O164 Different patterns of dysautonomia in relapsing and progressive multiple sclerosis

Abstract

Objectives To determine differences in autonomic dysfunction in patients with relapsing remitting multiple sclerosis (RMMS) and progressive forms of MS (PMS). Methods Forty RRMS (33 females,35.45 ± 9.15, median EDSS 1.25, median disease duration 923 days) and 30 PPMS (17 females, 48.03 ± 10.58, median EDSS 6.5, median disease duration 4538 days) patients were enrolled. The following autonomic tests were performed: heart rate and blood pressure responses to the Valsalva maneuver, heart rate response to deep breathing (RSA), blood pressure response to passive tilt and Quantitative Sudomotor Axon Reflex Test (QSART). All tests were interpreted in the form of the composite autonomic scoring scale (CASS). Results Median CASS was 1 (range 0 to 5) and 3 (range 0 to 6) for RRMS and PMS patients, respectively. Patients with PMS had significantly higher adrenergic, cardiovagal, sudomotor indices and total CASS compared to patients with RRMS (p = 0.029, p = 0.018, p 0.001 and p 0.001 , respectively). Disease duration positively correlated with adrenergic, cardiovagal, sudomotor indices and total CASS (rs = 0.294, p = 0.02; rs = rs = 0.275, p = 0.027; rs = 0.409, p 0.001 and rs = 0.472, p 0.001 , respectively). EDSS positively correlated with cardiovagal and sudomotor indices and total CASS (rs = 0.264, p = 0.033; rs = 0.411, p 0.001 and rs = 0.402, p = 0.001, respectively). Discussion Autonomic function is rarely investigated in MS, although it may have an impact on several important aspects like fatigue, exercise capacity and MS specific medication tolerance. Conclusion Autonomic dysfunction is more prevalent in progressive MS compared to RRMS. Significance Autonomic dysfunction in MS correlates well with the EDSS and disease duration.