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Cardiovascular autonomic function in multiple sclerosis.

J R Anema1, M W Heijenbrok, T J Faes

  • 1Department of Neurology, Free University Hospital, Amsterdam, The Netherlands.

Journal of the Neurological Sciences
|August 1, 1991
PubMed
Summary
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Cardiovascular autonomic dysfunction is common in multiple sclerosis (MS), affecting over half of patients. These autonomic abnormalities, including postural hypotension and abnormal heart rate responses, may originate outside the brainstem.

Area of Science:

  • Neurology
  • Cardiology
  • Autonomic Nervous System

Background:

  • Multiple sclerosis (MS) is a chronic demyelinating disease affecting the central nervous system.
  • Cardiovascular autonomic dysfunction is a recognized complication of MS, impacting patient quality of life.
  • Previous studies suggest autonomic dysfunction in MS, but localization of lesions remains debated.

Purpose of the Study:

  • To assess blood pressure (BP) and heart rate (HR) autonomic responses to postural change and deep breathing in multiple sclerosis (MS) patients.
  • To compare cardiovascular autonomic function between MS patients and healthy controls.
  • To investigate potential correlations between autonomic dysfunction and clinical parameters in MS.

Main Methods:

  • Evaluated BP and HR responses to standing and HR responses to deep breathing in 34 MS patients and 63 healthy controls.

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  • Established age-related normal ranges for HR responses.
  • Assessed postural hypotension, abnormal HR response to standing (including reduced reflex bradycardia), and abnormal HR changes during deep breathing.

    • Main Results:

    • Abnormal BP response to standing (postural hypotension) observed in 13% of MS patients.
    • Abnormal HR response to standing occurred in 28% of MS patients, characterized by a blunted initial increase and reduced reflex bradycardia.
    • 36% of MS patients exhibited abnormal HR changes during deep breathing; 53% showed at least one autonomic abnormality.
    • No correlation found between autonomic dysfunction and MS symptoms, duration, severity, or progression.
    • Clinical and MRI findings did not localize autonomic disturbances to the brainstem.

    Conclusions:

    • Significant cardiovascular autonomic dysfunction is prevalent in MS patients.
    • Autonomic lesions in MS may be located outside the brainstem, potentially in supramedullary pathways or the spinal cord.
    • Further research is needed to elucidate the precise anatomical location and clinical implications of autonomic dysfunction in MS.