title: Autonomic dysfunction in clinically isolated syndrome suggestive of multiple sclerosis.
abstract: OBJECTIVE
  The aim of this study was to determine the extent of autonomic dysfunction in patients with clinically isolated syndrome (CIS) by using a standardized battery of autonomic tests in the form of the Composite Autonomic Scoring Scale (CASS).
  
  
  METHODS
  This was a prospective, cross sectional study which included 24 consecutive patients who were diagnosed with CIS and 17 healthy controls. In all participants, heart rate and blood pressure responses to the Valsalva maneuver, heart rate response to deep breathing and blood pressure response to passive tilt were performed. In 16 patients, Quantitative Sudomotor Axon Reflex Test (QSART) and catecholamine measurement was performed.
  
  
  RESULTS
  The proportion of CIS patients with pathological adrenergic index was statistically significantly higher compared to healthy controls (12 vs 2, p=0.018), while there was no difference in cardiovagal index between groups. Five patients had a sudomotor index of 1 (in 4 there was hypohydrosis <50% and in 1 persistent foot hyperhidrosis). When combining adrenergic, cardiovagal and sudomotor index into CASS, 8 patients (50%) had evidence of autonomic dysfunction, 7 mild and one moderate.
  
  
  CONCLUSIONS
  Sympathetic nervous system is frequently affected in CIS patients.
  
  
  CONCLUSIONS
  CASS is able to detect autonomic nervous system dysfunction in CIS patients.
authors.affiliation: School of Medicine, University of Zagreb, Zagreb, Croatia.
authors.forename: Luka
authors.initials: L
authors.lastname: Crnošija
authors.affiliation: University Hospital Center Zagreb, Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Adamec
authors.affiliation: University Hospital Centre Zagreb, Department of Laboratory Diagnostics, Zagreb, Croatia.
authors.forename: Mila
authors.initials: M
authors.lastname: Lovrić
authors.affiliation: University Hospital Center Zagreb, Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia.
authors.forename: Anamari
authors.initials: A
authors.lastname: Junaković
authors.affiliation: University Hospital Center Zagreb, Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Krbot Skorić
authors.affiliation: University Hospital Center Split, Department of Neurology, Split, Croatia.
authors.forename: Ivo
authors.initials: I
authors.lastname: Lušić
authors.affiliation: School of Medicine, University of Zagreb, Zagreb, Croatia; University Hospital Center Zagreb, Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia. Electronic address: mhabek@mef.hr.
authors.forename: Mario
authors.initials: M
authors.lastname: Habek
mesh_terms: D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003711:Demyelinating Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000503:physiopathology*; D011446:Prospective Studies
keywords: Autonomic dysfunction; Clinically isolated syndrome; Composite Autonomic Scoring Scale