Abstract
Multiple sclerosis (MS) is a chronic, progressive central neurological disease characterized by inflammation and demyelination. In patients with MS, dysregulation of the autonomic nervous system may present with various clinical symptoms including sweating abnormalities, urinary dysfunction, orthostatic dysregulation, gastrointestinal symptoms, and sexual dysfunction. These autonomic disturbances reduce the quality of life of affected patients and constitute a clinical challenge to the physician due to variability of clinical presentation and inconsistent data on diagnosis and treatment. Early diagnosis and initiation of individualized interdisciplinary and multimodal strategies is beneficial in the management of autonomic dysfunction in MS. This review summarizes the current literature on the most prevalent aspects of autonomic dysfunction in MS and provides reference to underlying pathophysiological mechanisms as well as means of diagnosis and treatment.
Highlights
In developed countries, multiple sclerosis (MS) is the most prevalent chronic neurological disorder in young individuals, affecting over 400,000 persons in the United States alone [1]
There is a clinicoradiological paradox in Multiple sclerosis (MS) patients: only low-moderate association is shown between clinical disabilities and the burden represented by the amount of lesional tissue on the magnetic resonance imaging (MRI) [18]
Detrusor overactivity is often associated with suprasacral lesions found in the medial frontal lobe cortex, cerebellum, insula, dorsal midbrain, periaqueductal gray, pons micturition center [19,20]
Summary
Multiple sclerosis (MS) is the most prevalent chronic neurological disorder in young individuals, affecting over 400,000 persons in the United States alone [1]. Loss of central modulation on spinal cord segments may lead to sympathovagal imbalance which can lead to constipation, characterized by lengthened colon transit time, lack of increment in colonic motility postprandially, early sphincter excitation when rectal filling, and increased threshold for anorectal reflex [116,121,122]. Gastric emptying rate has been found to be abnormal in MS patients; the study did not correlate upper GI symptoms and gastric motility [127]. The most frequently measured parameters in MS patients assessing parasympathetic function are the pupillary light reflex latency (PLRL), reflex amplitude, contraction velocity, while the parameters representing sympathetic function are the redilatation velocity, time of 75% redilatation and redilatation at 5 s [233,236,237,241]
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