Peripheral neuropathy in patients with multiple sclerosis.

Adnan Khan,Blessy M Babu,Ioannis N Petropoulos,Rabia Khan,Dirk Deleu,Naveed Akhtar,Ashfaq Shuaib,Stacy S Wilins,Beatriz G Canibano,Pooja George,Georgios Ponirakis,Rayaz A Malik,Saadat Kamran,Faiza M Ibrahim,Sam Eldabe

doi:10.1371/journal.pone.0193270

Abstract

ObjectivesTo determine the prevalence and severity of neuropathic pain, sudomotor dysfunction and abnormal vibration perception in patients with MS.Methods73 patients with MS and 32 age-matched healthy controls underwent assessment of expanded disability severity score (EDSS), DN4 to assess neuropathic pain, electrochemical skin conductance (ESC) to assess sudomotor function and vibration perception threshold (VPT).ResultsPatients with MS had a higher DN4 score (p < 0.001) with 14% fulfilling the criteria for neuropathic pain elevated VPT (p < 0.001) and lower ESC on the feet (p < 0.001) and hands (p < 0.001) compared to control participants. ESC on the feet (32% of MS patients) and hands (30% of MS patients) were lower, and DN4 (77% of MS patients) and VPT (64% of MS patients) were greater than 2SD of the healthy control values, respectively. EDSS correlated with the number of relapses (r = 0.564, p < 0.001), VPT (r = –0.457, < 0.001) and ESC on the feet (r = –0.268, p = 0.023).ConclusionsPatients with multiple sclerosis have evidence of sudomotor dysfunction and elevated vibration perception, which were associated with neurological disability from MS.

Highlights

Multiple sclerosis (MS) is considered to be a progressive inflammatory disease characterized by demyelination in the central nervous system including the optic nerves
Patients with MS had a higher DN4 score (p < 0.001) with 14% fulfilling the criteria for neuropathic pain elevated vibration perception threshold (VPT) (p < 0.001) and lower electrochemical skin conductance (ESC) on the feet (p < 0.001) and hands (p < 0.001) compared to control participants
expanded disability severity score (EDSS) correlated with the number of relapses (r = 0.564, p < 0.001), VPT (r = –0.457, < 0.001) and ESC on the feet (r = –0.268, p = 0.023)

Summary

Introduction

Multiple sclerosis (MS) is considered to be a progressive inflammatory disease characterized by demyelination in the central nervous system including the optic nerves. Neuropathy in multiple sclerosis others have recently demonstrated significant small fibre damage in patients with MS [1,2,3]. A recent study has demonstrated a significant reduction in intraepidermal nerve fibre density in patients with MS [4]. Sudomotor dysfunction has been described in clinically isolated syndrome [5] and abnormal sweating is a feature of MS [6]. Impaired sudomotor function correlates with the severity of clinical disability in MS [7, 8] and is associated with sweat gland denervation [9]. Patients with MS exhibit the Uhthoff phenomenon, characterized by a worsening of neurological deficits when patients are exposed to heat, suggestive of vasomotor dysfunction

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Conclusion