Autonomic symptom burden can predict disease activity in early multiple sclerosis

Area of Science:

• Neurology
• Autonomic Nervous System Research
• Multiple Sclerosis Pathophysiology

Background:

• Clinically isolated syndrome (CIS) is the initial presentation of multiple sclerosis.
• Autonomic nervous system (ANS) dysfunction is increasingly recognized in neuroinflammatory conditions.
• The specific role of ANS abnormalities in CIS disease activity and progression requires further elucidation.

Purpose of the Study:

• To investigate the association between autonomic nervous system (ANS) dysfunction and disease activity (relapses, new MRI lesions) in people with clinically isolated syndrome (pwCIS).
• To determine if ANS abnormalities predict disease progression in pwCIS.

Main Methods:

• Prospective study of 121 pwCIS, with follow-up data available for 94.
• Baseline assessments included MRI, Composite Autonomic System Score-31 (COMPASS-31), and catecholamine levels (epinephrine, norepinephrine).
• Statistical analyses included univariable and multivariable logistic regression, Kaplan-Meier survival analysis, and Cox regression.

Main Results:

• A COMPASS-31 score > 7.32, >3 T2 lesions, and decreasing supine epinephrine levels were predictors of new relapses.
• Patients with COMPASS-31 > 7.32 had a significantly lower probability of remaining relapse-free (p=0.013).
• Multivariable analysis confirmed COMPASS-31 > 7.32 and T2 lesions increased relapse likelihood, while increasing epinephrine reduced it. Cox regression showed a 2.7 times higher hazard for relapse in those with COMPASS-31 > 7.32.

Conclusions:

• Autonomic nervous system (ANS) dysfunction is a significant contributor to disease activity in people with clinically isolated syndrome (pwCIS).
• COMPASS-31 score serves as a potential biomarker for predicting relapse risk in pwCIS.
• Targeting ANS dysfunction may represent a novel therapeutic strategy for managing early MS.