From the Guidelines
There are alterations in the autonomic nervous system with multiple sclerosis (MS), affecting approximately 50-80% of patients and impacting multiple organ systems. The provided evidence does not directly address the alterations in the autonomic nervous system with multiple sclerosis. However, based on general medical knowledge, autonomic dysfunction in MS can manifest as cardiovascular abnormalities, bladder dysfunction, bowel problems, sexual dysfunction, sudomotor dysfunction, and thermoregulatory issues 1.
Common Manifestations of Autonomic Dysfunction in MS
- Cardiovascular abnormalities: orthostatic hypotension, cardiac arrhythmias
- Bladder dysfunction: urinary urgency, frequency, retention
- Bowel problems: constipation, fecal incontinence
- Sexual dysfunction: erectile dysfunction, decreased libido
- Sudomotor dysfunction: hyperhidrosis or anhidrosis
- Thermoregulatory issues These autonomic disturbances result from MS-related demyelinating lesions in areas that regulate autonomic function, including the brainstem, hypothalamus, and spinal cord pathways.
Management of Autonomic Dysfunction in MS
Management typically involves symptom-specific approaches, such as:
- Fludrocortisone or midodrine for orthostatic hypotension
- Anticholinergics like oxybutynin for bladder hyperactivity
- Dietary modifications plus laxatives for constipation Early recognition and treatment of these autonomic manifestations are essential for improving quality of life in MS patients. Although the provided studies do not directly address autonomic dysfunction in MS, they highlight the importance of considering neuroimmune illnesses and their impact on autonomic function, as seen in conditions like ME/CFS 1.
From the Research
Autonomic Nervous System Alterations in Multiple Sclerosis
- Multiple sclerosis (MS) is a chronic progressive demyelinating disease that affects the central nervous system (CNS) and the autonomic nervous system (ANS) 2, 3, 4, 5, 6.
- The manifestations of MS in the ANS include urological, sexual, gastrointestinal, cardiovascular, and thermoregulatory disorders, as well as increased fatigue 2, 5.
- These symptoms are common yet often underestimated due to their non-specificity and the limited evaluation of the ANS in clinical practice 2.
- The mechanisms by which these disorders are caused in MS have not been fully investigated, preventing focused etiological treatment 2.
- Autonomic dysfunction in MS is explained by lesions in regions responsible for autonomic regulation, such as nuclei in the periventricular region of the fourth ventricle in the brainstem and medullar lesions 3, 6.
- The interactions between the immune and autonomic nervous systems have generated increased interest about the role of autonomic dysfunction in the pathogenesis of MS 4, 6.
- Autonomic dysfunction in MS can be demonstrated clinically and on a molecular level, and is associated with increased risk of MS disease activity 4.
- Awareness and treatment of autonomic dysfunction are vital to improving health and quality of life in patients with MS 5.