Cardiovascular autonomic dysfunction in multiple sclerosis is likely related to brainstem lesions

Impairment of cardiovascular autonomic reflexes has been described in multiple sclerosis (MS), and believed reflecting dysfunction of reflex pathways located within the central nervous system. A battery of cardiovascular autonomic tests were performed in 40 patients with definite MS: R-R interval variation test, deep breathing, Valsalva manoeuvre, blood pressure and heart rate responses to standing, sustained handgrip. The results were evaluated by Bayesian analysis, a pattern recognition technique. The patients had also magnetic resonance imaging (MRI) of brain and in 19 subjects of cervical spinal cord. Deep breathing test and sustained handgrip test produced most frequently abnormal results (17.5% and 40%, respectively). However, only 4 patients (10% had two or more tests abnormal, with a very variable pattern. Evaluation by Bayesian analysis revealed 7 patients (17.5%) with definite autonomic dysfunction. A correlation was found between the confidence level obtained by Bayesian analysis, as index of autonomic function, and the Kurtzke brainstem FS score (r = 0.43, P < 0.01). There was a significant association between presence of autonomic dysfunction and clinical (P < 0.02) and MRI (P < 0.005) evidence of brainstem lesions.