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Related Experiment Videos

Cardiovascular autonomic dysfunction in multiple sclerosis: correlation with orthostatic intolerance.

P Flachenecker1, A Wolf, M Krauser

  • 1Julius-Maximilians-Universität Würzburg. k.reiners@mail.uni-wuerzburg.de

Journal of Neurology
|August 27, 1999
PubMed
Summary

Autonomic dysfunction, specifically orthostatic dizziness in multiple sclerosis (MS), is linked to impaired sympathetic nervous system function. This study found sympathetic vasoconstriction issues contribute to orthostatic intolerance in MS patients.

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Area of Science:

  • Neuroscience
  • Autonomic Nervous System Research
  • Multiple Sclerosis Pathophysiology

Background:

  • Autonomic dysfunction is common in multiple sclerosis (MS), but its specific manifestations and underlying mechanisms, particularly orthostatic dizziness (OD), remain unclear.
  • Existing clinical studies show conflicting data regarding the prevalence and nature of autonomic abnormalities in MS patients.
  • Orthostatic intolerance, including OD, affects a significant portion of MS patients, yet its pathophysiology is poorly understood.

Purpose of the Study:

  • To investigate cardiovascular reflex tests and their association with orthostatic dizziness (OD) in patients with multiple sclerosis (MS).
  • To examine the hypothesis that the sympathetic nervous system is specifically involved in autonomic dysfunction observed in MS patients.
  • To determine if impaired sympathetic vasoconstriction contributes to orthostatic intolerance in MS.

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Main Methods:

  • Studied 40 MS patients (relapsing-remitting and secondary progressive) and 24 healthy volunteers using parasympathetic and sympathetic cardiovascular reflex tests.
  • Assessed heart rate responses to Valsalva maneuver, deep breathing, and postural change, alongside blood pressure responses to postural change and sustained handgrip.
  • Employed spectral analysis of heart rate variability and a standardized questionnaire for orthostatic intolerance symptoms.

Main Results:

  • Abnormal cardiovascular reflex test responses were found in 40% of MS patients versus 17% of controls, indicating significant sympathetic vasomotor system involvement.
  • Orthostatic intolerance was reported by 50% of MS patients, compared to 14% in the control group (P<0.006).
  • Subgroup analysis revealed that orthostatic intolerance in MS patients is associated with impaired sympathetic vasoconstriction.

Conclusions:

  • The sympathetic nervous system, particularly its vasoconstrictor function, plays a crucial role in the autonomic dysfunction observed in multiple sclerosis patients.
  • Impaired sympathetic vasoconstriction is a likely mechanism underlying orthostatic intolerance and dizziness in individuals with MS.
  • These findings highlight the need for targeted assessment and management of sympathetic nervous system dysfunction in MS care.