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In a patient with POTS or other autonomic symptoms, however, they may occur as part of broader autonomic instability or altered sympathetic nervous system regulation

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Although the precise mechanisms underlying disease progression are yet to be established, pathology could originate in the gut and proceed retrogradely to the brain via the vagal nerve or could start in the vagal nerve and extend to the gut via anterograde movement (Braak and Del Tredici, 2019)