Autonomic dysfunction in multiple sclerosis

Racosta, Juan Manuel; Kimpinski, Kurt; Morrow, Sarah A.; Kremenchutzky, Marcelo

doi:10.1016/j.autneu.2015.06.001

Cited by 49 publications

(53 citation statements)

References 74 publications

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“…Multiple sclerosis (MS) is frequently associated with autonomic dysfunction which afflicts up to 84% of MS‐patients and may comprise cardiovascular dysregulation, bowel, bladder, and sexual dysfunction, or sudomotor abnormalities (Hilz, ; Kaplan, Berkowitz, & Samuels, ; Merkelbach et al, ; Racosta, Kimpinski, Morrow, & Kremenchutzky, ; Winder et al, ). Particularly, cardiovascular dysfunction is associated with an increased risk of complications and reduced life expectancy (Hilz, ; Kaplan et al, ; Midaglia et al, ), and may manifest as baroreflex dysfunction with orthostatic intolerance or orthostatic hypotension, postural tachycardia syndrome, and altered sympathetic or parasympathetic heart rate modulation (Hilz, ; Kaplan et al, ; Merkelbach et al, ; Racosta et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…Autonomic cardiovascular modulation depends on the integrity of the central autonomic network which includes the insular and cingulate cortices, the amygdala, the prefrontal or orbitofrontal cortex, the hypothalamus, and brainstem structures (Benarroch, ; Racosta et al, ; Winder et al, ). MS‐associated lesions in the periventricular white matter, juxtacortical U‐fibers, the brainstem, the cerebellum or spinal cord areas (Ge, ; Vigeveno, Wiebenga, Wattjes, Geurts, & Barkhof, ; Winder et al, ) might compromise the centrally mediated sympathetic and parasympathetic cardiovascular modulation (Hilz, ; Racosta et al, ).…”

Section: Introductionmentioning

confidence: 99%

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Cerebral lesion correlates of sympathetic cardiovascular activation in multiple sclerosis

Winder

Linker

Seifert

et al. 2019

Human Brain Mapping

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Cardiovascular autonomic dysfunction is common in multiple sclerosis (MS) and contributes significantly to disability. We hypothesized that cerebral MS‐lesions in specific areas of the central autonomic network might account for imbalance of the sympathetic and parasympathetic cardiovascular modulation. Therefore, we used voxel‐based lesion symptom mapping (VLSM) to determine associations between cardiovascular autonomic dysfunction and cerebral MS‐related lesion sites. In 74 MS‐patients (mean age 37.0 ± 10.5 years), we recorded electrocardiographic RR‐intervals and systolic and diastolic blood pressure. Using trigonometric regressive spectral analysis, we assessed low (0.04–0.15 Hz) and high (0.15–0.5 Hz) frequency RR‐interval‐and blood pressure‐oscillations and determined parasympathetically mediated RR‐interval–high‐frequency modulation, mainly sympathetically mediated RR‐interval–low‐frequency modulation, sympathetically mediated blood pressure‐low‐frequency modulation, and the ratios of sympathetic and parasympathetic RR‐interval‐modulation as an index of sympathetic‐parasympathetic balance. Cerebral MS‐lesions were analyzed on imaging scans. We performed a VLSM‐analysis correlating parameters of autonomic dysfunction with cerebral MS‐lesion sites. The VLSM‐analysis showed associations between increased RR‐interval low‐frequency/high‐frequency ratios and lesions most prominently in the left insular, hippocampal, and right frontal inferior opercular region, and a smaller lesion cluster in the right middle cerebellar peduncle. Increased blood pressure‐low‐frequency powers were associated with lesions primarily in the right posterior parietal white matter and again left insular region. Our data indicate associations between a shift of cardiovascular sympathetic‐parasympathetic balance toward increased sympathetic modulation and left insular and hippocampal lesions, areas of the central autonomic network. The VLSM‐analysis further distinguished between right inferior fronto‐opercular lesions disinhibiting cardiac sympathetic activation and right posterior parietal lesions increasing sympathetic blood pressure modulation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cerebral lesion correlates of sympathetic cardiovascular activation in multiple sclerosis

