EEG Characteristics in Youth POTS and/or Syncope

All POTS and syncope patients referred to Nationwide Children's Hospital (Columbus, OH) and
meeting study eligibility criteria will be asked to participate. Consent and assent will be
obtained per IRB guidelines. Consenting patients will undergo head-upright tilt (HUT) testing
with video EEG and continuous sweat monitoring.

Prior to testing all medicines that can affect orthostatic tolerance will be held a minimum
of 5 half-lives. Caffeine will be held for a minimum of 24 hours. Urinalysis (for urine
specific gravity) and pregnancy testing (for female patients of child-bearing age) will be
done the day of HUT testing. A recumbent EEG sample of no less than 10 minutes will be
obtained. EKG leads, Holter leads, blood pressure monitors (beat-to-beat and conventional arm
cuff), intravenous (IV) line, and sweat monitors will be placed. Sweat rate, EEG, and blood
pressure monitoring will be synchronized by event trigger, allowing co-registration of all
timed studies during data post-processing. Serum norepinephrine levels will be obtained at
the time of IV placement and at 10 minutes of tilt or during/immediately after the syncope
prodrome if syncope occurs prior to 10 minutes.

Once all monitors are placed, 10 minutes of EEG have been collected, and the patient has been
recumbent for a minimum of 30 minutes, the table is tilted up-right to 70 degrees. A video
camera will be on during the test. Patients are encouraged to report all symptoms and they
are frequently examined for signs of pallor, acrocyanosis and sweating. Tilt testing is
continued until syncope occurs, up to 10 minutes if the patient meets POTS criteria, or up to
45 minutes if neither syncope or POTS is not present.

Those who do meet age-appropriate POTS criteria (symptomatic heart-rate increment >40 bpm or
symptomatic total HR of >130 bpm, all within 10 minutes of tilt for those <20 years of age)
will be lowered at 10 minutes (or sooner with syncope) and asked to repeat testing with
abdominal and lower extremity compression. The compression suit has been used by Dr. Heyer in
other NCH studies. It is composed of a Neoprene-like material with 5 Velcro straps that fit
snugly around the legs, thighs and abdomen. The abdominal strap contains an air-filled
bladder that potentiates abdominal compression. We have used the suit in over 30 consenting
patients from prior study. None of the study participants complained of discomfort. The suit
successfully reduced both heart rate and orthostatic symptoms in youth with POTS; 55% of
studied patients no longer met POTS diagnostic criteria while the suit was on (see PMID:
24840763 for manuscript). We will use the compression suit as our method of attenuating POTS
symptoms during HUT testing. EEG will be compared without and with compression.

The time frame for this study is on average 90 minutes. It will not exceed 3 hours. After
lowering the tilt table, all monitor leads and the IV will be removed. Once leads are removed
there are no further study obligations.

Inclusion Criteria:

- Patients aged 9-21 years

- Referred to the neurology POTS and Syncope clinic at Nationwide Children's Hospital
for clinical tilt table testing

- Has prior diagnosis or signs/symptoms of POTS (with or without syncope) or syncope
(without POTS)

Exclusion Criteria:

- Cognitive, somatic or psychiatric illness that precludes tilt table testing, prolonged
standing, or EEG lead placement

- Known seizure disorder

- Scalp or skull defect that could affect EEG amplitudes

- Pregnancy

- Non-English speaking