Cardiovascular autonomic dysfunction in neuromyelitis optica spectrum disorder and multiple sclerosis in Thai...

Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are central demyelinating diseases with overlapping features but distinct cardiovascular autonomic dysfunction profiles. However, the specific patterns in Asian populations remain underexplored. We aimed to compare clinical and laboratory profiles of Thai NMOSD and MS patients, focusing on cardiovascular autonomic dysfunction and its associated factors.

In this single-center, cross-sectional study, we included patients with NMOSD and MS diagnosed by standardized criteria. Demographic data, clinical syndrome, laboratory, and Expanded Disability Status Scale (EDSS) were collected. The primary outcome was autonomic dysfunction, assessed using cardiovascular autonomic dysfunction (CAD) score and subjective autonomic symptom burden (COMPASS-31). Quality of life was studies using the fatigue severity scale (FSS).

Twenty NMOSD and twenty MS patients were enrolled (mean age 49.7±13.6, 95 % female). CAD was more prevalent in NMOSD patients, with significantly higher CAD scores (2.0 [1.0, 3.0] vs. 1.0 [0.0, 1.5], P = 0.001) and COMPASS-31 scores (12.6 [9.7, 24.4] vs. 7.4 [4.0, 9.0], P < 0.001). NMOSD patients had significantly greater adrenergic dysfunction but not cardiovagal dysfunction compared to MS patients (80.0% vs. 20.0 %, P < 0.001, and 65.0 % vs. 40.0 %, P = 0.21, respectively). Baseline EDSS and cervical cord lesion were independent factors associated with CAD (adjusted odds ratio 3.2, 95 % confidence interval 1.2-8.6, P = 0.03, and 3.4, 1.8-6.4, P = 0.02, respectively).

Thai NMOSD patients exhibited more pronounced subjective and objective CAD compared to MS patients. Cardiovascular monitoring should be prioritized in NMOSD patients with higher disability and cervical myelopathy.