Contributions
Abstract: EP1385
Type: ePoster
Abstract Category: Clinical aspects of MS - Clinical assessment tools
Background: The aim was to determine the extent of autonomic dysfunction in patients with clinically isolated syndrome (CIS) and to correlate autonomic dysfunction with MRI lesions.
Methods: This was a prospective, cohort study, which included 104 consecutive CIS patients (31 males, mean 32.2 years). Standard battery of autonomic tests (i.e. Valsalva maneuver, deep breathing test, tilt-up table test, and quantitative sudomotor axon reflex test(QSART)) was performed, and results were interpreted in form of composite autonomic severity score(CASS). Three patients could not perform Valsalva maneuver, and in 9 patients QSART was not performed due to technical issues. Heart rate variability (HRV) analysis was performed for supine (s-) and tilted phase (t-) of testing in 103 patients. HF and HFnu were used as indices of vagal activity, LF as an index of sympathetic activity, LF/HF as a marker of sympathovagal balance, and SDNN as an indicator of overall HRV. MRI was analyzed for presence of brainstem and/or cervical spinal cord lesions.
Results: Thirty-two patients presented with optic neuritis, 32 with incomplete transverse myelitis, 27 with brainstem/cerebellar (BS) symptomatology, 10 with hemispheral symptoms and 3 with multifocal type of CIS. BS lesions were present in 42 patients, and 41 patients had cervical spinal cord lesions. Abnormal adrenergic, cardiovagal and sudomotor index of the CASS were present in 43 (42.6%), 5 (5.0%) and 31 (32.6%) patients, respectively. Median (range) of the adrenergic, cardiovagal and sudomotor index of the CASS was 0 (0-3), 0 (0-1) and 0 (0-3), respectively. Overall CASS was abnormal in 55 (59.8%) patients, with a median (range) of 1 (0-6). Brainstem lesions positively correlated with the abnormal adrenergic CASS (p< 0.04). BS CIS patients had lower t-LF/HF (p< 0.03) and higher t-HFnu (p< 0.03). Disregarding the CIS type, patients with BS lesions evident on MRI had lower t-SDNN (p< 0.05), and lower t-LF
(p< 0.02) compared to patients without those lesions. Patients with positive total CASS score had higher s-HFnu (p< 0.02), and lower s-LF/HF (p< 0.02). Total CASS score showed positive correlation with t-HFnu (p< 0.05) and negative correlation with t-LF/HF (p< 0.04).
Conclusion: Sympathetic (adrenergic and sudomotor) dysfunction is present in large proportion of patients in the earliest stages of multiple sclerosis. Results presented strongly suggest that this dysfunction in our cohort of CIS patients is due to brainstem damage.
Disclosure: Funding: Croatian Science Foundation grant HRZZ UIP-11-2013-2622
Abstract: EP1385
Type: ePoster
Abstract Category: Clinical aspects of MS - Clinical assessment tools
Background: The aim was to determine the extent of autonomic dysfunction in patients with clinically isolated syndrome (CIS) and to correlate autonomic dysfunction with MRI lesions.
Methods: This was a prospective, cohort study, which included 104 consecutive CIS patients (31 males, mean 32.2 years). Standard battery of autonomic tests (i.e. Valsalva maneuver, deep breathing test, tilt-up table test, and quantitative sudomotor axon reflex test(QSART)) was performed, and results were interpreted in form of composite autonomic severity score(CASS). Three patients could not perform Valsalva maneuver, and in 9 patients QSART was not performed due to technical issues. Heart rate variability (HRV) analysis was performed for supine (s-) and tilted phase (t-) of testing in 103 patients. HF and HFnu were used as indices of vagal activity, LF as an index of sympathetic activity, LF/HF as a marker of sympathovagal balance, and SDNN as an indicator of overall HRV. MRI was analyzed for presence of brainstem and/or cervical spinal cord lesions.
Results: Thirty-two patients presented with optic neuritis, 32 with incomplete transverse myelitis, 27 with brainstem/cerebellar (BS) symptomatology, 10 with hemispheral symptoms and 3 with multifocal type of CIS. BS lesions were present in 42 patients, and 41 patients had cervical spinal cord lesions. Abnormal adrenergic, cardiovagal and sudomotor index of the CASS were present in 43 (42.6%), 5 (5.0%) and 31 (32.6%) patients, respectively. Median (range) of the adrenergic, cardiovagal and sudomotor index of the CASS was 0 (0-3), 0 (0-1) and 0 (0-3), respectively. Overall CASS was abnormal in 55 (59.8%) patients, with a median (range) of 1 (0-6). Brainstem lesions positively correlated with the abnormal adrenergic CASS (p< 0.04). BS CIS patients had lower t-LF/HF (p< 0.03) and higher t-HFnu (p< 0.03). Disregarding the CIS type, patients with BS lesions evident on MRI had lower t-SDNN (p< 0.05), and lower t-LF
(p< 0.02) compared to patients without those lesions. Patients with positive total CASS score had higher s-HFnu (p< 0.02), and lower s-LF/HF (p< 0.02). Total CASS score showed positive correlation with t-HFnu (p< 0.05) and negative correlation with t-LF/HF (p< 0.04).
Conclusion: Sympathetic (adrenergic and sudomotor) dysfunction is present in large proportion of patients in the earliest stages of multiple sclerosis. Results presented strongly suggest that this dysfunction in our cohort of CIS patients is due to brainstem damage.
Disclosure: Funding: Croatian Science Foundation grant HRZZ UIP-11-2013-2622