title: Sympathetic cardiovascular and sudomotor functions are frequently affected in early multiple sclerosis.
abstract: The aim of this study was to determine the prevalence of autonomic dysfunction using the composite autonomic scoring scale (CASS) and heart rate variability (HRV) in patients with clinically isolated syndrome (CIS) and to correlate autonomic dysfunction with other measures of MS disease activity.
  
  
  
  CASS, HRV and plasma catecholamines during supine and tilted phase were performed in 104 CIS patients. MRI findings were analyzed for total number of lesions and the presence of brainstem and cervical spinal cord lesions.
  
  
  
  Autonomic dysfunction (CASS >1) was present in 59.8 % of patients, parasympathetic dysfunction in 5 %, sympathetic in 42.6 % and sudomotor in 32.7 % of patients. Patients with autonomic dysfunction on CASS had lower level of norepinephrine in the supine position compared to patients without autonomic dysfunction (1.06 ± 0.53 vs. 1.37 ± 0.86, p = 0.048). The CASS score showed positive correlation with s-HF (r = 0.226, p = 0.031), s-SDNN (r = 0.221, p = 0.035), t-HF (r = 0.225, p = 0.032), and t-HFnu (r = 0.216, p = 0.04), and a negative correlation with t-LF/HF (r = -0.218, p = 0.038). More patients with MRI brainstem lesions had a positive adrenergic index (p = 0.038). Patients with MRI brainstem lesions also had a lower t-SDNN (26.2 ± 14.2 vs. 32 ± 13.3, p = 0.036) and a lower t-LF (median 415.0 vs. 575.5, p = 0.018) compared to patients without these lesions. Patients with adrenergic index ≥1 had a significantly higher standing heart rate compared to patients with an adrenergic index of 0 (96 ± 13.5 vs. 90 ± 12, p = 0.032).
  
  
  
  Autonomic (primarily sympathetic) dysfunction is present in a large proportion of early MS patients and it seems to be related to brainstem involvement.
authors.affiliation: School of Medicine, University of Zagreb, Zagreb, Croatia. mhabek@mef.hr.|Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia. mhabek@mef.hr.|University Department of Neurology, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia. mhabek@mef.hr.
authors.forename: Mario
authors.identifier: 0000-0002-3360-1748
authors.initials: M
authors.lastname: Habek
authors.affiliation: School of Medicine, University of Zagreb, Zagreb, Croatia.
authors.forename: Luka
authors.initials: L
authors.lastname: Crnošija
authors.affiliation: Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia.
authors.forename: Mila
authors.initials: M
authors.lastname: Lovrić
authors.affiliation: Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia.
authors.forename: Anamari
authors.initials: A
authors.lastname: Junaković
authors.affiliation: Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Krbot Skorić
authors.affiliation: Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Adamec
mesh_terms: D000328:Adult; D001794:Blood Pressure; D001933:Brain Stem / Q000000981:diagnostic imaging; D002319:Cardiovascular System / Q000503:physiopathology*; D002395:Catecholamines / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012018:Reflex; D016683:Supine Position / Q000502:physiology; D013543:Sweat Gland Diseases / Q000209:etiology / Q000503:physiopathology*; D013545:Sweat Glands / Q000503:physiopathology*; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014636:Valsalva Maneuver
chemical_list: D002395:Catecholamines
keywords: Autonomic nervous system; Composite autonomic scoring scale; Heart rate variability; Multiple sclerosis; Sudomotor function