Assessment of autonomic nervous system dysfunction in multiple sclerosis and the association with clinical disability

Abstract

Inpatient rehabilitation has been traditionally employed in developed countries, while in developing countries, outpatient rehabilitation is the rule. The purpose of this study was to compare the patterns of recovery of upper extremity (UE) function, global impairment and independence in activities of daily living (ADL) during the first month after ischemic stroke in inpatient (United States) and outpatient (Brazil) rehabilitation settings.This is a prospective cohort comparison study. Twenty patients from each country were selected using identical inclusion criteria.The study measures employed were the UE portion of the Fugl-Meyer scale, the Action Research Arm test, the National Institutes of Health Stroke Scale and Barthel Index. Changes from baseline to the end of treatment, efficiency and effectiveness of each treatment were compared.Both populations exhibited significant improvement between the first and second evaluations in the four outcome scales (p<0.0001). There were no differences between the two rehabilitation settings on any of the four dependent measures (p>0.05).Substantially different treatment approaches after ischemic stroke led to similar results in UE function, global impairment and ADL. Further studies in larger populations should be performed in order to confirm the present results.

Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke

“…ICARE, timed in between, found no dose effect. This time window hypothesis provides a plausible explanation for why the results from ICARE are consistent with previous studies of therapy dosing that did not find large dose effects 31,32 but also are inconsistent with other findings in which a high dose of task-oriented training, as in EXCITE, was shown to be more effective compared with the control group when the dose of outpatient therapy varied considerably. Future trials in rehabilitation should use designs and methods that consider the natural recovery transpiring during the early period after stroke 33 as well as the degree of neurological severity and disability.…”

Evaluation of brainstem involvement in multiple sclerosis

“…AD in MS is explained by lesions in regions responsible for autonomic regulation, such as nuclei in the periventricular region of the fourth ventricle in the brainstem as well as medullar lesions [21,86]. Reports about frequency of AD in MS patients vary notably between groups, ranging from 15 to 80% [87]. Nevertheless, its impact on quality of life is substantial but, unfortunately, often overlooked.…”

No Effect of Cooling on Cognitive Fatigue, Vigilance and Autonomic Functioning in Multiple Sclerosis

“…Most studies focused on supratentorial lesions or demyelination, but dysfunctions of the autonomic nervous system, have also been mentioned [4]. Autonomic dysfunctions like sleep disorders [5], loss of bladder control [6], depressive mood [7] and orthostatic hypotension are common in MS [8], statistically associated with fatigue [9]. A recent review argues for a direct link between hypothalamic lesions and fatigue in neurological diseases [10].…”