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Published on: March 4, 2014
[Autonomic dysfunction in patients with multiple sclerosis]
A R Rakhmatullin1, K Z Bakhtiiarova1, R V Magzhanov2
1Bashkir State Medical University, Ufa, Russia; Republic Clinical Hospital, Ufa, Russia.
Aim:
To optimize the early diagnosis of the autonomic dysfunction in patients with MS.
Material And Methods:
The main group consisted of 46 patients: 15 men and 31 women with MS (McDonald, 2005), the average age was 33.35±9.9 years, the average score of the Expanded disability scale (EDSS) was 2.8±1.17 points. The control group consisted of 24 healthy subjects matched by age and sex with the main group. A study of the autonomic nervous system was carried out using the Scheme for detection of signs of autonomic disorders (A.M. Vein, 1998) and analysis of heart rate variability (HRV) at rest and after active orthostatic test (AOT).
Results:
Autonomic dysfunction was found in 73% of the patients. The overall score of the Scheme was significantly higher in MS patients (31.32±9.43 points) compared to the comparison group (2.36±4.39 points, p<0.05). According to HRV, the contribution of brainstem autonomic centers in the regulation of stress-response during AOP was significantly reduced (p<0.05) and was characterized by the lack of activation of the sympathetic division of the ANS. In patients with MS, cerebral influences were dominating on HRV baseline records, evaluated by the domination of the VLF component in the spectrum. During AOP, VLF was almost leveled in both groups, and the VLF changes in patients before and after the AOP reached statistical significance (p<0.05).
Conclusion:
The use of the Scheme is preferable in outpatient clinics to screen the large numbers of patients with MS, and then selected patients could be referred to the instrumental methods of investigation.
Insights
Early diagnosis of autonomic dysfunction in multiple sclerosis (MS) is crucial. A screening scheme combined with heart rate variability (HRV) analysis effectively identifies autonomic nervous system (ANS) disorders in MS patients.
Area of Science:
- Neurology
- Autonomic Neuroscience
- Medical Diagnostics
Background:
- Autonomic dysfunction is a common complication in multiple sclerosis (MS).
- Early and accurate diagnosis of autonomic nervous system (ANS) disorders is essential for managing MS patients.
- Current diagnostic methods may not be optimal for widespread screening in MS populations.
Purpose of the Study:
- To optimize the early diagnosis of autonomic dysfunction in patients with multiple sclerosis (MS).
- To evaluate the utility of a specific screening scheme and heart rate variability (HRV) analysis for detecting ANS disorders in MS.
Main Methods:
- Study included 46 MS patients (mean age 33.35±9.9 years, EDSS 2.8±1.17) and 24 healthy controls.
- Autonomic nervous system function was assessed using the Scheme for detection of signs of autonomic disorders and heart rate variability (HRV) analysis.
- HRV was measured at rest and during an active orthostatic test (AOT).
Main Results:
- Autonomic dysfunction was identified in 73% of MS patients.
- MS patients showed significantly higher scores on the screening scheme compared to controls (31.32±9.43 vs. 2.36±4.39, p<0.05).
- HRV analysis revealed reduced brainstem autonomic center contribution during AOT and sympathetic nervous system underactivation in MS patients. Cerebral influences dominated baseline HRV in MS patients.
Conclusions:
- The screening scheme is a valuable tool for outpatient clinics to efficiently screen large numbers of MS patients for autonomic dysfunction.
- Patients identified through screening can be further evaluated using instrumental diagnostic methods.
- Combined use of screening and HRV analysis aids in early detection and characterization of autonomic disorders in MS.
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