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. 2019 Feb:28:250-255.
doi: 10.1016/j.msard.2019.01.005. Epub 2019 Jan 3.

Autonomic symptom burden can predict disease activity in early multiple sclerosis

Magdalena Krbot Skorić  1 , Luka Crnošija  2 , Tereza Gabelić  3 , Barbara Barun  3 , Ivan Adamec  2 , Anamari Junaković  2 , Tin Pavičić  2 , Berislav Ruška  2 , Mario Habek  4
Affiliations

Autonomic symptom burden can predict disease activity in early multiple sclerosis

Magdalena Krbot Skorić et al. Mult Scler Relat Disord. 2019 Feb.

Abstract

Background: We aimed to evaluate the role of autonomic nervous system (ANS) abnormalities on disease activity (relapses and new MRI lesions) and disease progression in people with clinically isolated syndrome (pwCIS).

Methods: Out of 121 consecutive pwCIS, data on disease activity and progression after 2.9 (1.4-4.1) years of follow-up, was available for 94 pwCIS. Baseline characteristics included MRI parameters, Composite Autonomic System Score-31 (COMPASS-31), Composite Autonomic Scoring Scale, and supine and standing levels of epinephrine and norepinephrine.

Results: Univariable logistic regression analysis revealed three predictors for occurrence of new relapse, COMPASS-31 > 7.32, total number of T2 lesions > 3 and decreasing supine level of epinephrine. The Kaplan-Meier survival analysis showed that patients with COMPASS-31 > 7.32 have statistically significant lower probability that they will be relapse free (p = 0.013). It has also showed that the relative risk reduction for occurrence of new relapse in participants with COMPASS < 7.32 was 46%. The multivariable regression model confirmed that COMPASS-31 > 7.32 and total number of T2 lesions > 3 increase the likelihood and the increasing supine level of epinephrine reduces the likelihood for a relapse. Finally, results of the Cox regression analysis showed, that after controlling for age, sex, total number of T2 lesions > 3 and supine level of epinephrine, the hazard for occurrence of new relapse for participants with COMPASS-31 > 7.32 is 2.7 times that of participants with COMPASS-31 < 7.32.

Conclusion: This study provides evidence that ANS is an important contributor to development of disease activity in pwCIS.

Keywords: Autonomic nervous system; COMPASS-31; MRI; Multiple sclerosis.

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