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Autonomic dysfunction in multiple sclerosis

Journal of Neurology volume 253, pages i3–i9 (2006)Cite this article

Abstract

Multiple sclerosis (MS) is the most frequent chronic neurological disease affecting young persons in developed countries. MS is, however, considered as a secondary cause, of central origin, for autonomic dysfunction. The most common autonomic symptoms in MS are disorders of micturation, impotence, sudomotor and gastrointestinal disturbances, orthostatic intolerance as well as sleep disorders. The majority of the patients suffer at some period of the disease from lower urinary tract symptoms and sexual dysfunction.Awareness and treatment of these conditions is vital to improving health and quality of life in patients with MS. The increased understanding of the pathophysiological mechanisms in autonomic dysfunction in MS, along with technological and pharmaceutical developments has advanced our ability to treat the multiple aspects complicating autonomic failure in MS.

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References

  1. (1992) Impotence. NIH Consens Statement 10:1–33

  2. (1993) NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. Jama 270:83–90

  3. Acevedo AR, Nava C, Arriada N, Violante A, Corona T (2000) Cardiovascular dysfunction in multiple sclerosis. Acta Neurol Scand 101:85–88

    Article  CAS  PubMed  Google Scholar 

  4. Apostolidis AN, Fowler CJ (2003) Evaluation and treatment of autonomic disorders of the urogenital system. Semin Neurol 23:443–452

    PubMed  Google Scholar 

  5. Araki I, Matsui M, Ozawa K, Nishimura M, Kuno S, Saida T (2002) Relationship between urinary symptoms and disease-related parameters in multiple sclerosis. J Neurol 249:1010–1015

    Article  CAS  PubMed  Google Scholar 

  6. Araki I, Matsui M, Ozawa K, Takeda M, Kuno S (2003) Relationship of bladder dysfunction to lesion site in multiple sclerosis. J Urol 169:1384–1387

    Article  PubMed  Google Scholar 

  7. Bakshi R (2003) Fatigue associated with multiple sclerosis: diagnosis, impact and management. Mult Scler 9:219–227

    Article  PubMed  Google Scholar 

  8. Bateman AM, Goldish GD (2002) Autonomic dysreflexia in multiple sclerosis. J Spinal Cord Med 25:40–42

    PubMed  Google Scholar 

  9. Bilinska M, Pokryszko A, Gruszka E, Piechocki DW (1998) Evaluation of sweating function, changes in heart function and postural blood pressure in patients with multiple sclerosis. Pol Merkuriusz Lek 4:150–153

    CAS  PubMed  Google Scholar 

  10. Blackmer J (2003) Rehabilitation medicine: 1. Autonomic dysreflexia. Cmaj 169:931–935

    PubMed  Google Scholar 

  11. Bosma R, Wynia K, Havlikova E, De Keyser J, Middel B (2005) Efficacy of desmopressin in patients with multiple sclerosis suffering from bladder dysfunction: a meta-analysis. Acta Neurol Scand 112:1–5

    Article  CAS  PubMed  Google Scholar 

  12. Caminero AB, Perez-Jimenez A, Barreiro P, Ferrer T (1995) Sympathetic skin response: correlation with autonomic and somatic involvement in multiple sclerosis. Electromyogr Clin Neurophysiol 35:457–462

    CAS  PubMed  Google Scholar 

  13. Chokroverty S (1999) Sleep and the autonomic nervous system. In: Vinken PJ, Bruyn GW, Appenzeller O (eds) Handbook of Clinical Neurology: The Autonomic Nervous System. Part I Normal Functions. Elsevier, Amsterdam; New York, pp 523–570

  14. Culebras A (2000) Sleep disorders and neurological disease. M. Dekker, New York

  15. Cvetkovic RS, Plosker GL (2005) Desmopressin: in adults with nocturia. Drugs 65:99–107; discussion 108–109

    CAS  PubMed  Google Scholar 

  16. Davis SL, Wilson TE, Vener JM, Crandall CG, Petajan JH, White AT (2005) Pilocarpine-induced sweat gland function in individuals with multiple sclerosis. J Appl Physiol 98:1740–1744

