Unveiling the relationship between autonomic involvement, fatigue, and cognitive dysfunction in early relapsing–remitting multiple sclerosis

Dinoto, Alessandro; Baldini, Sara; Morelli, Maria Elisa; Pasquin, Fulvio; Bratina, Alessio; Bosco, Antonio; Sartori, Arianna; Manganotti, Paolo

doi:10.1007/s10072-021-05487-6

Cited by 4 publications

(2 citation statements)

References 30 publications

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“…Indeed, the autonomic nervous system dysfunction in patients with MS appears involved in the exacerbation of the symptom of fatigue [19][20][21][22][23]. Dinoto et al [24] reported a strong correlation between fatigue and autonomic nervous system dysfunction in patients with MS. Specifically, they found that patients with fatigue had a significantly higher dysautonomia compared to patients without fatigue.…”

Section: Introductionmentioning

confidence: 99%

Brain Structural and Functional Alterations in Multiple Sclerosis-Related Fatigue: A Systematic Review

Barbi

Pizzini

Tamburin

et al. 2022

Neurology International

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Fatigue is one of the most disabling symptoms of multiple sclerosis (MS); it influences patients’ quality of life. The etiology of fatigue is complex, and its pathogenesis is still unclear and debated. The objective of this review was to describe potential brain structural and functional dysfunctions underlying fatigue symptoms in patients with MS. To reach this purpose, a systematic review was conducted of published studies comparing functional brain activation and structural brain in MS patients with and without fatigue. Electronic databases were searched until 24 February 2021. The structural and functional outcomes were extracted from eligible studies and tabulated. Fifty studies were included: 32 reported structural brain differences between patients with and without fatigue; 14 studies described functional alterations in patients with fatigue compared to patients without it; and four studies showed structural and functional brain alterations in patients. The results revealed structural and functional abnormalities that could correlate to the symptom of fatigue in patients with MS. Several studies reported the differences between patients with fatigue and patients without fatigue in terms of conventional magnetic resonance imaging (MRI) outcomes and brain atrophy, specifically in the thalamus. Functional studies showed abnormal activation in the thalamus and in some regions of the sensorimotor network in patients with fatigue compared to patients without it. Patients with fatigue present more structural and functional alterations compared to patients without fatigue. Specifically, abnormal activation and atrophy of the thalamus and some regions of the sensorimotor network seem linked to fatigue.

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Section: Introductionmentioning

confidence: 99%

Brain Structural and Functional Alterations in Multiple Sclerosis-Related Fatigue: A Systematic Review

Barbi

Pizzini

Tamburin

et al. 2022

Neurology International

View full text Add to dashboard Cite

show abstract

“…Many epidemiological studies demonstrated a similar intercorrelation of ANS-related symptoms in MS patients. Investigations that used the COMPASS-31 questionnaire, focusing on ANS dysfunctions, have shown that MS patients suffer from more ANS-related symptoms than healthy controls (especially for pupillomotor symptoms and orthostatic intolerance), and that these symptoms correlate with fatigue [31][32][33][34], whereas no relationship between COMPASS-31 and EDSS, or disease duration could be established by Cortez et al [35].…”

Section: Ans Disorder and Multiple Sclerosismentioning

confidence: 99%

Heart rate variability and fatigue in MS: two parallel pathways representing disseminated inflammatory processes?

et al. 2022

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Background Fatigue is a disabling symptom of multiple sclerosis. Its biological causes are still poorly understood. Several years ago, we proposed that fatigue might be the subjective representation of inflammatory processes. An important step for a straight-forward evaluation of our model would be to show that the level of fatigue is associated with vagal activation. The heart rate is under partial control of the vagus nerve. Using power spectrum analysis allows to separate, at least partly, sympathetic and parasympathetic impact on heart rate variability. Methods This narrative review summarizes the evidence for heart rate variability changes in MS patients, their relationship with fatigue and disease course. To do this, we conducted a literature search, including 45 articles relevant to the topic treated in this review. Results We illustrate that (1) inflammation leads to a change in cardiac behavior during acute and chronic phases, both in animals and in humans; (2) MS patients show changes of heart rate variability (HRV) that resemble those during acute and chronic inflammation due to multiple causes; (3) existing evidence favors a set of specific predictions about fatigue and parallel HRV changes; and (4) that MS-related brainstem lesions or neurological impairments do not completely explain HRV changes, leaving enough place for an explanatory relation between HRV and fatigue. Discussion We discuss the results of this review in relation to our model of fatigue and propose several observational and experimental studies that could be conducted to gain a better insight into whether fatigue and HRV can be interpreted as a common pathway, both reflecting activated autoimmune processes in MS patients.

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Gait and heart rate: do they measure trait or state physical fatigue in people with multiple sclerosis?

Galperin,

Buzaglo,

Gazit

et al. 2024

J Neurol

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Background Trait and state physical fatigue (trait-PF and state-PF) negatively impact many people with multiple sclerosis (pwMS) but are challenging symptoms to measure. In this observational study, we explored the role of specific gait and autonomic nervous system (ANS) measures (i.e., heart rate, HR, r–r interval, R–R, HR variability, HRV) in trait-PF and state-PF. Methods Forty-eight pwMS [42 ± 1.9 years, 65% female, EDSS 2 (IQR: 0–5.5)] completed the Timed Up and Go test (simple and with dual task, TUG-DT) and the 6-min walk test (6MWT). ANS measures were measured via a POLAR H10 strap. Gait was measured using inertial-measurement units (OPALs, APDM Inc). Trait-PF was evaluated via the Modified Fatigue Impact Scale (MFIS) motor component. State-PF was evaluated via a Visual Analog Scale (VAS) scale before and after the completion of the 6MWT. Multiple linear regression models identified trait-PF and state-PF predictors. Results Both HR and gait metrics were associated with trait-PF and state-PF. HRV at rest was associated only with state-PF. In models based on the first 3 min of the 6MWT, double support (%) and cadence explained 47% of the trait-PF variance; % change in R–R explained 43% of the state-PF variance. Models based on resting R–R and TUG-DT explained 39% of the state-PF. Discussion These findings demonstrate that specific gait measures better capture trait-PF, while ANS metrics better capture state-PF. To capture both physical fatigue aspects, the first 3 min of the 6MWT are sufficient. Alternatively, TUG-DT and ANS rest metrics can be used for state-PF prediction in pwMS when the 6MWT is not feasible.

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Unveiling the relationship between autonomic involvement, fatigue, and cognitive dysfunction in early relapsing–remitting multiple sclerosis

Cited by 4 publications

References 30 publications

Brain Structural and Functional Alterations in Multiple Sclerosis-Related Fatigue: A Systematic Review

Brain Structural and Functional Alterations in Multiple Sclerosis-Related Fatigue: A Systematic Review

Heart rate variability and fatigue in MS: two parallel pathways representing disseminated inflammatory processes?

Gait and heart rate: do they measure trait or state physical fatigue in people with multiple sclerosis?

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