CardioVascular Dysfunction In Multiple Sclerosis
Acevedo AR, Nava C, Arriada N, Violante A, Corona T
Acta Neurol Scand 2000 Feb;101(2):85-8
Instituto Nacional de Neurologia y Neurocirugia MVS Mexico City, Mexico City, Mexico
PMID# 10685853; UI# 20148289
CardioVascular Dysfunction (CD) in Multiple Sclerosis (MS) is related to involvement of reflex pathways in the BrainStem.
The battery of CD tests was applied to a group of 40 healthy subjects and 40 patients with MS, divided in 2 subgroups according to the Expanded Disability Status Scale (EDSS).
The tests included:
- Postural blood pressure changes
- Postural Heart Rate changes
- Heart Rate changes on inspiration/forced expiration
- ECG R-R interval measurement on the Valsalva maneuver
Both groups were subjected to the functional independence scale (FIM). Imaging studies were reviewed and Autonomic Dysfunction at other levels was explored.
The results showed a statistically significant difference (P < 0.05) in all tests when comparing patients to controls.
Tests 1 and 4 had the highest significance, with findings of more severe involvement in patients with a higher EDSS and lower FIM. A correlation was also found between CD and BrainStem lesions on MRI (P < 0.01).
A significant number of MS patients had evidence of CD. Test 1 may be considered a simple marker, in daily clinical practice, to detect subclinical CD. Subclinical CD is a cause of disability in this group of patients.
CardioVascular Autonomic Function In Patients With Relapsing/Remitting Multiple Sclerosis
A new surrogate marker of disease evolution?
Nasseri K, Uitdehaag BM, van Walderveen MA, Ader HJ, Polman CH
Eur J Neurol 1999 Jan;6(1):29-33
Free Univ Hospital, Dept of Neurology, Amsterdam, The Netherlands
PMID# 10209346; UI# 20284200
Twenty patients with active Relapsing/Remitting Multiple Sclerosis (MS) were examined annually for 2 years with a set of Autonomic Function Tests (AFT) consisting of Heart Rate Variability during deep breathing (IE), standing-up, and Ratios of Valsalva manoeuvre (VR).
Disease characteristics, including T2-weighted Magnetic Resonance Imaging (MRI) of the Brain and the Expanded Disability Status Scale (EDSS) score were documented each year within 1 week of the AFT.
The EDSS score, MRI load lesion and VR did not change significantly over the follow-up period.
The IE and initial Heart Rate on standing during the first 30 s (DeltaHRMAX) showed significant worsening during follow-up. No relationship was found between deterioration of AFT and EDSS score, number of exacerbations, duration of disease, gender, age, size and number of lesions on MRI.
We conclude that patients with active Relapsing/Remitting MS show progression of Autonomic Dysfunction over a relatively short time.
Therefore, in the absence of changes in clinical disability or Brain MRI lesion load, AFT might be useful as a sensitive surrogate outcome measure for demonstrating subclinical change in MS.
Copyright 1999 Lippincott Williams & Wilkins
Sexual Dysfunction In Multiple Sclerosis
II. Correlation Analysis
Zivadinov R, Zorzon M, Bosco A, Bragadin LM, Moretti R, Bonfigli L, Iona LG, Cazzato G
Mult Scler 1999 Dec;5(6):428-31
Univ of Trieste, Clinical Neurology, Trieste, Italy
PMID# 10618700; UI# 20087451
Sexual Dysfunction affects a large part of patients suffering from Multiple Sclerosis, but some aspects of its clinical presentation and Etiology are not clearly defined yet.
In an unselected sample of 108 patients with definite Multiple Sclerosis we investigated the relationship between symptoms of Sexual Dysfunctioning and Sphincteric Dysfunction, patients' and disease characteristics, Disability and Neurological Impairment, Psychological and Cognitive functioning.
Sexual Dysfunction directly correlated with presence of:
- Physical Disorders (r=0.37, P=0.0004)
- Low Educational Level (r=0.32, P<0.002)
- Disability (r=0.31, P<0.003)
- Age at Onset of symptoms (r=0.30, P<0.003)
- Sphincteric Dysfunction (r=0.30, P<0.003)
- Age (r=0.30, P<0.004)
- Depression (r=0.29, P<0.005)
- Fatigue (r=0.29, P=0.005)
- Cognitive Deterioration (r=0.26, P<0.01)
- Primary/Progressive Disease (r=0.25, P<0.02)
- Neurological Impairment (r=0.25, P<0.02)
- Marriage (r=0.24, P<0.02)
- Anxiety (r=0. 23, P<0.03)
- Male Gender (r=0.22, P=0.03)
- Bladder Dysfunction (r=0. 29, P<0.04)
- Unemployment (r=0.21, P<0.04).
Sexual Dysfunction correlated inversely with Relapsing/Remitting course of disease (r=-0.31, P<0.002).
No correlation was found between Sexual Dysfunction and Bowel Dysfunction, duration of disease, Secondary/Progressive course of disease, number and frequency of sexual intercourses in the last year, number of partners, number of exacerbations in the last year, number of months since last exacerbation, masturbation, and fertility.
In conclusion, the association between Sexual Dysfunction and Sphincteric Dysfunction indicates a common Etiology corresponding to the frequent involvement of the Spinal Cord in Multiple Sclerosis.
But the concomitant correlation between Sexual Dysfunction and other variables suggests the possible aetiological role of Physical, Psychological and Sociological factors as well.