Abstract
A detailed non-invasive study of systemic and regional haemodynamic responses to a range of autonomic tests which assess sympathetic and parasympathetic pathways (mental arithmetic, cutaneous cold, isometric exercise, deep breathing, Valsalva manoeuvre and head-up tilt) were performed in ten patients with secondary progressive multiple sclerosis and ten age- and sex-matched healthy normal subjects (controls). Blood pressure rose in controls during the pressor tests and was maintained during tilt. In six out of ten patients with multiple sclerosis blood pressure was unchanged during one or more of the three pressor tests, but was maintained in all during tilt. In the controls, superior mesenteric artery blood flow fell during pressor tests and head-up tilt. In multiple sclerosis patients, superior mesenteric artery blood flow did not change during pressor tests but fell during tilt. Cardiac index rose during isometric exercise and fell during head-up tilt in controls. Forearm blood flow rose during mental arithmetic in the controls only, but fell during tilt in both groups. Individual analysis indicated that of the ten multiple sclerosis patients, four had responses during the pressor tests similar to controls. Responses to deep breathing and to the Valsava manoeuvre in controls and multiple sclerosis patients were similar. We conclude that some patients with an aggressive and disabling form of multiple sclerosis have selective autonomic dysfunction, in particular involving pressor responses, despite the lack of postural hypotension. The autonomic abnormality is likely to involve central autonomic interconnections rather than afferent or sympathetic efferent pathways. Further clarification of the nature, site and progression of these lesions is needed. Detection of these abnormalities, which may be clinically silent, may help in the prognostic and diagnostic evaluation of patients with multiple sclerosis.
Similar content being viewed by others
References
Callaman MM, Longsdall JS, Ron MA, Warrington EK (1989) Cognitive impairment in patients with clinically isolated lesions of the type seen in multiple sclerosis. Brain 112:361–374
Cartlidge NEF (1972) Autonomic function in multiple sclerosis. Brain 95:661–664
Chaudhuri KR, Thomaides T, Hernandez P, Mathias CJ (1991) Noninvasive quantification of superior mesenteric artery blood flow during sympathoneural activation in normal subjects. Clin Auton Res 1:37–42
Chaudhuri KR, Thomaides T, Mathias CJ (1992) Abnormality of superior mesenteric artery blood flow responses in human sympathetic failure. J Physiol (Lond) 457:477–489
Kurtzke J (1983) Rating neurological impairment in multiple sclerosis an expanded disability status scale (EDSS). Neurology 33:1444–1452
Mutani R, Clemente S, Lamberti A, Monaco F (1982) Assessment of autonomic disturbances in multiple sclerosis by measurement of heart rate responses to deep breathing and standing. Ital Neurol Sci 2:111–114
Neubauer B, Gundersen JG (1978) Analysis of heart rate variation in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 41:417–419
Nordenlo AM, Boesen F, Bo Andersen E (1989) Cardiovascular autonomic function in multiple sclerosis. J Auton Nerv Syst 26:77–84
Noronha MJ, Vas CJ, Aziz H (1968) Autonomic dysfunction (sweating response) in multiple sclerosis. J Neurol Neurosurg Psychiatry 31:19–22
Pentland B, Ewing DJ (1987) Cardiovascular reflexes in multiple sclerosis. Eur Neurol 26:46–50
Poser CM, Paty DW, Scheinberg L, et al (1983) New diagnostic criteria for multiple sclerosis guidelines for research protocols. Ann Neurol 13:227–231
Powell LB (1975) The splanchnic circulation. In: Zelis R (ed) The peripheral circulations. Grune & Stratton, New York, pp 163–192
Senaratne MPJ, Carrol D, Warren KG, Kappagala T (1982) Evidence for cardiovascular autonomic nerve dysfunction in multiple sclerosis. J Neurol Neurosurg Psychiatry 47:947–952
Sternman AB, Coyle PK, Panasci DJ, Grimson R (1985) Disseminated abnormalities of cardiovascular autonomic functions in multiple sclerosis. Neurology 36:1665–1668
Thompson AJ, Kermode AG, Wicks D, MacManus DG, Kendall BE, Kingsley DPE, McDonald IW (1991) Major differences in the dynamics of primary and secondary progressive multiple sclerosis. Ann Neurol 29:53–62
Vas CJ (1969) Sexual impotence and some autonomic disturbances in men with multiple sclerosis. Acta Neurol Scand 45:166–182
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Thomaides, T.N., Zoukos, Y., Chaudhuri, K.R. et al. Physiological assessment of aspects of autonomic function in patients with secondary progressive multiple sclerosis. J Neurol 240, 139–143 (1993). https://doi.org/10.1007/BF00857517
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00857517