the 23–36 Hz range (dark purple color) are outlined by red boxes
Fig. 2
Fig. 2
Change in asymmetry score for high frequency range (23–36 Hz) of brain electrical activity at bilateral temporal lobes (vertical axis), as a function of baseline asymmetry (horizontal axis)

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