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Brainstem dysfunction protects against syncope in multiple sclerosis.

Mario Habek1, Magdalena Krbot Skorić2, Luka Crnošija3

  • 1School 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.

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Summary
This summary is machine-generated.

Autonomic dysfunction in multiple sclerosis (MS) is linked to brainstem function. Lower vestibular evoked myogenic potential (VEMP) scores predict syncope, while orthostatic hypotension may relate to brainstem dysfunction.

Keywords:
Autonomic nervous systemBrainstemClinically isolated syndromeMultiple sclerosisOrthostatic hypotensionSyncope

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Area of Science:

  • Neurology
  • Neuroscience
  • Autonomic Medicine

Background:

  • Autonomic dysfunction is common in multiple sclerosis (MS).
  • Brainstem dysfunction is a potential contributor to autonomic symptoms in MS.
  • Vestibular evoked myogenic potentials (VEMP) offer a measure of brainstem function.

Purpose of the Study:

  • To explore the relationship between autonomic dysfunction in MS and brainstem dysfunction.
  • To correlate VEMP scores and MRI findings with autonomic parameters in clinically isolated syndrome (CIS) suggestive of MS.

Main Methods:

  • Forty-five CIS patients underwent VEMP testing, autonomic function tests (Valsalva maneuver, deep breathing, tilt table test), and brain/spinal cord MRI.
  • Autonomic parameters assessed included sympathetic and parasympathetic function, syncope, and orthostatic hypotension (OH).

Main Results:

  • No significant difference in VEMP scores was found between patients with or without sympathetic/parasympathetic dysfunction.
  • Patients experiencing syncope had significantly lower VEMP scores (p<0.01).
  • A trend suggested higher VEMP scores in patients with OH (p=0.06).
  • No correlation was observed between autonomic parameters and brainstem or cervical spinal cord lesions on MRI.
  • A model combining VEMP score ≤5 and normal midbrain/cervical spine MRI predicted syncope development with 83% sensitivity and specificity.

Conclusions:

  • Functional and structural autonomic nervous system disorders in MS have distinct pathophysiological mechanisms.
  • Preserved brainstem function appears necessary for syncope development in MS.
  • Orthostatic hypotension in MS may be associated with underlying brainstem dysfunction.