Autonomic evaluation by means of standard tests and power spectral analysis in multiple sclerosis

Linden, Dieter; Diehl, Rolf R.; Kretzschmar, Anke; Berlit, Peter

doi:10.1002/(sici)1097-4598(199707)20:7<809::aid-mus4>3.0.co;2-b

Cited by 27 publications

(10 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The impairment in parasympathetic function is supported by studies in which spectral analysis and 24-hour heart rate variabilities showed significantly smaller oscillations in high frequency (function of parasympathetic cardiovagal activity) in MS patients compared to healthy controls [13,16,17]. Ferini-Strambi et al evaluated autonomic function in sleep and showed that the ratio of the mean RR-interval before body movement during sleep to mean RR-interval during wakefulness (RRs/w), an index of vagal activity, was impaired in MS patients [12].…”

Section: Discussionmentioning

confidence: 91%

Abnormal heart rate and blood pressure responses to baroreflex stimulation in multiple sclerosis patients

et al. 2005

View full text Add to dashboard Cite

Cardiovascular autonomic neuropathy has been previously reported in patients with multiple sclerosis (MS) using standard reflex tests. However, no study has separately evaluated both parasympathetic and sympathetic cardiovascular autonomic regulation. We therefore assessed the baroreflex-mediated vagal and sympathetic control of the heart rate and sympathetic control of the blood vessels in MS patients using sinusoidal neck stimulation. We studied 13 multiple sclerosis patients aged 28-58 years and 18 healthy controls aged 26-58 years. The carotid baroreflex was stimulated by sinusoidal neck suction (0 to -30 mmHg) at 0.1 Hz to assess the autonomic control of the heart and blood vessels, and at 0.2 Hz to assess the vagal control of the heart. Continuous recordings were made of blood pressure, electrocardiographic RR-interval and respiration, with breathing paced at 0.25 Hz. Spectral analysis was used to evaluate the magnitude of the low frequency (LF, 0.03-0.14 Hz) and high frequency (HF, 0.15-0.50 Hz) oscillations in RR-interval and blood pressure in response to the sinusoidal baroreceptor stimulation. Responses to the applied stimulus were assessed as the change in the spectral power of the RR-interval and blood pressure fluctuations at the stimulating frequency from the baseline values. The increase in the power of 0.1 Hz RR-interval oscillations during the 0.1 Hz neck suction was significantly smaller (p<0.01) in the MS patients (4.47+/-0.27 to 5.62+/-0.25 ln ms(2)) than in the controls (4.12+/-0.37 to 6.82+/-0.33 ln ms(2)). The increase in the power of 0.1 Hz systolic BP oscillations during 0.1 Hz neck suction was also significantly smaller (p<0.01) in the MS patients (0.99+/-0.19 to 1.96+/-0.39 mmHg(2)) than in the healthy controls (1.27+/-0.34 to 9.01+/-4.10 mmHg(2)). Neck suction at 0.2 Hz induced RR-interval oscillations at 0.2 Hz that were significantly smaller (p<0.05) in the patients (3.22+/-0.45 ln ms(2)) than in the controls (5.27+/-0.29 ln ms(2)). These results indicate that in MS patients, baroreflex dysfunction is not only restricted to the cardiovagal limb of the baroreflex, but that the sympathetic modulation of the blood vessels is also affected.

show abstract

Section: Discussionmentioning

confidence: 91%

Abnormal heart rate and blood pressure responses to baroreflex stimulation in multiple sclerosis patients

et al. 2005

View full text Add to dashboard Cite

show abstract

“…A number of investigations have focused on cardiovascular reflex tests [2,11,12,16,17,23,24,26,36,38], but these have provided conflicting data about the frequency and distribution of cardiovascular autonomic dysfunction in MS. More than 50% of the patients observed by Pentland et al [26], Nordenbo et al [24], Gallai et al [12], and Anema et al [2] showed abnormal responses on one or more tests, while much lower frequencies were found by Linden et al [16,17], Ferini-Strambi et al [8], Frontoni et al [11] and Nasseri et al [23]. The proportion of patients with two or more abnormal test results (which is generally taken to establish significant autonomic dysfunction [21]) ranged from 10% [38] to 50% [34].…”

Section: Cardiovascular Reflex Testsmentioning

confidence: 99%

“…Other manifestations of autonomic dysfunction may include sweating, gastrointestinal, and cardiovascular disturbances. In this regard, orthostatic dizziness (OD) has been found in up to 49% of patients [2,16,38], and abnormal responses to cardiovascular reflex tests are reported with varying frequencies [2,11,12,17,24,26,36,38]. However, the mechanisms leading to OD are poorly understood, and the correlation with autonomic function tests (AT) has not been systematically studied before.…”

mentioning

confidence: 99%

Cardiovascular autonomic dysfunction in multiple sclerosis: correlation with orthostatic intolerance

