Impact of the autonomic dysfunction on the quality of life in people with NMOSD and MS: An international cross-sectional study.

Nikola Momcilovic,Maja Budimkic Stefanovic,Sarlota Mesaros,Ljiljana Radulovic,Marko Andabaka,Anamari Junakovic,Aleksa Jovanovic,Luka Crnosija,Olivera Tamas,Tatjana Pekmezovic,Magdalena Krbot Skoric,Gorica Maric,Tereza Gabelic,Vanja Jovicevic,Jelena Drulovic,Mario Habek,Milovan Roganovic,Nikola Veselinovic

doi:10.1016/j.msard.2023.104953

Abstract

A substantial autonomic nervous system (ANS) dysfunction has been described in multiple sclerosis (MS) and recently, also in neuromyelitis optica spectrum disorder (NMOSD). The prevalence of ANS symptoms contributes to the chronic symptom burden in both diseases. The aim of our study was to assess ANS dysfunction in people with (pw) NMOSD and MS, using the Composite Autonomic Symptom Score-31 (COMPASS-31), and additionally, to evaluate if ANS dysfunction have impact on the quality of life of these patients. We conducted cross-sectional study at three national referral neurological clinics in Serbia, Croatia, and Montenegro. A total of 180 consecutive subjects, 80 pwNMOSD and 100 pwMS, followed-up at these clinics, were enrolled in the study. Subjects included in the study completed: the validated versions of the COMPASS-31 and the Multiple Sclerosis Quality of Life-54 (MSQoL-54), and the Beck Depression Inventory (BDI). This study demonstrated that the total COMPASS-31 score > 0.0, implicating the presence of ANS dysfunction, was detected in almost all NMOSD and MS study participants tested (80/80, and 97/100, respectively). Our findings showed that autonomic symptom burden was statistically significantly correlated with decreased quality of life, in both NMOSD and MS cohorts. The independent predictors of the better quality of life in pwNMOSD were lower autonomic burden, particularly the absence of the orthostatic intolerance (p=0.005), along with lower EDSS and BDI score (p≤0.001). Similarly, in pwMS, independent predictors were EDSS, BDI, orthostatic intolerance, and the total COMPASS-31 (p≤0.001). Our study demonstrated that a significant proportion of persons with both NMOSD and MS have considerable dysautonomic symptom burden which is correlated with the decreased quality of life. Further investigations are warranted in order to optimize treatment interventions in MS and NMOSD.

Full Text