Contributions
Abstract: EP1294
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background and aims: The aim of this study was to determine the extent of autonomic symptom burden measured with the Composite Autonomic System Score-31 (COMPASS-31) and presence of objective dysautonomia measured with adrenergic index (AI) and cardiovagal index (CI) in people with neuromyelitis optica spectrum disorders (pwNMOSD). Furthermore, we wanted to compare both parameters in pwNMOSD and people with multiple sclerosis (pwMS).
Design/Methods: 20 pwNMOSD (16 females, mean age 48.2±10.8, disease duration 9.8±8.0) and 20 pwMS, matched for age, sex and disease duration were enrolled. All patients completed the COMPASS-31. The following ANS tests were performed: heart rate (Valsalva ratio (VR)) and blood pressure responses to the Valsalva maneuver, heart rate response to deep breathing (respiratory sinus arrhythmia (RSA)) and the tilt table test. The quantification of autonomic dysfunction was made using the two indices of the Composite Autonomic Scoring Scale (CASS): adrenergic index (AI) and cardiovagal index (CI).
Results: In all pwNMOSD, COMPASS-31 was >0. AI >0, indicating sympathetic dysfunction, was present in 8 (40%) and CI>0, indicating parasympathetic dysfunction, was present in 10 (50%) pwNMOSD. Orthostatic hypotension on tilt-table test was present in 6 (30%) of pwNMOSD. The frequency of presence of autonomic symptom burden was higher in pwNMOSD for the vasomotor and pupilomotor domains of the COMAPSS-31 compared to pwMS (p=0.048 and p=0.006, respectively). There was no difference in AI and CI between groups (all p>0.05). pwNMOSD had significantly greater drop in diastolic blood pressure (dBP) during tilt-table test compared to pwMS, p=0.044. A binary logistic regression model showed that drop in dBP during tilt-table test and normal function of autonomic nervous system, defined as AI=0 and CI = 0, are independent predictors of pwNMOSD (p=0.042 and p=0.029, respectively).
Conclusion: Significant proportion of pwNMOSD experience dysautonomia, which seems to be different from dysautonomia observed in pwMS.
Disclosure: Jelena Drulovic serves on scientific advisory boards for Bayer Schering Pharma, Merck Serono, Teva, Genzyme, a Sanofi Company, and received honoraria for speaking from Merck Serono, Teva, Bayer Schering, Genzyme, a Sanofi Company, Medis, Roche; and has also received research grant support from the Ministry of Education and Science, Republic of Serbia (project no. 175031).
Tatjana Pekmezovic has received compensation for consulting services, travel expenses for scientific meetings, and speaking honoraria from Bayer Schering Pharma, Merck Serono, Actavis/Teva, Roche, Gedeon Richter, Novartis; supported by a grant of the Ministry of Education, Science and Technological Development, Republic of Serbia (No. 175087 and 175090).
Mario Habek participated as clinical investigator and/or speaker for: Biogen, Sanofi Genzyme, Merck, Bayer, Novartis, Pliva/Teva, Roche, Alvogen, Actelion, Alexion Pharmaceuticals, TGI pharmaceuticals.
Abstract: EP1294
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background and aims: The aim of this study was to determine the extent of autonomic symptom burden measured with the Composite Autonomic System Score-31 (COMPASS-31) and presence of objective dysautonomia measured with adrenergic index (AI) and cardiovagal index (CI) in people with neuromyelitis optica spectrum disorders (pwNMOSD). Furthermore, we wanted to compare both parameters in pwNMOSD and people with multiple sclerosis (pwMS).
Design/Methods: 20 pwNMOSD (16 females, mean age 48.2±10.8, disease duration 9.8±8.0) and 20 pwMS, matched for age, sex and disease duration were enrolled. All patients completed the COMPASS-31. The following ANS tests were performed: heart rate (Valsalva ratio (VR)) and blood pressure responses to the Valsalva maneuver, heart rate response to deep breathing (respiratory sinus arrhythmia (RSA)) and the tilt table test. The quantification of autonomic dysfunction was made using the two indices of the Composite Autonomic Scoring Scale (CASS): adrenergic index (AI) and cardiovagal index (CI).
Results: In all pwNMOSD, COMPASS-31 was >0. AI >0, indicating sympathetic dysfunction, was present in 8 (40%) and CI>0, indicating parasympathetic dysfunction, was present in 10 (50%) pwNMOSD. Orthostatic hypotension on tilt-table test was present in 6 (30%) of pwNMOSD. The frequency of presence of autonomic symptom burden was higher in pwNMOSD for the vasomotor and pupilomotor domains of the COMAPSS-31 compared to pwMS (p=0.048 and p=0.006, respectively). There was no difference in AI and CI between groups (all p>0.05). pwNMOSD had significantly greater drop in diastolic blood pressure (dBP) during tilt-table test compared to pwMS, p=0.044. A binary logistic regression model showed that drop in dBP during tilt-table test and normal function of autonomic nervous system, defined as AI=0 and CI = 0, are independent predictors of pwNMOSD (p=0.042 and p=0.029, respectively).
Conclusion: Significant proportion of pwNMOSD experience dysautonomia, which seems to be different from dysautonomia observed in pwMS.
Disclosure: Jelena Drulovic serves on scientific advisory boards for Bayer Schering Pharma, Merck Serono, Teva, Genzyme, a Sanofi Company, and received honoraria for speaking from Merck Serono, Teva, Bayer Schering, Genzyme, a Sanofi Company, Medis, Roche; and has also received research grant support from the Ministry of Education and Science, Republic of Serbia (project no. 175031).
Tatjana Pekmezovic has received compensation for consulting services, travel expenses for scientific meetings, and speaking honoraria from Bayer Schering Pharma, Merck Serono, Actavis/Teva, Roche, Gedeon Richter, Novartis; supported by a grant of the Ministry of Education, Science and Technological Development, Republic of Serbia (No. 175087 and 175090).
Mario Habek participated as clinical investigator and/or speaker for: Biogen, Sanofi Genzyme, Merck, Bayer, Novartis, Pliva/Teva, Roche, Alvogen, Actelion, Alexion Pharmaceuticals, TGI pharmaceuticals.