title: Autonomic dysfunction in multiple sclerosis is better detected by heart rate variability and is not correlated with central autonomic network damage.
abstract: BACKGROUND
  MS-associated autonomic dysfunction (AD) in multiple sclerosis (MS) is poorly understood and the best method for its detection unestablished. We compared classical Ewing battery and newer methods as heart rate variability (HRV) and spontaneous baroreflex sensibility (BRS) to detect AD in MS and related them to central autonomic network (CAN) lesions.
  
  
  METHODS
  We enrolled 20 relapsing-remitting MS patients, median age of 36 (interquartile range 32-46) years, disease duration of 5.5 (2.2-6.8) years, Expanded Disability Status Scale (EDSS) score of 1.0 (1.0-1.5) and 20 age- and gender-matched healthy controls. We assessed Ewing battery and spontaneous HRV and BRS. CAN involvement was evaluated by magnetic resonance imaging.
  
  
  RESULTS
  HRV showed both parasympathetic and sympathetic significant impairment in MS (p<0.05). From Ewing battery only isometric test was significantly decreased in MS (p=0.006). Disease duration and severity, lesion burden and CAN involvement were not correlated with laboratorial parameters.
  
  
  CONCLUSIONS
  Our MS cohort had both sympathetic and parasympathetic dysfunction independently from disease duration, neurological deficits and lesion burden or CAN involvement. HRV analysis maybe more useful than classical Ewing battery to screen AD.
authors.affiliation: Dept. Neurology, Centro Hospitalar de São João, Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address: pgoncalomv@gmail.com.
authors.forename: Gonçalo
authors.initials: G
authors.lastname: Videira
authors.affiliation: Dept. Neurology, Centro Hospitalar de São João, Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address: pedromacc@gmail.com.
authors.forename: Pedro
authors.initials: P
authors.lastname: Castro
authors.affiliation: Dept. Neurology, Centro Hospitalar de São João, Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address: vieira.bitia@gmail.com.
authors.forename: Bítia
authors.initials: B
authors.lastname: Vieira
authors.affiliation: Dept. Neuroradiology, Centro Hospitalar de São João, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address: mail.jpfilipe@gmail.com.
authors.forename: João Pedro
authors.initials: JP
authors.lastname: Filipe
authors.affiliation: Dept. Neurology, Centro Hospitalar de São João, Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address: rosampsantos2@gmail.com.
authors.forename: Rosa
authors.initials: R
authors.lastname: Santos
authors.affiliation: Dept. Neurology, Centro Hospitalar de São João, Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address: eazevedo@med.up.pt.
authors.forename: Elsa
authors.initials: E
authors.lastname: Azevedo
authors.affiliation: Dept. Neurology, Centro Hospitalar de São João, Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Faculty of Health Sciences, University Fernando Pessoa, Praça 9 de Abril 349, 4249-004 Porto, Portugal. Electronic address: mjsa@med.up.pt.
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Sá
authors.affiliation: Dept. Neurology, Centro Hospitalar de São João, Faculty of Medicine of University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address: pmabreu@netcado.pt.
authors.forename: Pedro
authors.initials: P
authors.lastname: Abreu
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000000981:diagnostic imaging / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D017704:Baroreflex / Q000502:physiology; D001933:Brain Stem / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D004185:Disability Evaluation; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D013116:Spinal Cord / Q000000981:diagnostic imaging
keywords: Autonomic nervous system; Central autonomic network; Heart rate variability; Magnetic resonance imaging; Multiple sclerosis