Highlights
- •Pathophysiological differences exist between different autonomic disorders in MS.
- •Preserved brainstem function is needed for development of syncope in MS.
- •Orthostatic hypotension could be associated with brainstem dysfunction in MS.
Abstract
Background
The aim of this study was to investigate the correlation between autonomic dysfunction
in multiple sclerosis (MS) and brainstem dysfunction evaluated with the vestibular
evoked myogenic potentials (VEMP) score and conventional MRI.
Methods
Forty-five patients with the diagnosis of clinically isolated syndrome (CIS) suggestive
of MS were enrolled. VEMP, heart rate, and blood pressure responses to the Valsalva
maneuver, heart rate response to deep breathing, and pain provoked head-up tilt table
test, as well as brain and spinal cord MRI were performed.
Results
There was no difference in the VEMP score between patients with and without signs
of sympathetic or parasympathetic dysfunction. However, patients with syncope had
significantly lower VEMP score compared to patients without syncope (p < 0.01). Patients with orthostatic hypotension (OH) showed a trend of higher VEMP score
compared to patients without OH (p = 0.06). There was no difference in the presence of lesions in the brainstem or cervical
spinal cord between patients with or without any of the studied autonomic parameters.
The model consisting of a VEMP score of ≤5 and normal MRI of the midbrain and cervical spinal cord has sensitivity and specificity
of 83% for the possibility that the patient with MS can develop syncope.
Conclusions
Pathophysiological mechanisms underlying functional and structural disorders of autonomic
nervous system in MS differ significantly. While preserved brainstem function is needed
for development of syncope, structural disorders like OH could be associated with
brainstem dysfunction.
Keywords
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References
- Brainstem lesions in clinically isolated syndromes.Neurology. 2010; 75: 1933-1938
- Evaluation of brainstem involvement in multiple sclerosis.Expert. Rev. Neurother. 2013; 13: 299-311
- The vestibular evoked myogenic potentials (VEMP) score: a promising tool for evaluation of brainstem involvement in multiple sclerosis.Eur. J. Neurol. 2015; 22 (e21): 261-269
- Cardiovascular autonomic dysfunction in multiple sclerosis is likely related to brainstem lesions.J. Neurol. Sci. 1993; 120: 82-86
- Cardiovascular dysfunction in multiple sclerosis.Acta Neurol. Scand. 2000; 101: 85-88
- Autonomic dysfunction in multiple sclerosis: cervical spinal cord atrophy correlates.J. Neurol. 2001; 248: 297-303
- Disorders of the autonomic nervous system.in: Daroff R. Fenichel G. Jankovic J. Mazziotta J. Neurology in Clinical Practice. 6th ed. Elsevier/Saunders, Philadelphia, PA2012
- Assessment of cardiovascular autonomic function.Clin. Neurophysiol. 2006; 117: 716-730
- Quantitative autonomic testing.J. Vis. Exp. 2011;
- Short pain-provoked head-up tilt test for the confirmation of vasovagal syncope.Neurol. Sci. 2013; 34: 869-873
- New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal syncope international study.Europace. 2000; 2: 66-76
- Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome.Auton. Neurosci. 2011; 161: 46-48
- Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure.Mayo Clin. Proc. 1993; 68: 748-752
- Vestibular evoked myogenic potentials: past, present and future.Clin. Neurophysiol. 2010; 121: 636-651
- International guidelines for the clinical application of cervical vestibular evoked myogenic potentials: an expert consensus report.Clin. Neurophysiol. 2014; 125: 658-666
- Vasovagal syncope in humans and protective reactions in animals.Europace. 2015; 17: 345-349
- Prevalence and triggers of syncope in medical students.Am. J. Cardiol. 2003; 9: 1006-1008
- The human fear circuitry and fear-induced fainting in healthy individuals. The paleolithic-threat hypothesis.Clin. Auton. Res. 2005; 15: 238-241
- Genetic aspects of vasovagal syncope: a systematic review of current evidence.Europace. 2009; 11: 414-420
- Pathophysiological basis of syncope and neurological conditions that mimic syncope.Prog. Cardiovasc. Dis. 2013; 55: 345-356
- Vasovagal reactions may occur after orthotopic heart transplantation.J. Am. Coll. Cardiol. 1993; 21: 1132-1137
- Vasovagal syncope after infusion of a vasodilator in a heart transplant recipient.N. Engl. J. Med. 1990; 322: 602-604
- Perioperative bradycardia and asystole: relationship to vasovagal syncope and the Bezold–Jariisch reflex.Br. J. Anaesth. 2001; 86: 859-868
- Cerebral vasoconstriction in vasovagal syncope: any link with symptoms? A transcranial Doppler study.Circulation. 2001; 104: 2694-2698
- The semiology of tilt-induced reflex syncope in relation to EEG changes.Brain. 2014; 137: 576-585
- Correlations between clinical and MRI involvement in multiple sclerosis: assessment using T(1), T(2) and MT histograms.J. Neurol. Sci. 1999; 171: 121-129
- Infratentorial atrophy on magnetic resonance imaging and disability in multiple sclerosis.Brain. 1999; 122: 291-301
- Autonomic dysfunction in multiple sclerosis: correlation with disease-related parameters.Eur. Neurol. 2002; 48: 1-5
- Epidemiologic features of isolated syncope: the Framingham study.Stroke. 1985; 16: 626-629
- Postural orthostatic tachycardia syndrome associated with multiple sclerosis.Auton. Neurosci. 2013; 173: 65-68
Article info
Publication history
Published online: June 30, 2015
Accepted:
June 29,
2015
Received in revised form:
June 27,
2015
Received:
May 11,
2015
Identification
Copyright
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
