Autonomic involvement in multiple sclerosis: a pupillometric study

Pozzessere, G.; Rossi, Pietro De; Valle, E.; Froio, C. P.; Petrucci, Antonio; Morocutti, C

doi:10.1007/bf02267724

Cited by 33 publications

(38 citation statements)

References 48 publications

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“…This pupillary function impairment appears to be affected early in MS. 23,24 Vasomotor symptoms were rare in this group, with only a small percentage of patients complaining about colour changes in the skin.…”

Section: Discussionmentioning

confidence: 77%

Prevalence of Autonomic Dysfunction in Patients with Multiple Sclerosis

et al. 2015

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(1):51-55 RESUMOIntrodução: A disfunção do sistema nervoso autónomo é comum na esclerose múltipla e deveria ser explorada na avaliação de rotina. O questionário Composite Autonomic Symptom Score foi validado como instrumento de auto-avaliação de sintomas autonómicos. Objetivos: Determinar a frequência de sintomas autonómicos em doentes com esclerose múltipla através de uma versão portuguesa do Composite Autonomic Symptom Score; comparar os resultados do questionário entre um grupo de doentes e um grupo controlo; avaliar a viabilidade da aplicação deste questionário em doentes portugueses. Material e Métodos: Neste estudo caso-controlo utilizou-se uma tradução portuguesa do questionário para determinar a frequência de sintomas autonómicos em doentes com esclerose múltipla. Resultados: Incluíram-se 103 doentes com esclerose múltipla surto-remissão -idade média 41 anos, mediana de duração da doença 6 anos, EDSS médio 1 -e 80 indivíduos saudáveis. Dos doentes, 97,1% tinham alterações da função autonómica, com significado estatístico nos domínios intolerância ortostática e gastrointestinal. Não encontramos diferenças estatísticas entre doentes (41,7%) sem fatores de confundimento que podiam interferir com a função autonómica (i.e. comorbilidades ou medicações) e o grupo controlo. Discussão: Os resultados obtidos podem estar relacionados com a curta duração de doença, idade jovem e baixo grau de incapacidade dos doentes sem fatores de confundimento. O questionário utilizado não foi desenhado especificamente para a esclerose múltipla e pode não ser tão sensível para sintomas autonómicos mais precoces como para manifestações mais graves da doença. Conclusões: Outros estudos serão necessários para obter resultados mais robustos, validar este questionário e avaliar a sua aplicação nos doentes portugueses. Palavras-chave: Esclerose Múltipla; Portugal; Questionários; Sistema Nervoso Autónomo. ABSTRACT Background:Autonomic nervous system dysfunction is commonly seen in multiple sclerosis patients and should be explored in the routine evaluation. Composite Autonomic Symptom Score questionnaire was validated as a self-assessment instrument of autonomic symptoms. Objectives: Determine the frequency of autonomic symptoms in multiple sclerosis patients through a Portuguese version of Composite Autonomic Symptom Score; compare questionnaire results between patients and a control group; assess the feasibility of this questionnaire application in multiple sclerosis Portuguese patients. Material and Methods:This case-control study used a Portuguese translated version of Composite Autonomic Symptom Score to determine the frequency of autonomic symptoms in multiple sclerosis patients. Results: One-hundred and three relapsing-remitting multiple sclerosis patients -median age 41 years, median disease duration 6 years, median EDSS score 1 -and 80 healthy subjects were included. Alterations in autonomic function were reported in 97.1% of the cases, with statistical significance in orthostatic intolerance and gastrointestinal domain scores....

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Section: Discussionmentioning

confidence: 77%

Prevalence of Autonomic Dysfunction in Patients with Multiple Sclerosis

et al. 2015

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“…Jacobsen [6] showed that the functions are well preserved in patients with normal visual acuity. In the study by Pozzessere et al [13] pupillary abnormalities were demonstrated in 25% of the 36 MS patients with mean EDSS of 1.6. They concluded that the reduction in parasympathetic tone, together with a relative increase of sympathetic dilator tone, results from a non-specific involvement of central pathways serving the activity of the pupil.…”

Section: Discussionmentioning

confidence: 94%

Pupillary function in early multiple sclerosis

et al. 2008

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Autonomic pupillary function was assessed with pupillometry in 95 mildly or moderately disabled patients with multiple sclerosis (MS) and 81 healthy subjects. The parasympathetic pupillary function was measured as initial diameter (mm), time to minimum diameter (seconds), reflex amplitude (mm), relative reflex amplitude (%), and maximal constriction velocity (mm/seconds). To reflect the sympathetic pupillary function maximal redilatation velocity (mm/seconds), and time of 75% of redilatation (seconds) were measured. Of MS patients 85-99% were within the reference values of healthy subjects. In MS patients the effect of age was observed in the initial diameter, reflex amplitude, and time of 75% redilatation. There were no such age related effects in healthy subjects. In age adjusted analysis the initial diameter and time of 75% redilatation differed significantly from healthy controls. Autonomic pupillary functions were not associated with fatigue, visual defect, or bladder disturbance, as measured by Fatigue Severity Scale, Kurtzke's Functional System Scales, Expanded Disability Status Scale, or the Multiple Sclerosis Functional Composite. Our results suggest that both parasympathetic and sympathetic pupillary functions are disturbed already early in the course of MS. However, the disturbance is not severe at this stage of the disease. The dysfunction is age-dependent and thus possibly related to the dimished remyelination capacity of the central nervous system.

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“…MS is a well-known chronic inflammatory demyelinating disorder of the central nervous system and may be accompanied by clinical symptoms of autonomic dysfunction including impaired secretory functions, sexual impotence,and impaired sphincter control and pupillary dilatation [3,19]. Relapsing-remitting form of MS often causes disturbances of autonomic nervous system.In addition, frequently observed autonomic nervous system disturbances include bladder, bowel, sphincters, sexual dysfunction and sweating; cardiovascular rhythm disturbances (usually atrial fibrillation) have been observed in acute relapses of MS [4,10,21].…”

Section: Discussionmentioning

confidence: 99%

“…Autonomic involvement may become manifest by pupillary, bowel, bladder, sweating, and sexual problems [3,19]. Cardiovascular reflexes are also known to be abnormal in MS patients [1,17,18].Abnormalities in heart rate variability and autonomic regulation in this population suggest that a significant number of MS patients show evidence of autonomic dysfunction during both baseline and exercise conditions [1,17,18,22].…”

Section: Introductionmentioning

confidence: 98%