Key result
Patients with secondary progressive multiple sclerosis had significantly higher rates of impaired cerebral vasomotor reactivity compared to those with relapsing-remitting multiple sclerosis (90% vs 55%, p<0.001).
Why the study?
Autonomic dysfunction affects many multiple sclerosis patients, and brain vasculature changes can occur and contribute to pathophysiology, prompting evaluation of cerebral hemodynamics and autonomic dysfunction in relation to disease status.
Do cerebral hemodynamics and autonomic dysfunction differ between SPMS and RRMS patients?
Cross-Sectional (n=80)
No
Do cerebral hemodynamics and autonomic dysfunction differ between SPMS and RRMS patients?
Absolute Event Rate: 90% vs 55%
p-value: p=<0.001
Patients with secondary progressive MS have worse cerebrovascular hemodynamic insufficiency and autonomic dysfunction compared to those with relapsing-remitting MS.
Background Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. Autonomic dysfunction is present in a wide range of patients (15–80%) that might present with abnormalities in the regulation of the cardiovascular system, sleep disturbance, urinary symptoms, sexual problems, and temperature regulation problem. Although the predominant view is that of an autoimmune inflammatory condition, changes in brain vasculature can occur and contribute to pathophysiology. Objectives The aim of this study was to evaluate cerebral hemodynamics and assess autonomic dysfunction in patients with MS and explore its relationship with disease status. Methods Eighty patients diagnosed with MS according to McDonald criteria 2017 were recruited to this comparative cross-sectional study. All participants underwent assessment of cerebral hemodynamics through transcranial Doppler ultrasonography. Cerebral vasomotor reactivity (CVR) to hypercapnia was measured by the breath-holding index (BHI). They were also assessed for autonomic dysfunction by autonomic questionnaire and blood pressure measurements in both erect and supine positions. Results BHI values showed decreased CVR and were significantly lower in SPMS than in RRMS patients. Autonomic functions were more affected in SPMS than RRMS with total score 2.58 ± 1.13 for the RRMS group and 4.05 ± 1.04 for the SPMS group. Conclusions Cerebrovascular hemodynamic insufficiency in MS may be secondary to the downstream effects of neuro-inflammatory cascades.
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Salah et al. (2021) conducted a cross-sectional in Multiple Sclerosis (n=80). Secondary progressive multiple sclerosis (SPMS) vs. Relapsing remitting multiple sclerosis (RRMS) was evaluated on Impaired cerebral vasomotor reactivity (Breath-Holding Index < 0.6) (p=<0.001). Patients with secondary progressive multiple sclerosis had significantly higher rates of impaired cerebral vasomotor reactivity compared to those with relapsing-remitting multiple sclerosis (90% vs 55%, p<0.001).
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