Flachenecker¹,

Wolf²,

Krauser³

et al. 1999

Journal of Neurology

101

View full text Add to dashboard Cite

Autonomic dysfunction is frequently observed in patients with multiple sclerosis (MS), but clinical studies disagree on the frequency and type of abnormalities in autonomic function tests. Orthostatic dizziness (OD) has been reported in up to 49% of patients, but the pathophysiological mechanisms are poorly understood. This study investigated cardiovascular reflex tests and their association with OD in patients with MS in order to examine the hypothesis that the sympathetic nervous system is specifically involved in these patients. Forty patients with clinically active relapsing-remitting (n = 27) and secondary progressive MS (n = 13), aged 35.0+/-8.5 years, were studied by parasympathetic (heart rate responses to the Valsalva maneuver, deep breathing, and active change in posture) and sympathetic function tests (blood pressure responses to active change in posture and sustained handgrip), and by spectral analysis of heart rate variability during rest and during standing. Results were compared to those obtained in 24 healthy volunteers, aged 29.4+/-7.2 years. A standardized questionnaire was used to evaluate symptoms of orthostatic intolerance. Abnormal responses on at least one cardiovascular reflex test were observed in 40% of MS patients, compared to 17% of the control group, with a statistically significant involvement of the sympathetic vasomotor system. Orthostatic intolerance was reported in 50% of patients (controls: 14%, P<0.006). Subgroup comparison of patients with and without OD suggests that orthostatic intolerance results from impaired sympathetic vasoconstriction. These results provide further evidence that the sympathetic nervous system is involved in patients with MS.

show abstract

“…L'hypotension toucherait près de 50 % des patients atteints de SEP [20]. La dysrégulation cardiovasculaire au cours de la SEP est bien mise en évidence par l'étude de la variabilité de la FC [2,21,22]. L'atteinte pupillaire est décrite avec une [23].…”

Section: Discussionunclassified

Dysautonomie et troubles urinaires au cours de la sclérose en plaques

Amarenco

Hubeaux²,

Jousse³

et al. 2010

Pelv Perineol

View full text Add to dashboard Cite

Reçu le 22 mars 2010 ; accepté le 6 avril 2010 © Springer-Verlag France 2010Résumé Les symptômes de dysautonomie sont fréquents au cours de la sclérose en plaques (SEP). Matériel et méthodes : Nous avons investigué 65 SEP (âge moyen de 47,5 ans) avec troubles urinaires, par scores de symptômes, bilan urodynamique, tests cardiovasculaires de la fonction autonome et étude des réponses cutanées sympathiques. Résultats : Quarante-cinq patients avaient une incontinence urinaire, 48 une dysurie, 14 une rétention urinaire et 13 une incontinence fécale. Le bilan urodynamique objectivait un détrusor hyperactif dans 46 cas et un détrusor hypoactif dans quatre cas. Vingt-cinq patients sur 65 (38 %) avaient une dysautonomie sans corrélation avec la typologie clinique ou urodynamique ou avec la gravité de la maladie. Conclusion : La dysautonomie est fréquente au cours de la SEP et peut être considérée comme un des facteurs physiopathologiques des troubles urinaires. Pour citer cette revue : Pelvi-Périnéologie 5 (2010).Mots clés Sclérose en plaques · Dysautonomie · Incontinence urinaire · Test cardiovasculaire de la fonction autonome Abstract Symptoms related to alterations of the autonomic nervous system are frequent in patients with multiple sclerosis (MS). Material and methods: We investigated 65 MS patients (mean age 47,5 years) with urological dysfunction by means symptom scores and urodynamic investigation, cardiovascular autonomic function tests (orthostatic hypotension testing, Valsalva test, deep breath test, cold pressor test) and sympathtetic skin responses. Results: Forty-five patients presenting with urinary incontinence, 48 difficulties to empty the bladder, 14 urinary retention and 13 fecal incontinence. Urodynamic investigation demonstrated 46 overactive detrusor and 4 underactive detrusor. 25/65 (38%) patients had dysautonomia without correlation neither with clinical or urodynamic data, nor gravity of multiple sclerosis (EDSS). Conclusion: Dysautonomia is frequent in MS and can be considered as one of the pathophysiological mechanism of urinary disorders in this disease. To cite this journal: PelviPérinéologie 5 (2010).

show abstract

Autonomic evaluation by means of standard tests and power spectral analysis in multiple sclerosis

Cited by 27 publications

References 26 publications

Abnormal heart rate and blood pressure responses to baroreflex stimulation in multiple sclerosis patients

Abnormal heart rate and blood pressure responses to baroreflex stimulation in multiple sclerosis patients

Cardiovascular autonomic dysfunction in multiple sclerosis: correlation with orthostatic intolerance

Dysautonomie et troubles urinaires au cours de la sclérose en plaques

Contact Info

Product

Resources

About