Impact of autonomic dysfunction on Multiple Sclerosis characteristics: Insights from a Tunisian cohort study

Autonomic nervous system (ANS) dysfunction is frequently reported in people with Multiple Sclerosis (pwMS), although it remains underdiagnosed. Our aim is to evaluate the frequency of ANS dysfunction in pwMS using clinical and electrophysiological assessments and to investigate its relationship with disease characteristics, such as fatigue, as well as its impact on quality of life.

A cross-sectional study was conducted, in the Department of Neurology in Razi University Hospital, including 100 pwMS. The ANS was evaluated via the Composite Autonomic Symptom Score-31 (COMPASS-31) and the neurophysiological study. Fatigue assessment was based on the modified form of the Fatigue Impact Scale (MFIS), while MS quality of life was analyzed using the Sclérose en plaques-59 (SEP-59) questionnaire.

The mean COMPASS-31 was 21.65±14.7, with 93 % of our patients having at least one affected domain. The COMPASS-31 score was significantly correlated to the Expanded Disability Status Scale (r = 0.412). Neurophysiological assessment, performed in 70 cases, confirmed autonomic dysfunction (AD) in 62.8 % of cases. Fatigue was reported in 59 % of cases and was correlated with the COMPASS-31 score (r = 0.529). The SEP-59 quality of life questionnaire showed a strong correlation with the COMPASS-31 score for cognitive functions (r =-0.582).

Our study confirms the high prevalence of AD in pwMS and highlights its correlation with the degree of disability, the presence of fatigue, and its negative impact on patients' quality of life.