Frequency and characteristics of dysautonomic symptoms in multiple sclerosis: a cross-sectional double-center study with the validated Italian version of the Composite Autonomic Symptom Score-31

Abstract

Background Dysautonomic symptoms (DS) are frequent but often underrecognized in multiple sclerosis (MS) patients, despite the relevant impact on quality of life and physical performance. Objectives To assess frequency and characteristics of DS in our MS population compared with healthy controls (HC). To investigate the relationship between DS and disease characteristics (MS subtype, disease duration, Expanded Disability Status Scale (EDSS), clinical and/or radiological activity, disability progression). Patients and methods Cross-sectional study includes 324 MS patients (mean age 44.9 ± 10.7 years; 66% female) and 190 HC (mean age 40.60 ± 12.83 years; 63% female). DS were assessed using the Italian validated version of the Composite Autonomic Symptom Score-31 (COMPASS-31). Possible confounding factors were considered. Results More than 94% of enrolled MS patients reported alterations in ≥ 2 domains of the COMPASS-31 scale (score > 0) and significantly higher COMPASS-31 total and single domain median scores compared with HC, independently from possible confounding factors (orthostatic intolerance: p = 0.001; vasomotor: p = 0.017; secretomotor: p = 0.040; gastrointestinal: p = 0.047; bladder: p < 0.001; pupillomotor: p < 0.001; COMPASS-31 total score: p < 0.001). COMPASS-31 total, secretomotor, gastrointestinal, and bladder domain scores showed weak to moderate correlation with disease duration (Rho = 0.19, p < 0.001; Rho = 0.18, p = 0.01; Rho = 0.25, p = 0.030; Rho = 0.28, p < 0.001, respectively). A moderate correlation between EDSS score, COMPASS-31 total, and bladder domain scores (Rho = 0.32, p < 0.001 and Rho = 0.48, p < 0.001, respectively) was observed. Progressive subtypes showed higher COMPASS-31 total (p = 0.025), gastrointestinal (p = 0.07), and bladder (p < 0.001) domain scores vs relapsing-remitting patients. Conclusions Our findings confirm that MS-related DS are frequent and tend to increase paralleling disease duration and clinical worsening, reaching the highest clinical impact in progressive subtypes.

Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study

“…The absence of a significant association between age and COMPASS-31 score may depend on the specific questions asking for new dysautonomic symptoms after COVID-19, which might suggest an age-independent ANS response to the disease. Females were more commonly characterized by a higher COMPASS-31 score, in line with previous findings suggesting a higher prevalence of OI [35,36] and symptomatic dysautonomia [37] in women. Comparison between patients with and without neurological complaining at the time of the visit suggested only minor differences, with a greater overall COMPASS-31 score in the neurological patients characterized by a higher OI domain score (despite no differences in the proportion of participants reporting at least one OI symptom) partially compensated by less GI, urinary and pupillomotor symptoms.…”

Gastrointestinal motility disorders in patients with multiple sclerosis: A single‐center study

“…In our study of 166 patients with MS who had also undergone clinically indicated scintigraphic gastrointestinal and colonic transit and anorectal manometry, 93% had bladder and/or bowel symptoms. In these patients, just as previously reported for bladder symptoms, constipation and fecal incontinence attributable to lower gastrointestinal dysfunction were observed to be more frequent at an older age, with higher spinal cord involvement on imaging and during the progressive phase as expected 4 . However, intriguingly, we did not observe an association between phases of MS and GI transit study results.…”

“…In these patients, just as previously reported for bladder symptoms, constipation and fecal incontinence attributable to lower gastrointestinal dysfunction were observed to be more frequent at an older age, with higher spinal cord involvement on imaging and during the progressive phase as expected. 4 However, intriguingly, we did not observe an association between phases of MS and GI transit study results. Progressive MS is known to be associated with spinal cord lesions, as also observed in our study, and with craniocaudal pattern of spinal cord degeneration.…”

“…Bladder and/or bowel dysfunction affects more than 80% of patients with MS, greatly impacts quality of life and healthcare costs, and is an early prognostic sign of worse prognosis. 2 Composite Autonomic Symptoms Score screening 3 is abnormal in 94% of MS patients, and impairment in secretomotor, gastrointestinal, or bladder domains most strongly correlates with the disease duration and progressive phase of MS. 4 In the latter study, which consisted of 324 consecutively enrolled patients referred to two MS centers in Italy, the incidence rate ratio of gastrointestinal symptoms (relative to healthy controls adjusted for age, sex, and cigarette smoking) was significant [1.2 (1.1-1.3) p < 0.001]. Some previous studies based on questionnaires explored the prevalence of upper and lower gastrointestinal symptoms suggestive of motility dysfunction in patients with MS such as dysphagia…”

Autonomic dysfunction in non-critically ill COVID-19 patients during the acute phase of disease: an observational, cross-sectional study

“…COMPASS-31, a screening tool for dysautonomia mostly employed to evaluate the occurrence of small fibres neuropathies in diabetes [ 29 ], was recently adopted in other neurological conditions, such as multiple sclerosis and parkinsonism [ 30 , 31 ]. Adopting this dysautonomic tool, we observed in our sample a prevalence of AD of 36.8%, defined as a total COMPASS-31 score > 17.…”