Autonomic dysfunction in multiple sclerosis and optic neuritis
1University of Oulu, Faculty of Medicine, Institute of Clinical Medicine, Department of Neurology
2Oulu University Hospital, Department of Medical Rehabilitation
|Online Access:||PDF Full Text (PDF, 0.6 MB)|
|Persistent link:|| http://urn.fi/urn:isbn:9789514262395
|Publish Date:|| 2010-08-10
|Thesis type:||Doctoral Dissertation
|Defence Note:||Academic dissertation to be presented with the assent of the Faculty of Medicine of the University of Oulu for public defence in Auditorium 8 of Oulu University Hospital, on 20 August 2010, at 12 noon
Docent Esko Kinnunen
Docent Juhani Ruutiainen
Multiple sclerosis (MS) is one of the major causes of disability in the young, mostly affecting people between 20–45 years of age. MS is considered as an autoimmune disorder, characterized by discrete areas of central nervous system inflammation, demyelination and axonal injury. Symptoms related to alterations of the autonomic nervous system are frequent in patients with MS. Bladder dysfunction or impairment of sexual performance is highly distressing for most MS patients, whereas the clinical relevance of other autonomic symptoms is less clear.
The present study was designed to clarify the involvement of cardiovascular and sudomotor dysfunctions in patients with MS, to study the sudomotor functions in patients with optic neuritis (optic neuritis being a frequent initial manifestation of MS), and to assess the extent of demyelinative lesions in the CNS by using magnetic resonance imaging and by correlating the findings thus obtained with autonomic nervous system responses.
The study showed cardiovascular autonomic regulation failure in MS patients manifesting itself both in the heart rate responses to deep breathing and in the heart rate and blood pressure responses in the tilt table test. In particular, midbrain lesions were found to be associated with cardiovascular dysfunction. MS patients also showed abnormal sympathetic skin responses indicating sudomotor failure. Focal MS lesions in the temporal lobe, in the pons and in the cerebellum were also associated with abnormal sympathetic skin responses. MS patients were also found to have an impairment in thermoregulatory sweating, which seemed to be related to disease severity and to total lesion volume in the brain. Sympathetic skin responses were also abnormal in optic neuritis patients, suggesting sudomotor autonomic failure. Patients with optic neuritis showed no thermoregulatory dysfunction.
Acta Universitatis Ouluensis. D, Medica
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