    PubMed  Google Scholar 

  17. de Seze J, Arndt C, Stojkovic T, Ayachi M, Gauvrit JY, Bughin M, Saint Michel T, Pruvo JP, Hache JC, Vermersch P (2001) Pupillary disturbances in multiple sclerosis: correlation with MRI findings. J Neurol Sci 188:37–41

    Article  CAS  PubMed  Google Scholar 

  18. Dewis ME, Thornton NG (1989) Sexual dysfunction in multiple sclerosis. J Neurosci Nurs 21:175–179

    CAS  PubMed  Google Scholar 

  19. Drory VE, Nisipeanu PF, Kroczyn AD (1995) Tests of autonomic dysfunction in patients with multiple sclerosis. Acta Neurol Scand 92:356–360

    CAS  PubMed  Google Scholar 

  20. el-Maghraby TA, Shalaby NM, Al-Tawdy MH, Salem SS (2005) Gastric motility dysfunction in patients with multiple sclerosis assessed by gastric emptying scintigraphy. Can J Gastroenterol 19:141–145

    PubMed  Google Scholar 

  21. Elie B, Louboutin JP (1995) Sympathetic skin response (SSR) is abnormal in multiple sclerosis. Muscle Nerve 18:185–189

    Article  CAS  PubMed  Google Scholar 

  22. Ferini-Strambi L, Filippi M, Martinelli V, Oldani A, Rovaris M, Zucconi M, Comi G, Smirne S (1994) Nocturnal sleep study in multiple sclerosis: correlations with clinical and brain magnetic resonance imaging findings. J Neurol Sci 125:194–197

    CAS  PubMed  Google Scholar 

  23. Fernandez O (2002) Mechanisms and current treatments of urogenital dysfunction in multiple sclerosis. J Neurol 249:1–8

    PubMed  Google Scholar 

  24. Fernández O (2000) Urogenital dysfunction in multiple sclerosis. In: 10th Meeting of the European Neurological Society. Jerusalem, Israel

  25. Flachenecker P, Rufer A, Bihler I, Hippel C, Reiners K, Toyka KV, Kesselring J (2003) Fatigue in MS is related to sympathetic vasomotor dysfunction. Neurology 61:851–853

    CAS  PubMed  Google Scholar 

  26. Fowler CJ, Miller JR, Sharief MK, Hussain IF, Stecher VJ, Sweeney M (2005) A double blind, randomised study of sildenafil citrate for erectile dysfunction in men with multiple sclerosis. J Neurol Neurosurg Psychiatry 76:700–705

    Article  CAS  PubMed  Google Scholar 

  27. Fowler CJ, van Kerrebroeck PE, Nordenbo A, Van Poppel H (1992) Treatment of lower urinary tract dysfunction in patients with multiple sclerosis. Committee of the European Study Group of SUDIMS (Sexual and Urological Disorders in Multiple Sclerosis). J Neurol Neurosurg Psychiatry 55:986–989

    CAS  PubMed  Google Scholar 

  28. Gupta P HW, Rahman K, Walters A, Chokroverty S (1996) Periodic limb movements (PLMs) in a patient with multiple sclerosis and central sleep apnea: independent right and left leg movement periods suggest lateralized PLM oscillators. Sleep Res 25:417

    Google Scholar 

  29. Happe S (2003) Excessive daytime sleepiness and sleep disturbances in patients with neurological diseases: epidemiology and management. Drugs 63:2725–2737

    Article  PubMed  Google Scholar 

  30. Hinds JP, Eidelman BH, Wald A (1990) Prevalence of bowel dysfunction in multiple sclerosis.A population survey. Gastroenterology 98:1538–1542

    CAS  PubMed  Google Scholar 

  31. Kragt JJ, Hoogervorst EL, Uitdehaag BM, Polman CH (2004) Relation between objective and subjective measures of bladder dysfunction in multiple sclerosis. Neurology 63:1716–1718

