Autonomic dysfunction (sweating responses) in multiple sclerosis.

Noronha, M. J.; Vas, C. J.; Aziz, Hiba Abdel

doi:10.1136/jnnp.31.1.19

Cited by 75 publications

(49 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In another small study of 14 patients and 10 normal subjects, 4 patients had reduced beat-to-beat heart rate variation [5], This study also found a 'flatter' heart rate response to standing in the patients com pared with normal subjects. The blood pres sure response to standing was found to be normal in the group of patients described by Cartlidge [2] but others have reported a drop in systolic blood pressure in 4 out of 60 patients with MS [1], although in this study the actual number of patients who were able to stand is not given. In a recent study com paring MS patients with 20 healthy controls abnormal heart rate responses to the Valsalva manoeuvre were reported in 4 of 19 patients, and to deep breathing in 6 of 11 patients tested [6], Arm ergometry was used as a mea sure of the cardiovascular response to exer cise, with the blood pressure response being attenuated in seven of 21 patients.…”

Section: Discussionmentioning

confidence: 70%

“…Patients with multiple sclerosis (MS) may show impaired sphincter control, impotence and abnormal sweating responses [1,2] which are all suggestive of autonomic nervous sys tem damage. However, only very limited ob jective information is available about cardio vascular autonomic function in this disorder [2][3][4][5][6], Recently there has been increasing in terest in the use of simple non-invasive tests of cardiovascular reflex function as markers of autonomic damage in diabetics, and in other conditions with somatic nervous system damage such as acute infective polyneuropa thy [7] and syringomyelia [8].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cardiovascular Reflexes in Multiple Sclerosis

Pentland

Ewing²

1987

Eur Neurol

View full text Add to dashboard Cite

Cardiovascular autonomic function was studied in 50 patients with multiple sclerosis using 5 simple non-invasive tests: the heart rate responses to the Valsalva manoeuvre, deep breathing and standing, and the blood pressure responses to standing and sustained handgrip. Abnormalities of one or more tests were found in 37 subjects. There was a variable distribution of abnormalities with most occurring in the heart rate response to deep breathing and the blood pressure response to sustained handgrip. This pattern contrasts with that in diabetics and probably reflects the scattered central pathological lesions of multiple sclerosis.

show abstract

Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Cardiovascular Reflexes in Multiple Sclerosis

Pentland

Ewing²

1987

Eur Neurol

View full text Add to dashboard Cite

show abstract

“…This is evidenced by previous studies that report reduced sweating responses in MS patients (10,53,79). In the aforementioned studies, abnormal sweating responses were identified by using quinizarin powder placed on the skin of individuals followed by exposure to a heat stress.…”

Section: Thermoregulatory Effector Responses In Msmentioning

confidence: 85%

Thermoregulation in multiple sclerosis

Davis

Wilson

White

et al. 2010

Journal of Applied Physiology

146

147

View full text Add to dashboard Cite

Davis SL, Wilson TE, White AT, Frohman EM. Thermoregulation in multiple sclerosis. J Appl Physiol 109: 1531-1537. First published July 29, 2010 doi:10.1152/japplphysiol.00460.2010.-Multiple sclerosis (MS) is a progressive neurological disorder that disrupts axonal myelin in the central nervous system. Demyelination produces alterations in saltatory conduction, slowed conduction velocity, and a predisposition to conduction block. An estimated 60 -80% of MS patients experience temporary worsening of clinical signs and neurological symptoms with heat exposure. Additionally, MS may produce impaired neural control of autonomic and endocrine functions. This review focuses on five main themes regarding the current understanding of thermoregulatory dysfunction in MS: 1) heat sensitivity; 2) central regulation of body temperature; 3) thermoregulatory effector responses; 4) heat-induced fatigue; and 5) countermeasures to improve or maintain function during thermal stress. Heat sensitivity in MS is related to the detrimental effects of increased temperature on action potential propagation in demyelinated axons, resulting in conduction slowing and/or block, which can be quantitatively characterized using precise measurements of ocular movements. MS lesions can also occur in areas of the brain responsible for the control and regulation of body temperature and thermoregulatory effector responses, resulting in impaired neural control of sudomotor pathways or neural-induced changes in eccrine sweat glands, as evidenced by observations of reduced sweating responses in MS patients. Fatigue during thermal stress is common in MS and results in decreased motor function and increased symptomatology likely due to impairments in central conduction. Although not comprehensive, some evidence exists concerning treatments (cooling, precooling, and pharmacological) for the MS patient to preserve function and decrease symptom worsening during heat stress. demyelination; core temperature; sweating; skin blood flow; fatigue MULTIPLE SCLEROSIS (MS) is a disabling progressive neurological disorder affecting ϳ400,000 individuals in the United States. The pathophysiology of MS results in a disruption or loss of axonal myelin in the central nervous system (CNS), leading to the formation of scar tissue (sclerosis). MS is thought to involve a number of autoimmune injury cascades that appear to be dependent on the interaction of complex epigenetic and environmental factors. Immune responses in individuals with MS are skewed toward a proinflammatory state, resulting in inflammation, demyelination, and ultimately loss of axons and disorganization of normal tissue architecture within the CNS (23). Demyelination is associated with corresponding changes in axonal physiology, including a loss of saltatory properties of electrical conduction, reduction in conduction velocity, and a predisposition to conduction block. These pathophysiological mechanisms underlie the myriad of symptoms (Table 1) in individuals with MS and are contingent on the neuroanatomic l...

show abstract

“…Decreased sudomotor response occurs significantly higher in MS patients than in healthy controls and is related to disease activity [73]. Thermoregulation is impaired in MS patients because of interruption in the central sudomotor pathways that originate in the preoptic region of the hypothalamus and descend to intermediolateral column of the spinal cord where they exit the central nervous system and travel to sweat glands via peripheral nerves [74]. Temperature increase can diminish the current needed for depolarization of axons [75].…”

Section: Sudomotor Dysfunctionmentioning

confidence: 99%