Autonomic Dysregulation in Multiple Sclerosis

Abstract

Multiple sclerosis (MS) is a chronic, progressive central neurological disease characterized by inflammation and demyelination. In patients with MS, dysregulation of the autonomic nervous system may present with various clinical symptoms including sweating abnormalities, urinary dysfunction, orthostatic dysregulation, gastrointestinal symptoms, and sexual dysfunction. These autonomic disturbances reduce the quality of life of affected patients and constitute a clinical challenge to the physician due to variability of clinical presentation and inconsistent data on diagnosis and treatment. Early diagnosis and initiation of individualized interdisciplinary and multimodal strategies is beneficial in the management of autonomic dysfunction in MS. This review summarizes the current literature on the most prevalent aspects of autonomic dysfunction in MS and provides reference to underlying pathophysiological mechanisms as well as means of diagnosis and treatment.

The prevalence of lower urinary tract symptoms based on individual and clinical parameters in patients with multiple sclerosis

“…Moreover, the prevalence of severe LUTS among patients with MS and severe disability was higher than those with mild to moderate disability. In this regard, the results of a study showed that the prevalence of LUTS increased with increase in the duration of the disease, as an average of 35.0-39.0% of the patients reported the onset of the disease after 5-6 years; in contrast, 64% of the patients with a 17.1-year history of the disease reported LUTS [1,11]. However, the study by Khalaf et al indicated that despite the increasing incidence of LUTS with the progress of the disease, these symptoms were not basically related to the duration of the disease or degree of disability [10].…”

“…In developed countries, multiple sclerosis (MS) is the most prevalent chronic neurological disorder among young individuals, with an incidence rate of more than 400 thousand people in the United States [1] and 500-700 thousand people in Europe [2]. Based on a previous study, the prevalence rate of this disease in Iran is estimated to be between 5.3 and 74.28 per 100 thousand people [3].…”

The Prevalence of Lower Urinary Tract Symptoms Based on Individual and Clinical Parameters in Patients with Multiple Sclerosis

“…In this regard, the results of a study showed that the prevalence of LUTS increased with increase in the duration of the disease, as an average of 35.0-39.0% of the patients reported the onset of the disease after 5-6 years; in contrast, 64% of the patients with a 17.1-year history of the disease reported LUTS. [1,11] However, the study by Khalaf et al indicated that despite the increasing incidence of LUTS with the progress of the disease, these symptoms were not basically related to the duration of the disease or degree of disability. [10] In addition, in the study by Nakipoglu et al, there was no correlation between LUTS and characteristics of the disease.…”

“…There was a higher probability of a urinary tract problem among patients with MS and a high EDSS score. Therefore, it is recommended that the health system take the necessary measures regarding timely detection and treatment of LUTS among these patients in order to prevent secondary outcomes and improve the quality of life (QOL) of patients with MS. Keywords: Multiple sclerosis, prevalence, urinary symptoms Background In developed countries, multiple sclerosis (MS) is the most prevalent chronic neurological disorder among young individuals, with an incidence rate of more than 400 thousand people in the United States [1] and 500-700 thousand people in Europe. [2] Based on a previous study, the prevalence rate of this disease in Iran is estimated to be between 5.3 and 74.28 per 100 thousand people.…”

Abdominal massage plus advice, compared with advice only, for neurogenic bowel dysfunction in MS: a RCT

“…The coexistence of FI and constipation can be explained by inco-ordinated action of the external/internal anal sphincter during expulsion; poor pelvic musculature relaxation may cause incomplete emptying of the rectum, which precipitates FI when anal sphincter weakness and anorectal hyposensitivity are present. 14,15 Current treatment/management options Management of NBD in PwMS has been little explored and lacks supporting evidence. 16 It is costly both in terms of patient time and to the NHS (e.g.…”