Winder

Linker

Seifert

et al. 2019

Human Brain Mapping

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“…1 Up to 84% of MS patients experience dysfunction of autonomic organ regulation. 1 Common complaints include bowel and bladder disturbances, sexual dysfunction, or sweating abnormalities.…”

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confidence: 99%

“…1 Up to 84% of MS patients experience dysfunction of autonomic organ regulation. 1 Common complaints include bowel and bladder disturbances, sexual dysfunction, or sweating abnormalities. 1,2 Cardiovascular autonomic dysfunction may include baroreflex dysfunction with orthostatic intolerance and orthostatic hypotension, postural tachycardia syndrome, or decreased heart rate variability 3 which is associated with an increased risk of cardiovascular complications and reduced life expectancy.…”

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confidence: 99%

Cardiac stunning as first manifestation of multiple sclerosis: A case report reminding us not to overlook cardiovascular autonomic dysfunction in multiple sclerosis

Hilz

2016

Mult Scler

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“…Several previous studies have explored the bowel dysfunction in MS with the evidence of slow colonic transit, lower resting anal pressure, and decreased anal squeeze pressure compared with constipated non‐MS patients . Although the pathophysiology of bowel dysfunction in MS may be multifactorial and not completely characterized, it is believed to be associated with autonomic dysfunction due to spinal cord lesions, since it frequently coexists with urinary disturbances …”

Section: Introductionmentioning

confidence: 99%

Bowel symptoms predate the diagnosis among many patients with multiple sclerosis: A 14‐year cohort study

Almeida

Silvernale

Kuo

et al. 2019

Neurogastroenterology Motil

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Background Multiple sclerosis (MS) is an autoimmune, neurodegenerative disease frequently complicated by bowel symptoms. Multiple sclerosis typically first manifests with a demyelination event, also known as a clinically isolated syndrome (CIS). We sought to examine the prevalence of prodromal bowel symptoms predating a CIS in patients with MS as part of a recently characterized prodromal phase of disease. Methods We constructed a retrospective cohort of MS patients with bowel symptoms and an identifiable CIS at two tertiary care centers over 14 years using administrative and billing data. We determined the date of onset of reported bowel symptoms in comparison with the date of first CIS and determined the overall prevalence of prediagnosis bowel symptoms within 1, 2, 3, and >3 years from a CIS. We used multivariable modeling to determine demographic and clinical risk factors for prediagnosis bowel symptoms. Key Results Among 385 MS patients with reported bowel symptoms, 122 (31.6%) reported bowel symptoms prior to CIS. The most common first bowel symptom was constipation (50.0%), followed by diarrhea (29.5%). The average lead time between a first bowel symptom and a CIS event was 3.7 ± 3.4 years. Pre‐CIS fatigue (OR 4.48, 95% CI: 2.68‐7.51, P < 0.001) and pre‐CIS sensory disturbances (OR 1.88, 95% CI: 1.15‐3.08, P < 0.05) were all associated with bowel symptoms prior to a CIS event. Conclusions and Inferences Nearly a third of MS patients with bowel symptoms reported bowel symptoms prior to a demyelinating event/CIS. Characterization of a prodromal phase of disease may provide important insights into understanding disease progression.

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Autonomic dysfunction in multiple sclerosis

Cited by 49 publications

References 74 publications

Cerebral lesion correlates of sympathetic cardiovascular activation in multiple sclerosis

Cerebral lesion correlates of sympathetic cardiovascular activation in multiple sclerosis

Cardiac stunning as first manifestation of multiple sclerosis: A case report reminding us not to overlook cardiovascular autonomic dysfunction in multiple sclerosis

Bowel symptoms predate the diagnosis among many patients with multiple sclerosis: A 14‐year cohort study

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