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Cardiovascular autonomic dysfunction in multiple sclerosis: a meta-analysis.

Juan Manuel Racosta1, Luciano A Sposato1, Sarah A Morrow1

  • 1Department of Clinical Neurological Sciences, London Health Sciences Centre. Western, University, London, ON, Canada.

Multiple Sclerosis and Related Disorders
|March 20, 2015
PubMed
Summary

Defining cardiovascular autonomic dysfunction in multiple sclerosis (MS) is debated. Using one abnormal test diagnosed 42.1% of MS patients, while two abnormal tests diagnosed 18.8%.

Keywords:
Autonomic dysfunctionAutonomic nervous systemDiagnosisMultiple sclerosis

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Area of Science:

  • Neurology
  • Cardiology
  • Autonomic Nervous System

Background:

  • The definition and prevalence of cardiovascular autonomic dysfunction in multiple sclerosis (MS) patients remain unclear.
  • Existing diagnostic criteria for cardiovascular dysautonomia in MS lack consensus.

Purpose of the Study:

  • To systematically review and compare the proportion of MS patients diagnosed with cardiovascular dysautonomia using two different definitions.
  • To evaluate the impact of diagnostic criteria on the estimated prevalence of autonomic dysfunction in MS.

Main Methods:

  • A systematic review and meta-analysis of studies published from 1980 to 2013.
  • Searched PubMed, Embase, and Scopus for publications on autonomic tests in MS patients.
  • Calculated the proportion of patients diagnosed with autonomic dysfunction using definitions of at least one abnormal test versus at least two abnormal tests.

Main Results:

  • Included 16 studies with 611 MS patients assessing at least three cardiovascular autonomic tests.
  • The proportion of MS patients diagnosed with autonomic dysfunction was significantly higher (42.1%) when using the definition of at least one abnormal test compared to at least two abnormal tests (18.8%).
  • A two-fold difference in prevalence was observed based on the diagnostic threshold used (p=0.006).

Conclusions:

  • A significant variation exists in diagnosing cardiovascular dysautonomia in MS patients depending on the definition used.
  • Consensus is required to establish a standardized definition for autonomic dysfunction in MS.
  • Researchers are encouraged to report autonomic dysfunction prevalence using both one and two abnormal test criteria.