Cardiovascular autonomic dysfunction in multiple sclerosis
Keywords:
multiple sclerosis, cardiovascular dysfunction, autonomic nervous systemAbstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system and may have in its clinical picture symptoms of autonomic dysfunction.
Demyelinating lesions in MS can affect brain structures that are part of the central autonomic network and lead to impaired regulation of many functions that are under the control of the autonomic nervous system (ANS). MS patients often have disturbances in urinary, gastrointestinal, sexual, sudomotor, pupilomotor and cardiovascular functions. Urinary and sexual dysfunction are particularly stressful for most patients, limit their activity, and play a significant role in their overall disability and quality of life. The clinical role of other autonomic symptoms, including cardiovascular, is less well understood.
Contemporary clinical investigation of ANS is performed in equipped laboratories by applying standardized tests to quantify and objectively examine autonomic functions. Various studies have found that abnormalities in cardiovascular autonomic tests in MS patients are heterogeneous and variable.
The results of the conducted studies show dysfunction of the parasympathetic and sympathetic ANS in varying degrees and frequency. The correlation of cardiovascular dysfunction with the type, severity and duration of MS varies across a wide range. This fact is mainly due to the relatively small groups of patients and the application of few cardiovascular tests in part of the studies.
Investigation of ANS is usually not performed in MS, but determining the extent and nature of cardiovascular disorders can serve as an indicator of the severity of the disease, refine the clinical assessment and the prognosis of the patients.
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