title: Clinical and subclinical autonomic dysfunction in chronic inflammatory demyelinating polyradiculoneuropathy.
abstract: Autonomic neuropathy, although common in Guillain-Barré syndrome, is considered rare in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and has not been systematically investigated in that disorder. The present study was aimed at determining the prevalence of autonomic dysfunction and investigating the integrity of autonomic nervous system (ANS) reflexes in CIDP. We studied 17 patients with idiopathic CIDP and 20 healthy controls. Six quantitative autonomic function tests (AFTs) were used: Valsalva ratio, 30/15 ratio, and inspiration-expiration difference for parasympathetic function; and tilt test, handgrip test, and sympathetic skin response for sympathetic function. Eleven patients had symptoms of autonomic dysfunction. AFTs were abnormal in 13 patients. Parasympathetic and sympathetic systems were affected with equal frequency. The tilt test was abnormal most frequently, followed by the 30/15 ratio. Three patients developed postural hypotension with loss of consciousness during the tilt test. Abnormality of AFTs did not correlate with the presence of dysautonomic symptoms; duration, severity, and clinical course of the disease; or with age or gender of patients. Our study suggests a higher frequency of clinical and subclinical involvement of the ANS in CIDP than previously estimated. Dysautonomic symptoms are frequent but are mild. However, upon prolonged passive standing, autonomic failure can lead to loss of consciousness. The subclinical involvement of the ANS affects mainly the sympathetic vasomotor and parasympathetic cardiovascular fibers.
authors.affiliation: Department of Neurology, University of Athens, Aeginition Hospital, 74 Vas Sophias Avenue, Athens GR-115 28, Greece. gkoutsi2@otenet.gr
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Stamboulis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Katsaros
authors.forename: Georgios
authors.initials: G
authors.lastname: Koutsis
authors.forename: Heleni
authors.initials: H
authors.lastname: Iakovidou
authors.forename: Anastasia
authors.initials: A
authors.lastname: Giannakopoulou
authors.forename: Irene
authors.initials: I
authors.lastname: Simintzi
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D003935:Diagnostic Techniques, Cardiovascular; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000175:diagnosis* / Q000503:physiopathology*