Autonomic dysfunction in multiple sclerosis is better detected by heart rate variability and is not correlated with central autonomic network damage

Videira, Gonçalo; Castro, Pedro; Vieira, Bitia; Filipe, João; Santos, Rosa; Azevedo, Elsa; Sá, María José; Abreu, Pedro

doi:10.1016/j.jns.2016.05.049

Cited by 29 publications

(29 citation statements)

References 30 publications

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“…All functions of the TFM were validated and successfully used in a number of clinical studies [ 24 , 25 , 27 ]. HRV and BPV have become substantial diagnostic tools for the detection of cardiovascular autonomic regulation in neurological diseases [ 7 , 10 , 16 , 25 , 28 ].…”

Section: Methodsmentioning

confidence: 99%

“…Although reports related to the disease course in patients with MS are increasing, the nature of autonomic dysfunction (AD) seen frequently in MS remains unclear. It is well established that autonomic nervous system (ANS) impairment contributes to long-term disability in MS patients, but it is still not clear whether autonomic dysfunction results from damage to the central autonomic network (CAN) or whether additional immune-mediated peripheral, pathophysiology [ 6 , 7 , 8 ]. The interrelationship between AD and the clinical features of MS has been documented in several studies [ 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Cardiac Autonomic Modulation Is Different in Terms of Clinical Variant of Multiple Sclerosis

Zawadka‐Kunikowska

Rzepiński²,

Newton

et al. 2020

JCM

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This study evaluates whether the cardiac autonomic response to head-up tilt test (HUTT) differs between patients with relapsing-remitting multiple sclerosis (RRMS) and those with progressive MS (PMS) as compared to healthy controls (HC). Baroreflex sensitivity, cardiac parameters, heart rate (HRV) and blood pressure variability (BPV) were compared between 28 RRMS, 21PMS and 25 HC during HUTT. At rest, PMS patients had higher values of the sympathovagal ratio, a low-frequency band HRV (LFnu-RRI) and lower values of parasympathetic parameters (HFnu-RRI, HF-RRI) compared to RRMS and HC. Resting values of cardiac parameters were significantly lower in RRMS compared to PMS patients. No intergroup differences were observed for post-tilt cardiac and autonomic parameters, except for delta HF-RRI with lower values in the PMS group. The MS variant corrected for age, sex and Expanded Disability Status Scale (EDSS) score was an independent predictor of changes in the sympathovagal ratio as measured by HRV. Furthermore, a higher overall EDDS score was related to a higher sympathovagal ratio, lower parasympathetic parameters at rest, and decrease post-tilt changes of the sympathovagal ratio of sBP BPV. Autonomic imbalance is markedly altered in the MS patient group compared to control changes were most pronounced in the progressive variant of MS disease. The MS variant appeared to have a potential influence on cardiac autonomic imbalance at rest.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiac Autonomic Modulation Is Different in Terms of Clinical Variant of Multiple Sclerosis

Zawadka‐Kunikowska

Rzepiński²,

Newton

et al. 2020

JCM

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“…In addition, the authors performed a short-term analysis of HRV by recording only the last 10 min of resting ECG recording. They concluded that short-term analysis of HRV may be more useful than the standard Ewing battery of tests, showing both parasympathetic and sympathetic impairment in MS patients (p < 0.05) [28]. An earlier study in 18 MS patients and 20 healthy controls, also using the frequency domain technique, suggested that vagal power, the respiratory component of HRV, could be an alternative non-invasive measure [29].…”

Section: Testing For Cad In Msmentioning

confidence: 99%

Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies

Findling

Hauer

Pezawas

et al. 2020

JCM

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Cardiac autonomic dysfunction (CAD) has been reported in patients with multiple sclerosis (MS). This systematic review summarizes the evidence for the types and prevalence of CAD in MS patients, as well as its association with MS type, disease characteristics, fatigue and immunotherapies used to treat MS. The analysis revealed that CAD is correlated with pathophysiological processes of MS, can trigger serious cardiovascular complications that may reduce life expectancy, and may have implications for treatment with immunotherapies, especially fingolimod. Numerous mainly small case-control or cohort studies have reported various measures of CAD (particularly heart rate variation) in MS patients, showing higher rates of abnormality versus controls. A smaller number of studies have reported on cardiac autonomic symptoms in MS, including orthostatic intolerance/dizziness in around 50% of patients. CAD also appears to be associated with disease duration and to be more common in progressive than relapsing-remitting MS. However, although a substantial evidence base suggests that assessing CAD in people with MS may be important, standardised methods to evaluate CAD in these patients have not yet been established. In addition, no studies have yet looked at whether treating CAD can reduce the burden of MS symptoms, disease activity or the rate of progression.

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“…Some of these studies have shown that >50% of patients with MS suffer from cardiovascular autonomic dysfunction, whereas some others have reported no significant differences in these patients, similar to our observations in the present study. 27 , 28 Most studies have reported a significant association between increased MS severity and cardiovascular autonomic dysfunction. 29 In another study, Ozkan et al 30 revealed that blood flow velocities were significantly lower than that in controls during attack periods, and increased during the attack-free period along with clinical improvement.…”

Section: Discussionmentioning

confidence: 99%

Investigation of ischemic and demyelinating lesions by cerebral vasoreactivity based on transcranial Doppler sonography: a comparative study

Zoghi¹,

Petramfar²,

Nikseresht³

et al. 2018

NDT

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PurposeVariations of cerebral blood flow in response to hypoxia and hyperoxia in different disease conditions can provide new insights into disease etiopathogenesis. This study aimed to determine the characteristics of cerebral vasoreactivity for ischemia and demyelination.Materials and methodsThis case–control study included: 28 patients with lacunar infarctions verified by history, physical examination, and MRI; 28 age- and sex-matched healthy controls; 28 patients with relapsing–remitting multiple sclerosis (MS), based on McDonald criteria; and 28 age- and sex-matched healthy controls for the MS group. Transcranial Doppler sonography was undertaken in all subjects to calculate the mean flow velocity (MFV) of the right middle cerebral artery (MCA) and, after a breath-holding (BH) maneuver, the breath-holding index (BHI) was determined.ResultsThere was no significant difference of BHI and changes of MFV of the MCA in MS patients compared to controls (1.02 ± 0.4 vs 1.02 ± 0.3, p = 0.993; and 16.8 ± 8.1 vs 11.3 ± 10.8, p = 0.057). BHI in patients with lacunar infarctions was significantly lower (0.8 ± 0.4 vs 1.2 ± 0.3, p < 0.001) compared to controls. The BHI (p = 0.040) and variations of MFV of MCA (p = 0.007) in MS patients were significantly higher than in patients with lacunar infarctions. The vasoreactivity of demyelinating lesions was higher than that of ischemic ones.ConclusionTherefore, cerebral vasoreactivity determined by transcranial Doppler could be utilized for differentiating demyelinating from ischemic lesions.

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Autonomic dysfunction in multiple sclerosis is better detected by heart rate variability and is not correlated with central autonomic network damage

Cited by 29 publications

References 30 publications

Cardiac Autonomic Modulation Is Different in Terms of Clinical Variant of Multiple Sclerosis

Cardiac Autonomic Modulation Is Different in Terms of Clinical Variant of Multiple Sclerosis

Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies

Investigation of ischemic and demyelinating lesions by cerebral vasoreactivity based on transcranial Doppler sonography: a comparative study

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