School Attendance

A good number of my patients find that they cannot keep up with the rigors of a full school schedule.

I actively participate in helping arrange 504 plans and home schooling for sometimes as short as a single semester or as long as a few years straight. On-line high school courses of high quality that are accepted as credit by most high schools have made this decision easier.

Prognosis
The most common form of dysautonomia, developmental dysautonomia, which is usually Grade 0 to II, has a very good prognosis. It tends to peak at about age 16 or during the years of greatest growth velocity and then slowly fade away in young adulthood. About 80% of adolescent-onset Grade III dysautonomia resolves by mid-20s. What’s not clear is whether the body adapts where the vagus nerve becomes less hyperactive and the blood vessels stiffer or whether the per- son afflicted simply develops lifestyle habits that become second nature. They know intuitively that they can never miss a meal and naturally keep well-hydrated least they not do well.

POTS Pretenders
Occasionally chronically repetitive syncopal events with unusual histories arise. Work-up of these reveals no underlying cause and yet the history is still not consistent with a vasovagal mechanism. Sometimes these are due to narcolepsy, conversion reactions, or malingering. Treatment with lifestyle changes and the above medications may prove ineffective in these cases. There may be a role for cognitive therapy in these situations.

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