Understanding and managing autonomic dysfunction in persons with multiple sclerosis

ABSTRACT

Introduction

Multiple sclerosis (MS) is a chronic demyelinating immune mediated disease of the central nervous system. Autonomic dysfunction (AD) is frequently present in persons with MS (pwMS) and increases with disease duration and progression.

Areas covered

Cardiovascular, genitourinary, and sudomotor autonomic dysfunction in pwMS are reviewed and managing of these disorders is addressed.

Expert opinion

AD in pwMS can manifest with a myriad of symptoms including cardiovascular, urogenital, and sweating disorders. These symptoms can significantly impact the quality of life of pwMS with poor tolerance of upright position, difficulties in sexual function, and low endurance of physical activity especially in warm environments. Health professionals involved in care of pwMS should possess basic knowledge of the function of the autonomic nervous system and be informed of the way disorders of the autonomic function may manifest in pwMS in order to provide the proper care.

KEYWORDS:

• Autonomic dysfunction
• cardiovascular autonomic dysfunction
• bladder dysfunction
• multiple sclerosis
• sexual dysfunction
• sudomotor dysfunction

Funding

This paper was not funded.

Article highlights

• Autonomic dysfunction is commonly present in people with MS, beginning from the early stages of the disease.

• During the course of MS, cardiovascular autonomic dysfunction is observed in up to two thirds of patients and is more pronounced in the progressive stages of MS.

• Cardiovascular autonomic dysfunction can present as orthostatic intolerance and may lead to falls.

• Genitourinary dysfunction is one of the most common symptoms of MS and can manifest as sexual dysfunction, urinary frequency, incontinence, and retention.

• Sweating disorders in MS can lead to overheating and worsen preexisting neurologic disability.

• Autonomic dysfunction in people with MS should be actively searched for and managed.

Declaration of interests

I Adamec and M Habek participated as a clinical investigator and/or received consultation and/or speaker fees from: Biogen, Sanofi Genzyme, Merck, Bayer, Novartis, Pliva/Teva, Roche, Alvogen, Actelion, Alexion Pharmaceuticals, and TG Pharmaceuticals. M Krbot Skoric gave consultation and/or received speaker fees from: Sanofi Genzyme and Roche. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.