Autonomic Dysfunction in Multiple Sclerosis: Correlation with Disease-Related Parameters

Abstract

Cardiovascular autonomic functions were investigated in a prospective, controlled study of 22 consecutive relapsing-remitting multiple sclerosis (MS) patients and 22 healthy subjects using 5 simple noninvasive tests and sympathetic skin response testing. Tests included the heart rate response to deep breathing, valsalva maneuver and standing, blood pressure response to standing and sustained hand grip, and were graded according to the Ewing and Clark classification as early, definite or severe impairment. The relationship between autonomic dysfunction and disease-related parameters such as the expanded disability status scale (EDSS) and disease duration was studied. Ninety percent of the patients had symptoms related with autonomic dysfunction, and 45.5 % had abnormal results in cardiovascular autonomic function testing with 4 patients also having abnormal sympathetic skin responses. Statistical analysis indicated that patients with a long disease duration rather than high EDSS carried a risk of autonomic involvement in MS. Both parasympathetic and sympathetic functions were impaired and this could have been easily overlooked by a standard EDSS follow-up. In this regard, autonomic function testing seems necessary in order to detect subclinical changes in MS patients and should be considered in outcome measures.

Prevalence of Autonomic Dysfunction in Patients with Multiple Sclerosis

“…7,14,15 The percentage of patients complaining about gastrointestinal symptoms was the highest of all domains. This finding supported former studies showing that gastrointestinaldysfunction is a common feature in MS patients, who tend to have slowergastric emptying rate16 as well as bowel symptoms 17,18 Previous evidence showed that orthostatic intolerance can be present in up to 50% of MS patients 19 and in our study it affected around 60%.…”

“…1 The autonomic nervous system dysfunction (ANSD) is commonly seen in patients with MS and is characterized by bladder and gastrointestinal disturbances, sexual dysfunction, abnormalities in cardiovascular function and sudomotor disorders. [1][2][3][4][5][6][7] These symptoms may have a significant impact in patients' quality of life and should be explored as part of the routine evaluation. [1][2][3][4][5]8 Neurological disability assessed by Expanded Disability Status Scale Revista Científica da Ordem dos Médicos www.actamedicaportuguesa.com Vieira B, et al Prevalence of autonomic dysfunction in patients with multiple sclerosis, Acta Med Port 2015 Jan-Feb;28(1): [51][52][53][54][55] (EDSS) focuses mainly on the somatic nervous system and undervalues the role of autonomic failure, only taking into account bladder and bowel dysfunction.…”

“…1,3,4 Hence, autonomic symptoms can be easily overlooked by exclusive EDSS follow-up. 7 Several studies have suggested the use of questionnaires to evaluate ANSD in order to improve disease management. 2,[7][8][9][10][11] Recently, the questionnaire Composite Autonomic Symptom Score (COMPASS 31) 12 was developed and validated as a self-assessment instrument of autonomic symptoms and function, based on the well-established Autonomic Symptom Profile (ASP).…”

“…7 Several studies have suggested the use of questionnaires to evaluate ANSD in order to improve disease management. 2,[7][8][9][10][11] Recently, the questionnaire Composite Autonomic Symptom Score (COMPASS 31) 12 was developed and validated as a self-assessment instrument of autonomic symptoms and function, based on the well-established Autonomic Symptom Profile (ASP). 8 Although not specifically designed for MS, this questionnaire is up-to-date, broadly applicable, easy to administer and based on a scientific approach.…”

Autonomic dysfunction in multiple sclerosis

“…Since the pathophysiology of MS is characterized by dissemination in space, as well as in time, the autonomic nervous system is inevitably damaged in the course of the disease in many patients and the proportion of affected patients increases with disease duration [2].…”