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Longitudinal assessment of autonomic nervous system in patients with first demyelinating event suggestive of multiple sclerosis
Author(s) -
Habek M.,
Crnošija L.,
Gabelić T.,
Barun B.,
Adamec I.,
Junaković A.,
Ruška B.,
Pavičić T.,
Krbot Skorić M.
Publication year - 2019
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13989
Subject(s) - medicine , multiple sclerosis , autonomic nervous system , neuroscience , demyelinating disorder , central nervous system , demyelinating disease , event (particle physics) , physical medicine and rehabilitation , psychiatry , psychology , heart rate , blood pressure , physics , quantum mechanics
Background and purpose As a high proportion of people with clinically isolated syndrome (pw CIS ) exhibit sympathetic adrenergic and sudomotor dysfunction, the aim of this study was to investigate the evolution of autonomic nervous system ( ANS ) abnormalities in pw CIS over a 2‐year follow‐up. Methods This was a prospective cohort study in which 121 pw CIS were enrolled and followed for 2 years. After 2‐year follow‐up, data were available for 84 pw CIS . ANS symptoms were evaluated with the Composite Autonomic System Score‐31 ( COMPASS ‐31) and results of the ANS tests were expressed using the Composite Autonomic Scoring Scale ( CASS ) at baseline and visit at month 24. Symptomatic dysautonomia was defined if the patient had a COMPASS ‐31 value above the median of the whole cohort at baseline evaluation ( COMPASS ‐31 > 6.79) and CASS score >0. Results Complete CASS data at baseline and month 24 were available for 62 patients; in 24 (38.7%) patients there was worsening, in 16 (25.8%) there was improvement and in 22 (35.5%) there was no change in CASS score. In 90% of pw CIS (72 of 80) there was no change in parasympathetic nervous system tests, whereas 47.3% (35 of 74) had either worsening or improvement in sympathetic adrenergic and 28.6% (20 of 70) had either worsening or improvement in sudomotor function. A multivariable regression model identified the total number of T2 lesions as an independent predictor for worsening of symptomatic dysautonomia. No predictors for worsening or improving of CASS score were identified. Conclusion A substantial proportion of pw CIS experienced worsening of ANS abnormalities during the 2‐year follow‐up and magnetic resonance imaging parameters seemed to predict these abnormalities.