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Symptoms and objective signs of peripheral sensory neuropathy in POTS and correlations to gastrointestinal symptoms

Ekman, Linnéa LU orcid ; Tufvesson, Hanna LU orcid ; Englund, Elisabet LU orcid ; Dahlin, Lars B. LU orcid and Ohlsson, Bodil LU (2025) In PLOS ONE 20(7 July).
Abstract

Aim Postural orthostatic tachycardia syndrome (POTS) is a disorder with cardiovascular autonomic dysfunction where multiple and variable symptoms are common, including those from the peripheral and enteric nervous systems. We aimed to investigate subjective and objective signs of small and large fiber neuropathy in a Swedish POTS cohort compared with healthy controls. Secondly, we wanted to examine potential associations between gastrointestinal symptoms and neuropathy signs in POTS. Methods Forty-three patients with POTS (93% female) and 54 healthy controls (76% female) were included in the study. All participants completed a questionnaire including modified neuropathy symptoms score (NSS) and irritable bowel syndrome severity scoring... (More)

Aim Postural orthostatic tachycardia syndrome (POTS) is a disorder with cardiovascular autonomic dysfunction where multiple and variable symptoms are common, including those from the peripheral and enteric nervous systems. We aimed to investigate subjective and objective signs of small and large fiber neuropathy in a Swedish POTS cohort compared with healthy controls. Secondly, we wanted to examine potential associations between gastrointestinal symptoms and neuropathy signs in POTS. Methods Forty-three patients with POTS (93% female) and 54 healthy controls (76% female) were included in the study. All participants completed a questionnaire including modified neuropathy symptoms score (NSS) and irritable bowel syndrome severity scoring system (IBS-SSS) for gastrointestinal evaluation. Small nerve fibers were investigated by assessing the intraepidermal nerve fiber density (IENFD). Large nerve fiber function was examined through pinprick and vibration perception thresholds (VPTs), using neurothesiometry and multi-frequency vibrometry (MFV). The patients were classified as “High NSS” and “High IBS-SSS” if their total NSS vs. IBS-SSS were above median levels in POTS. Results Peripheral sensory and gastrointestinal symptoms were more prevalent and severe in POTS than in controls. Median VPTs were normal and IENFDs were comparable between POTS and controls (2.26 [1.62–3.08] vs. 1.63 [0.73–2.68] fibers/mm; p=0.108). The patients with “high NSS” had slightly higher VPTs measured by MFV, although within normal ranges, compared to patients with “low NSS”. The patients within the “high IBS-SSS” group had higher NSS (18.0 [14.3–22.8] vs. 11.0 [4.0–15.0]; p=0.002) compared to patients with low total IBS-SSS. Conclusion Symptoms of peripheral and enteric neuropathy are common in POTS but no solid evidence was found regarding functional or morphological signs of small or large fiber neuropathy. Neuropathic and gastrointestinal symptoms were closely associated within POTS.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
PLOS ONE
volume
20
issue
7 July
article number
e0327549
publisher
Public Library of Science (PLoS)
external identifiers
  • scopus:105009858076
  • pmid:40608783
ISSN
1932-6203
DOI
10.1371/journal.pone.0327549
language
English
LU publication?
yes
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Publisher Copyright: © 2025 Ekman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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ba7fa9c2-4c25-4bf0-99cf-28ec783d9481
date added to LUP
2025-12-11 09:42:22
date last changed
2025-12-11 09:43:30
@article{ba7fa9c2-4c25-4bf0-99cf-28ec783d9481,
  abstract     = {{<p>Aim Postural orthostatic tachycardia syndrome (POTS) is a disorder with cardiovascular autonomic dysfunction where multiple and variable symptoms are common, including those from the peripheral and enteric nervous systems. We aimed to investigate subjective and objective signs of small and large fiber neuropathy in a Swedish POTS cohort compared with healthy controls. Secondly, we wanted to examine potential associations between gastrointestinal symptoms and neuropathy signs in POTS. Methods Forty-three patients with POTS (93% female) and 54 healthy controls (76% female) were included in the study. All participants completed a questionnaire including modified neuropathy symptoms score (NSS) and irritable bowel syndrome severity scoring system (IBS-SSS) for gastrointestinal evaluation. Small nerve fibers were investigated by assessing the intraepidermal nerve fiber density (IENFD). Large nerve fiber function was examined through pinprick and vibration perception thresholds (VPTs), using neurothesiometry and multi-frequency vibrometry (MFV). The patients were classified as “High NSS” and “High IBS-SSS” if their total NSS vs. IBS-SSS were above median levels in POTS. Results Peripheral sensory and gastrointestinal symptoms were more prevalent and severe in POTS than in controls. Median VPTs were normal and IENFDs were comparable between POTS and controls (2.26 [1.62–3.08] vs. 1.63 [0.73–2.68] fibers/mm; p=0.108). The patients with “high NSS” had slightly higher VPTs measured by MFV, although within normal ranges, compared to patients with “low NSS”. The patients within the “high IBS-SSS” group had higher NSS (18.0 [14.3–22.8] vs. 11.0 [4.0–15.0]; p=0.002) compared to patients with low total IBS-SSS. Conclusion Symptoms of peripheral and enteric neuropathy are common in POTS but no solid evidence was found regarding functional or morphological signs of small or large fiber neuropathy. Neuropathic and gastrointestinal symptoms were closely associated within POTS.</p>}},
  author       = {{Ekman, Linnéa and Tufvesson, Hanna and Englund, Elisabet and Dahlin, Lars B. and Ohlsson, Bodil}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  number       = {{7 July}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLOS ONE}},
  title        = {{Symptoms and objective signs of peripheral sensory neuropathy in POTS and correlations to gastrointestinal symptoms}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0327549}},
  doi          = {{10.1371/journal.pone.0327549}},
  volume       = {{20}},
  year         = {{2025}},
}