Sympathetic cardiovascular and sudomotor functions are frequently affected in early multiple sclerosis

Habek, Mario; Crnošija, Luka; Lovrić, Mila; Junaković, Anamari; Skorić, Magdalena Krbot; Adamec, Ivan

doi:10.1007/s10286-016-0370-x

Cited by 51 publications

(41 citation statements)

References 30 publications

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“…Although recent evidences point to a widespread and early involvement of ANS in MS, 2 with sympathetic cardiovascular dysregulation and impaired sudomotor function found even in clinically isolated syndrome patients, 18 available data are far from defining clearly the pattern and evolution of autonomic dysfunction in MS. Here we have shown specific altered patterns of HRV in MS related to different phases of disease.…”

Section: Discussionmentioning

confidence: 99%

Heart rate variability is differentially altered in multiple sclerosis: implications for acute, worsening and progressive disability

Studer

Rocchi

Motta

et al. 2017

Multiple Sclerosis Journal - Experimental, Translational and Cl

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BackgroundSympathovagal imbalance has been associated with poor prognosis in chronic diseases, but there is conflicting evidence in multiple sclerosis.ObjectivesThe objective of this study was to investigate the autonomic nervous system dysfunction correlation with inflammation and progression in multiple sclerosis.MethodsHeart rate variability was analysed in 120 multiple sclerosis patients and 60 healthy controls during supine rest and head-up tilt test; the normalised units of low frequency and high frequency power were considered to assess sympathetic and vagal components, respectively. Correlation analyses with clinical and radiological markers of disease activity and progression were performed.ResultsSympathetic dysfunction was closely related to the progression of disability in multiple sclerosis: progressive patients showed altered heart rate variability with respect to healthy controls and relapsing–remitting patients, with higher rest low frequency power and lacking the expected low frequency power increase during the head-up tilt test. In relapsing–remitting patients, disease activity, even subclinical, was associated with lower rest low frequency power, whereas stable relapsing–remitting patients did not differ from healthy controls. Less sympathetic reactivity and higher low frequency power at rest were associated with incomplete recovery from relapse.ConclusionsAutonomic balance appears to be intimately linked with both the inflammatory activity of multiple sclerosis, which is featured by an overall hypoactivity of the sympathetic nervous system, and its compensatory plastic processes, which appear inefficient in case of worsening and progressive multiple sclerosis.

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Section: Discussionmentioning

confidence: 99%

Heart rate variability is differentially altered in multiple sclerosis: implications for acute, worsening and progressive disability

Studer

Rocchi

Motta

et al. 2017

Multiple Sclerosis Journal - Experimental, Translational and Cl

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“…This view has been highly criticized due to the controversial and uncertain relationship between LF power and sympathetic activity and the nonreciprocal and nonlinear relationship between sympathetic and parasympathetic activity [5, 11, 15]. However, a number of recently published studies still rely on the use of LF/HF as an indicator of sympathovagal balance [7, 8, 22-24, 27-29]. In fact, a recent review by Laborde et al [5] indicated that 65% of HRV studies are still basing their conclusions on the LF/HF.…”

Section: Introductionmentioning

confidence: 99%

Validity of Commonly Used Heart Rate Variability Markers of Autonomic Nervous System Function

et al. 2019

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Background: Despite strong reservations regarding the validity of a number of heart rate variability (HRV) measures, these are still being used in recent studies. Aims: We aimed to compare the reactivity of ostensible sympathetic HRV markers (low and very low frequency [LF and VLF]) to that of electrodermal activity (EDA), an exclusively sympathetic marker, in response to cognitive and orthostatic stress, investigate the possibility of LF as a vagal-mediated marker of baroreflex modulation, and compare the ability of HRV markers of parasympathetic function (root mean square of successive differences [RMSSD] and high frequency [HF]) to quantify vagal reactivity to cognitive and orthostatic stress. Results: None of the purported sympathetic HRV markers displayed a reactivity that correlated with electrodermal reactivity. LF (ms²) reactivity correlated with the reactivity of both RMSSD and HF during baroreflex modulation. RMSSD and HF indexed the reactivity of the parasympathetic nervous system under conditions of normal breathing; however, RMSSD performed better as a marker of vagal activity when the task required breathing changes. Conclusions: Neither LF (in ms² or normalized units [nu]) nor VLF represent cardiac sympathetic modulation of the heart. LF (ms²) may reflect vagally mediated baroreflex cardiac effects. HRV linear analysis therefore appears to be restricted to the determination of vagal influences on heart rate. With regard to HRV parasympathetic markers, this study supports the suggestion that HRV frequency domain analyses, such as HF, should not be used as an index of vagal activity in study tasks where verbal responses are required, as these responses may induce respiratory changes great enough to distort HF power.

