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Published on: January 29, 2016
Sudomotor dysfunction in multiple sclerosis: A systematic review and meta-analysis
Mašan Sredanović1, Magdalena Krbot Skorić2, Hana Rakuša3
1University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.
Objective:
To estimate the prevalence of sudomotor dysfunction in multiple sclerosis (MS), compare subjective and objective assessments, and evaluate differences versus healthy controls and between relapsing-remitting MS (RRMS) and progressive MS (PMS).
Methods:
PubMed, Scopus, and Web of Science were searched from inception through June 9, 2026, for studies reporting sudomotor dysfunction in adults with MS using history/questionnaires or objective testing. Random-effects models pooled prevalence estimates and odds ratios (ORs) with 95% confidence intervals (CIs). Risk of bias was assessed using Joanna Briggs Institute tools, and certainty of evidence for objective prevalence using an adapted Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results:
Twenty-seven studies including 1317 people with MS were included. Pooled prevalence was 33.0% (95% CI 28.0-38.4%; I²=0%) by history/questionnaire and 35.0% (95% CI 29.0-41.5%; I²=77.1%) by objective testing. Absent sympathetic skin response had a pooled prevalence of 33.6% (95% CI 26.1-42.1%) and was more frequent in MS than in healthy controls (160/461 vs 0/342; OR 24.13, 95% CI 10.71-54.39; I²=0%). Objective dysfunction was more frequent in PMS than RRMS (60/104 vs 35/104; OR 3.12, 95% CI 1.71-5.68; I²=0%). Certainty of evidence for objective prevalence was very low.
Conclusions:
Sudomotor dysfunction affects approximately one-third of people with MS, is substantially more frequent than in healthy controls, and appears more common in progressive disease. Standardized, multimodal, longitudinal studies are needed to refine prevalence estimates and clarify underlying mechanisms.
