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psychopraxis. neuropraxis

, Volume 22, Issue 2, pp 77–80 | Cite as

Sudomotor Dysfunction in a Patient with Primary Progressive Multiple Sclerosis

  • Ivan Adamec
  • Mario HabekEmail author
Neurologie
  • 14 Downloads

Abstract

Autonomic dysfunction (AD) is known to be frequent among multiple sclerosis (MS) patients, even in early stages of the disease. During the course of disease, AD becomes more pronounced, with patients in progressive stages of MS experiencing a higher autonomic burden than MS patients in relapsing-remitting stages. The same pattern of AD progression is true for sudomotor dysfunction, with 35% of MS patients with a relapsing-remitting phenotype experiencing sudomotor dysfunction compared to 73% of MS patients with a progressive phenotype. We present the case of a patient with primary progressive MS suffering from severe sudomotor dysfunction. The presented patient had avoided physical therapy as he could not tolerate the accompanying temperature rise. One way to deal with this obstacle is to cool the patient down prior to physical therapy or let the patient workout at a cooler room temperature. From a research point of view, sudomotor dysfunction detected in MS patients may actually be a sign of small fiber neuropathy and not just a reflection of central nervous system dysfunction, a possibility which requires further investigation.

Keywords

Multiple Sclerosis, relapsing-remitting Autonomic nervous system diseases Small fiber neuropathy Physical therapy modalities Hypohidrosis 

Sudomotorische Dysfunktion bei einem Patienten mit primär progressiver multipler Sklerose

Zusammenfassung

Häufig tritt eine autonome Dysfunktion (AD) bekanntermaßen bei Patienten mit Multipler Sklerose (MS) auf, sogar in frühen Erkrankungsstadien. Im Krankheitsverlauf wird die AD ausgeprägter, was bei Patienten in fortschreitenden MS-Stadien zu einer höheren Last autonomer Symptome führt als bei MS-Patienten mit schubförmigem Verlauf (rezidivierend-remittierende Stadien). Das gleiche Muster der AD-Progression besteht auch bei der sudomotorischen Dysfunktion; diese Dysfunktion kommt bei 35% der MS-Patienten mit rezidivierend-remittierendem Phänotyp vor, aber im Vergleich dazu bei 73% der MS-Patienten mit einem progressiven Phänotyp. Die Autoren stellen den Fall eines Patienten mit primär progressiver MS vor, der unter schwerer sudomotorischer Dysfunktion litt. Der vorgestellte Patient hatte physikalische Therapie gescheut, da er den damit verbundenen Temperaturanstieg nicht ertragen konnte. Eine Möglichkeit, mit diesem Problem umzugehen, besteht darin, den Patienten vor der physikalischen Therapie herunterzukühlen oder den Patienten bei kühlerer Raumtemperatur trainieren zu lassen. Aus wissenschaftlicher Sicht ist die bei MS-Patienten festgestellte sudomotorische Dysfunktion möglicherweise eigentlich Zeichen einer Small-Fiber-Neuropathie, also einer Neuropathie der dünnen Nervenfasern, und nicht Ausdruck einer Störung des zentralen Nervensystems – eine Möglichkeit, die weitere Untersuchungen erfordert.

Schlüsselwörter

Multiple Sklerose, rezidivierend-remittierend Erkrankungen des autonomen Nervensystems Small-Fiber-Neuropathie Modalitäten der physikalischen Therapie Hypohidrose 

Notes

Compliance with ethical guidelines

Conflict of interest

None of the authors (I. Adamec and M. Habek) have relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was used in the production of this manuscript.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurology, Referral Center for Autonomic Nervous System DisordersUniversity Hospital Center ZagrebZagrebCroatia
  2. 2.School of MedicineUniversity of ZagrebZagrebCroatia

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