    PubMed  Google Scholar 

  32. Krupp LB (2003) Fatigue in multiple sclerosis: definition, pathophysiology and treatment. CNS Drugs 17:225–234

    Article  CAS  PubMed  Google Scholar 

  33. Krupp LB, Christodoulou C (2001) Fatigue in multiple sclerosis. Curr Neurol Neurosci Rep 1:294–298

    CAS  PubMed  Google Scholar 

  34. Kurz A, Sessler DI, Tayefeh F, Goldberger R (1998) Poikilothermia syndrome. J Intern Med 244:431–436

    Article  CAS  PubMed  Google Scholar 

  35. Lee MS, Choi YC, Lee SH, Lee SB (1996) Sleep-related periodic leg movements associated with spinal cord lesions. Mov Disord 11:719–722

    Article  CAS  PubMed  Google Scholar 

  36. Linden D, Diehl RR, Berlit P (1995) Subclinical autonomic disturbances in multiple sclerosis. J Neurol 242:374–378

    Article  CAS  PubMed  Google Scholar 

  37. Linden D, Diehl RR, Kretzschmar A, Berlit P (1997) Autonomic evaluation by means of standard tests and power spectral analysis in multiple sclerosis. Muscle Nerve 20:809–814

    Article  CAS  PubMed  Google Scholar 

  38. Lopez G (1999) Sexual function, dysfunction, orientation and the autonomic nervous system. In: Appenzeller O (ed) The autonomic nervous system. Part II. Dysfunctions. Handbook of clinical neurology. Elsevier, Amsterdam; New York, pp 84–103

  39. Lundberg PO, Brattberg A (1992) Sexual dysfunction in selected neurologic disorders: hypothalamopituitary disorders, epilepsy, myelopathies, polyneuropathies, and sacral nerve lesions. Semin Neurol 12:115–119

    CAS  PubMed  Google Scholar 

  40. McAllister TW (2003) The safety and efficacy of modafinil in multiple sclerosis-related fatigue. Curr Psychiatry Rep 5:367

    Google Scholar 

  41. Merkelbach S, Dillmann U, Kolmel C, Holz I, Muller M (2001) Cardiovascular autonomic dysregulation and fatigue in multiple sclerosis. Mult Scler 7:320–326

    Article  CAS  PubMed  Google Scholar 

  42. Nasseri K, TenVoorde BJ, Ader HJ, Uitdehaag BM, Polman CH (1998) Longitudinal follow-up of cardiovascular reflex tests in multiple sclerosis. J Neurol Sci 155:50–54

    Article  CAS  PubMed  Google Scholar 

  43. Nasseri K, Uitdehaag BM, van Walderveen MA, Ader HJ, Polman CH (1999) Cardiovascular autonomic function in patients with relapsing remitting multiple sclerosis: a new surrogate marker of disease evolution? Eur J Neurol 6:29–33

    Article  CAS  PubMed  Google Scholar 

  44. Noronha MJ, Vas CJ, Aziz H (1968) Autonomic dysfunction (sweating responses) in multiple sclerosis. J Neurol Neurosurg Psychiatry 31:19–22

    CAS  PubMed  Google Scholar 

  45. Pozzessere G, Rossi P, Valle E, Froio CP, Petrucci AF, Morocutti C (1997) Autonomic involvement in multiple sclerosis: a pupillometric study. Clin Auton Res 7:315–319

    Article  CAS  PubMed  Google Scholar 

  46. Rosenberg JH, Shafor R (2005) Fatigue in multiple sclerosis: a rational approach to evaluation and treatment. Curr Neurol Neurosci Rep 5:140–146

    PubMed  Google Scholar 

  47. Saari A, Tolonen U, Paakko E, Suominen K, Pyhtinen J, Sotaniemi K, Myllyla V (2004) Cardiovascular autonomic dysfunction correlates with brain MRI lesion load in MS. Clin Neurophysiol 115:1473–1478

