A Study on the Spectrum of Autonomic Dysfunction in Primary Central Nervous System Demyelinating Disorders in a...

Primary central nervous system (CNS) demyelinating disorders such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and seronegative longitudinally extensive transverse myelitis (LETM) frequently affect the autonomic nervous system (ANS). Comprehensive data across genitourinary, sudomotor, gastrointestinal, and sexual domains remain limited, especially in Southeast Asian populations. This study aimed to explore the spectrum of autonomic dysfunction in patients with primary CNS demyelination.

In this cross-sectional observational study, 90 patients aged 18-60 years with confirmed diagnoses of MS, NMOSD, MOGAD, or LETM were enrolled after applying strict exclusion criteria. Autonomic function was assessed through clinical history, bedside examination, and validated questionnaires, including Composite Autonomic Symptom Score-31 (COMPASS-31), International Index of Erectile Function (IIEF), and Female Sexual Function Index (FSFI).

Of the 90 patients, significant autonomic involvement (COMPASS > 13.6) was present in 42.2%, most pronounced in LETM (69.2%). Urinary retention with overflow incontinence was common. Erectile dysfunction affected 96.8% of men, with severe dysfunction in 41.7% of MS, 66.7% of NMOSD, and 75% of LETM. Female sexual dysfunction was documented in 29.7%-41.7% across subgroups. Orthostatic intolerance, gastrointestinal abnormalities, and pupillomotor disturbances were frequent. LETM patients showed the worst autonomic profile overall.

Autonomic dysfunction is highly prevalent in CNS demyelination, with urinary and sexual dysfunction particularly burdensome in NMOSD and LETM. Parasympathetic dysfunction predominated in MS, whereas sympathetic impairment was equivocally evident in MS and NMOSD. Comprehensive screening of autonomic domains should be integrated into routine care.