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“…As the cervical spinal cord is an anatomical center of the sympathetic nervous system, different MRI measures have been used to try to correlate spinal cord damage and ANS abnormalities. Cervical spinal cord lesions on the MRI were not associated with ANS dysfunction in a large cohort on pwCIS , whereas spinal cord atrophy correlated with ANS dysfunction in a heterogeneous population of pwMS , indicating that the way in which we measure spinal cord damage may be responsible for observed differences. Furthermore, in people with neuromyelitis optica spectrum disorder, in whom, unlike in pwMS, disability is totally dependent on the central nervous system locations of lesions, severe sympathetic dysfunction has been associated with spinal cord and/or brainstem lesions , which could explain the lack of association between spinal cord lesion in MS and worsening of ANS dysfunction.…”

Section: Discussionmentioning

confidence: 84%

“…MS usually begins with a first clinical episode called the clinically isolated syndrome (CIS), which usually occurs in young adults and affects the optic nerves, brainstem or spinal cord, the latter two being anatomically responsible for the majority of ANS functions . In line with this, the ANS can frequently be involved in people with CIS (pwCIS) and MS (pwMS) . However, one of the unanswered questions is what happens with ANS functions during the disease course.…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal assessment of autonomic nervous system in patients with first demyelinating event suggestive of multiple sclerosis

Habek

Crnošija

Gabelić

et al. 2019

Euro J of Neurology

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Background and purpose As a high proportion of people with clinically isolated syndrome (pwCIS) exhibit sympathetic adrenergic and sudomotor dysfunction, the aim of this study was to investigate the evolution of autonomic nervous system (ANS) abnormalities in pwCIS over a 2‐year follow‐up. Methods This was a prospective cohort study in which 121 pwCIS were enrolled and followed for 2 years. After 2‐year follow‐up, data were available for 84 pwCIS. ANS symptoms were evaluated with the Composite Autonomic System Score‐31 (COMPASS‐31) and results of the ANS tests were expressed using the Composite Autonomic Scoring Scale (CASS) at baseline and visit at month 24. Symptomatic dysautonomia was defined if the patient had a COMPASS‐31 value above the median of the whole cohort at baseline evaluation (COMPASS‐31 > 6.79) and CASS score >0. Results Complete CASS data at baseline and month 24 were available for 62 patients; in 24 (38.7%) patients there was worsening, in 16 (25.8%) there was improvement and in 22 (35.5%) there was no change in CASS score. In 90% of pwCIS (72 of 80) there was no change in parasympathetic nervous system tests, whereas 47.3% (35 of 74) had either worsening or improvement in sympathetic adrenergic and 28.6% (20 of 70) had either worsening or improvement in sudomotor function. A multivariable regression model identified the total number of T2 lesions as an independent predictor for worsening of symptomatic dysautonomia. No predictors for worsening or improving of CASS score were identified. Conclusion A substantial proportion of pwCIS experienced worsening of ANS abnormalities during the 2‐year follow‐up and magnetic resonance imaging parameters seemed to predict these abnormalities.

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Sympathetic cardiovascular and sudomotor functions are frequently affected in early multiple sclerosis

Abstract: Autonomic (primarily sympathetic) dysfunction is present in a large proportion of early MS patients and it seems to be related to brainstem involvement.

Cited by 51 publications

References 30 publications

Heart rate variability is differentially altered in multiple sclerosis: implications for acute, worsening and progressive disability

Heart rate variability is differentially altered in multiple sclerosis: implications for acute, worsening and progressive disability

Validity of Commonly Used Heart Rate Variability Markers of Autonomic Nervous System Function

Longitudinal assessment of autonomic nervous system in patients with first demyelinating event suggestive of multiple sclerosis

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