Autonomic dysfunction in multiple sclerosis

Abstract

Multiple sclerosis (MS) is the most frequent chronic neurological disease affecting young persons in developed countries. MS is, however, considered as a secondary cause, of central origin, for autonomic dysfunction. The most common autonomic symptoms in MS are disorders of micturation, impotence, sudomotor and gastrointestinal disturbances, orthostatic intolerance as well as sleep disorders. The majority of the patients suffer at some period of the disease from lower urinary tract symptoms and sexual dysfunction. Awareness and treatment of these conditions is vital to improving health and quality of life in patients with MS. The increased understanding of the pathophysiological mechanisms in autonomic dysfunction in MS, along with technological and pharmaceutical developments has advanced our ability to treat the multiple aspects complicating autonomic failure in MS.

Multiple Sclerosis Related Bowel Dysfunction: Pathophysiology, Clinical Manifestation and Management

“…One proposed mechanism for MS to affect bowel function is that sclerotic plaques directly or indirectly affect the central descending autonomic pathways, affecting these reflexes [24]. Injuries to these pathways are thought to be why urinary and colorectal dysfunction coexists [25].…”

Autonomic dysfunction in multiple sclerosis

“…These symptoms occur in up to 97% of MS patients during the course of the disease [30]. Incontinence often leads to social embarrassment and can have a severe impact on quality of life.…”

“…Therefore the residual urine volume should be always measured. If there is a raised post-micturition residual urinary volume, the most efficient, but incommodious therapy, is intermittent selfcatheterization [30]. α blockers can be used if the residual volume is not substantial but [43].…”

Modulation of Immunity and the Inflammatory Response: A New Target for Treating Drug-resistant Epilepsy

“…An autoimmune process is reflected in the development of demyelinating lesions in the white matter. Analysis of the lesions seen on Magnetic resonance imaging that are evident pathologically as MS plaques, reveals inflammatory lymphocytic infiltration consistent with active inflammation, both humoral and cellular [116]. Seizures are a well-described feature and occasionally are the first manifestation of the disease [117].…”