Longitudinal Follow-Up Of CardioVascular Reflex Tests In Multiple Sclerosis
Nasseri K, TenVoorde BJ, Ader HJ, Uitdehaag BM, Polman CH
J Neurol Sci 1998 Feb 18;155(1):50-4
Free Univ Hospital, Dept of Neurology, Amsterdam, The Netherlands
PMID# 9562322; UI# 98220791
Several studies have shown various degrees of Autonomic Dysfunction in patients with Multiple Sclerosis. Longitudinal follow-up studies are remarkably scarce up to now.
We assessed Autonomic Dysfunction twice with an interval of 1 year in 20 Relapsing/Remitting and 26 Secondary/Progressive MS-patients.
Autonomic function was assessed by the Heart rate response during deep breathing, standing up and Valsalva manoeuvre.
Only the maximum change in Heart rate after standing up (in ms and beats/min) and the Max/Min ratio after standing up showed significant worsening over 1 year.
The changes in EDSS scores also documented gradual deterioration of the neurological condition over the study period.
We conclude that there is progression of Autonomic Dysfunction in MS over 1 year and that this could correlate with progression in clinical disability.
CardioVascular Autonomic Function
In Multiple Sclerosis
Anema JR, Heijenbrok MW, Faes TJ, Heimans JJ, Lanting P, Polman CH
J Neurol Sci 1991 Aug;104(2):129-34
Free Univ Hospital, Dept of Neurology, Amsterdam, The Netherlands
PMID# 1940968; UI# 92044608
In this study blood pressure (BP) and Heart rate (HR) responses to standing and HR responses to deep breathing were assessed in 34 patients with Clinically Definite Multiple Sclerosis (MS) and 63 healthy subjects.
Normal ranges, which were clearly age related for both HR responses, were obtained. The BP response to standing was abnormal in 13% of the MS patients, these patients demonstrating significant postural hypotension.
The HR response to standing was abnormal in 28% of the MS patients, with a normal initial increase in Heart rate and a significantly reduced reflex Bradycardia.
On deep breathing 36% of MS patients showed abnormal HR changes.
The resting HR did not differ between both groups. Abnormalities of one or more tests were found in 53% of the MS patients.
No relationship was found between abnormal CardioVascular Autonomic responses and the symptoms, duration, severity and progression of the disease.
Based on clinical and Magnetic Resonance Imaging findings, no indications were found for localization of the Autonomic disturbances in the BrainStem.
It is suggested that at least a part of the CardioVascular Autonomic lesions in MS is located outside the BrainStem, i.e. in SupraMedullary Reflex Pathways or in the Spinal Cord.
Cardiac Autonomic Function During Sleep
And Wakefulness In Multiple Sclerosis
Ferini-Strambi L, Rovaris M, Oldani A, Martinelli V, Filippi M, Smirne S, Zucconi M, Comi G
J Neurol 1995 Oct;242(10):639-43
State University, Dept of Neurology, Milan, Italy
PMID# 8568524; UI# 96122570
Some studies in Multiple Sclerosis (MS) patients have shown evidence of Autonomic Dysfunction involving the CardioVascular System.
However, the findings in these studies have not been completely consistent. The discrepancy may be related to the limits of the traditional Autonomic tests during wakefulness.
In our study, after the investigation of the CardioVascular reflexes during wakefulness, Heart rate (HR) variations were considered during sleep in order to avoid the limits of cooperation and the emotional state of the patient.
We evaluated tonic (vagal activity) HR modifications in relation to the deepening of sleep, as well as phasic (Sympathetic activity) HR modifications in relation to spontaneous body movements during sleep, in 25 MS patients and 25 age-matched controls.
No difference was found between the two groups in Autonomic function during wakefulness.
A reduced ParaSympathetic activity was observed in MS subjects during both Rapid Eye Movement (REM) and non-REM sleep, while no difference was found in Sympathetic function between patients and controls.
No significant correlation was found between cardiac Autonomic data during sleep and MRI lesion load in the InfraTentorial areas and, in particular, of the BrainStem.
The findings of our study suggest that Autonomic Nervous System evaluation during sleep could show impairment earlier than the traditional Autonomic tests during wakefulness.
Cardiac Autonomic Dysfunction In Relapsing/Remitting Multiple Sclerosis During A Stable Phase
Giubilei F, Vitale A, Urani C, Frontoni M, Fiorini M, Millefiorini E, Fiorelli M, Santini M, Strano S
Eur Neurol 1996;36(4):211-4
UnivLa Sapienza, Dept of Neurological Sciences, Rome, Italy
PMID# 8814423; UI# 96409441
The Autonomic CardioVascular System was studied by means of Autonomic tests and Heart rate variability related to body movements during sleep, in 20 patients with Relapsing/Remitting Multiple Sclerosis in a stable phase and in 9 normal subjects.
Responses to Autonomic tests in Multiple Sclerosis and control subjects were similar. Heart rate variability, instead, showed a lower degree of adaptability in patients with Multiple Sclerosis than in controls during sleep, because of Sympathetic System Dysfunction.
No significant correlation between Magnetic Resonance lesions and CardioVascular sleep indexes was found.
NeuroPeptide Y Plasma Levels And Serum Dopamine-ß-Hydroxylase Activity In MS Patients With And Without Abnormal CardioVascular Reflexes
Gallai V, Sarchielli P, Firenze C, Trequattrini A, Paciaroni M, Usai F, Franceschini M, Palumbo R
Acta Neurol Belg 1994;94(1):44-52
Univ of Perugia, Dept of Clinical Neurology and Psychiatry, Italy
PMID# 8140886; UI# 94189264
An impairment in the Autonomic function has been demonstrated in patients with Multiple Sclerosis (MS) using ElectroPhysiological, Pupillary and BioChemical tests.
Particularly evident were alterations in the CardioVascular reflexes, Cutaneous Sympathetic response and LymphoMonocyte Adrenergic binding. Electrophysiological and biochemical findings in MS patients have only occasionally been compared.
Among the peripheral markers of the Autonomic system, NeuroPeptide Y (NPY) and Dopamine-ß-Hydroxylase (DBH) have been singled out as reliable indices of Sympathetic function.
The former is a Peptide with a strong VasoConstrictive action, which is released from Adrenergic endings together with NorAdrenaline following Sympathetic activation.
The latter is the Enzyme which catalyses the conversion of Dopamine to NorEpinephrine. It is located both in Sympathetic Endings and the Chromaffin granules of Adrenal Medulla.
To verify a failure in Autonomic function in the course of MS, a battery of CardioVascular tests (assessing Sympathetic and ParaSympathetic functions) was performed on 25 MS patients.
The results were compared with a group of 20 age- and sex-matched control individuals. The Plasma levels of NPY and the Serum DBH activity were also determined in both groups.
52% of patients showed an impairment in Sympathetic function in one or more tests (sustained handgrip, Postural Hypotension, cold face test).
48% of the patients had abnormal values in deep breathing test, indicating a failure of the ParaSympathetic function.
44% of patients showed also a Paroxysmal Tachycardia after cold face test, indicating an abnormal function of the Vagal-Cardiac and Sympathetic-Vascular Smooth Muscle pathways of the Trigeminal Nerve.