    Article  CAS  PubMed  Google Scholar 

  48. Sakakibara R, Mori M, Fukutake T, Kita K, Hattori T (1997) Orthostatic hypotension in a case with multiple sclerosis. Clin Auton Res 7:163–165

    Article  CAS  PubMed  Google Scholar 

  49. Sanya EO, Tutaj M, Brown CM, Goel N, Neundorfer B, Hilz MJ (2005) Abnormal heart rate and blood pressure responses to baroreflex stimulation in multiple sclerosis patients. Clin Auton Res 15:213–218

    PubMed  Google Scholar 

  50. Singer C (1995) Sexual Dysfunction. In: Korczyn AD (ed) Handbook of autonomic nervous system dysfunction. Neurological disease and therapy; 38. M Dekker, New York, pp 381–397

  51. Stankoff B, Waubant E, Confavreux C, Edan G, Debouverie M, Rumbach L, Moreau T, Pelletier J, Lubetzki C, Clanet M (2005) Modafinil for fatigue in MS: a randomized placebo-controlled double-blind study. Neurology 64:1139–1143

    CAS  PubMed  Google Scholar 

  52. Tachibana N, Howard RS, Hirsch NP, Miller DH, Moseley IF, Fish D (1994) Sleep problems in multiple sclerosis. Eur Neurol 34:320–323

    CAS  PubMed  Google Scholar 

  53. Thomaides TN, Zoukos Y, Chaudhuri KR, Mathias CJ (1993) Physiological assessment of aspects of autonomic function in patients with secondary progressive multiple sclerosis. J Neurol 240:139–143

    Article  CAS  PubMed  Google Scholar 

  54. Thomas P Leist SG, Karen Hartnett, Bernadette Kalman (2005) Monitoring of Cardiac Function during Mitoxantrone Therapy. In: 57th Annual Meeting AAN. Miami

  55. Ueno M, Tokunaga Y, Terachi S, Gondo K, Hara T (2000) Asymmetric sweating in a child with multiple sclerosis. Pediatr Neurol 23:74–76

    Article  CAS  PubMed  Google Scholar 

  56. Vas CJ (1969) Sexual impotence and some autonomic disturbances in men with multiple sclerosis. Acta Neurol Scand 45:166–182

    CAS  PubMed  Google Scholar 

  57. Vita G, Fazio MC, Milone S, Blandino A, Salvi L, Messina C (1993) Cardiovascular autonomic dysfunction in multiple sclerosis is likely related to brainstem lesions. J Neurol Sci 120:82–86

    Article  CAS  PubMed  Google Scholar 

  58. Waldron DJ, Horgan PG, Patel FR, Maguire R, Given HF (1993) Multiple sclerosis: assessment of colonic and anorectal function in the presence of faecal incontinence. Int J Colorectal Dis 8:220–224

    Article  CAS  PubMed  Google Scholar 

  59. Zifko UA (2004) Management of fatigue in patients with multiple sclerosis. Drugs 64:1295–1304

    Article  CAS  PubMed  Google Scholar 

  60. Zifko UA, Rupp M, Schwarz S, Zipko HT, Maida EM (2002) Modafinil in treatment of fatigue in multiple sclerosis. Results of an open-label study. J Neurol 249:983–987

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Dept. of.Neurology, HELIOS Klinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Germany

    Carl-Albrecht Haensch &  Johannes Jörg

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  1. Carl-Albrecht Haensch
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  2. Johannes Jörg
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Correspondence to Carl-Albrecht Haensch.

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Haensch, CA., Jörg, J. Autonomic dysfunction in multiple sclerosis. J Neurol 253, i3–i9 (2006). https://doi.org/10.1007/s00415-006-1102-2

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  • DOI: https://doi.org/10.1007/s00415-006-1102-2

Key words

  • autonomic dysfunction
  • multiple sclerosis
  • bladder dysfunction
  • sleep
  • gastrointestinal disturbances