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Clin Neurophysiol. 2016 Jan;127(1):864-869. doi: 10.1016/j.clinph.2015.06.010. Epub 2015 Jun 16.

Autonomic dysfunction in clinically isolated syndrome suggestive of multiple sclerosis.

Author information

1
School of Medicine, University of Zagreb, Zagreb, Croatia.
2
University Hospital Center Zagreb, Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia.
3
University Hospital Centre Zagreb, Department of Laboratory Diagnostics, Zagreb, Croatia.
4
University Hospital Center Split, Department of Neurology, Split, Croatia.
5
School of Medicine, University of Zagreb, Zagreb, Croatia; University Hospital Center Zagreb, Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia. Electronic address: mhabek@mef.hr.

Abstract

OBJECTIVES:

The aim of this study was to determine the extent of autonomic dysfunction in patients with clinically isolated syndrome (CIS) by using a standardized battery of autonomic tests in the form of the Composite Autonomic Scoring Scale (CASS).

METHODS:

This was a prospective, cross sectional study which included 24 consecutive patients who were diagnosed with CIS and 17 healthy controls. In all participants, heart rate and blood pressure responses to the Valsalva maneuver, heart rate response to deep breathing and blood pressure response to passive tilt were performed. In 16 patients, Quantitative Sudomotor Axon Reflex Test (QSART) and catecholamine measurement was performed.

RESULTS:

The proportion of CIS patients with pathological adrenergic index was statistically significantly higher compared to healthy controls (12 vs 2, p=0.018), while there was no difference in cardiovagal index between groups. Five patients had a sudomotor index of 1 (in 4 there was hypohydrosis <50% and in 1 persistent foot hyperhidrosis). When combining adrenergic, cardiovagal and sudomotor index into CASS, 8 patients (50%) had evidence of autonomic dysfunction, 7 mild and one moderate.

CONCLUSION:

Sympathetic nervous system is frequently affected in CIS patients.

SIGNIFICANCE:

CASS is able to detect autonomic nervous system dysfunction in CIS patients.

KEYWORDS:

Autonomic dysfunction; Clinically isolated syndrome; Composite Autonomic Scoring Scale

PMID:
26138149
DOI:
10.1016/j.clinph.2015.06.010
[Indexed for MEDLINE]

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