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MS and autonomic dysfunction
How often does autonomic dysfunction occur in MS and can it improve after the relapse that set it off?
BLOOD PRESSURE CONTROL
"An important feature of autonomic failure is orthostatic hypotension [or postural hypotension, where your blood pressure drops abruptly when you stand up or change posture], which results in wide-ranging symptoms. Patients may describe dizziness, lightheadedness, or syncope [fainting] when adopting a sitting or standing position."
This is #1 on my personal Autonomic Dysfunction Hit Parade :-)
Kyle
"An important feature of autonomic failure is orthostatic hypotension [or postural hypotension, where your blood pressure drops abruptly when you stand up or change posture], which results in wide-ranging symptoms. Patients may describe dizziness, lightheadedness, or syncope [fainting] when adopting a sitting or standing position."
This is #1 on my personal Autonomic Dysfunction Hit Parade :-)
Kyle
Dear Sho,
Thank you for all your research (and citations!). !! I found some of this info and some aI learned in school but you have found some very specific examples of the problems I am facing. I plan on presenting this information to my doctors, especially some of the finer points you quoted.
I appreciate this so much! You are great at what you do!
Many thanks,
Ren
Thank you for all your research (and citations!). !! I found some of this info and some aI learned in school but you have found some very specific examples of the problems I am facing. I plan on presenting this information to my doctors, especially some of the finer points you quoted.
I appreciate this so much! You are great at what you do!
Many thanks,
Ren
Love the quote you made, "my body forgot to read the anatomy books" perhaps too, "my body forgot to read the physiology books". LOL
Here's to low B/Ps and low HRs!
As you know, Im not diagnosed with MS, but as you're aware, my HR goes in the 30's and 80's/30's too. But it is not consistent like for a month, but only lasts for a few days, the longest has been about 6 to 7. You feel very weak, unable to stand type deal. It *****.
My heart goes out to you with this issue for I can at least say I know what it feels like with HRs and B/P's too low.
I wish you could catch a break with all this stuff going on. Although, it is good you have a great sense of humor which your body did take classes in to tolerate this crap! LOL!
Lots of love and hugs
Lisa
Here's to low B/Ps and low HRs!
As you know, Im not diagnosed with MS, but as you're aware, my HR goes in the 30's and 80's/30's too. But it is not consistent like for a month, but only lasts for a few days, the longest has been about 6 to 7. You feel very weak, unable to stand type deal. It *****.
My heart goes out to you with this issue for I can at least say I know what it feels like with HRs and B/P's too low.
I wish you could catch a break with all this stuff going on. Although, it is good you have a great sense of humor which your body did take classes in to tolerate this crap! LOL!
Lots of love and hugs
Lisa
I've struggled with a fast heart rate, blood pressure fluctuations, chest pain, etc, since I was fourteen or so. I would wager a guess that is when the MS actually began.
I cannot express how much suffering I have undergone since this started. No one understood what was going on, many doctors thought I was a hypochondriac for having issues they could not pinpoint as a teenager.I remember crying for hours without ceasing, knowing that I needed a wheelchair because of my erratic heart rate.I remember all the days I refused to do things because I could barely sit up.My weight also fell drastically because my heart rate would go through the roof when I dared to eat more than the bare minumum.However, all of my heart tests were fine.
This aspect of the disease desperately needs attention.Dysautonomia, in and of itself, NEEDS more recognition.
I cannot express how much suffering I have undergone since this started. No one understood what was going on, many doctors thought I was a hypochondriac for having issues they could not pinpoint as a teenager.I remember crying for hours without ceasing, knowing that I needed a wheelchair because of my erratic heart rate.I remember all the days I refused to do things because I could barely sit up.My weight also fell drastically because my heart rate would go through the roof when I dared to eat more than the bare minumum.However, all of my heart tests were fine.
This aspect of the disease desperately needs attention.Dysautonomia, in and of itself, NEEDS more recognition.
Why yes!!!! It's my favorite response from all of my docs...NOT!!!!! My OB-GYN once told me that my body forgot to read the anatomy books.
From your comment, I suppose you've heard the same response before. Why can't they just say, "I don't know, here's your money back for your visits and time lost from work since I can't figure out what's wrong with you.'
Plenty of other businesses have a money-back guarantee. Why not docs ????? Just wondering...........;-D,
From your comment, I suppose you've heard the same response before. Why can't they just say, "I don't know, here's your money back for your visits and time lost from work since I can't figure out what's wrong with you.'
Plenty of other businesses have a money-back guarantee. Why not docs ????? Just wondering...........;-D,
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I have the problem with being too cold all the time. I am always the one with a heavy coat or sweater. I know people with MS aren't supposed to do this, but I'm always turning up the heat in the shower. I didn't use to be this way. Plus the cold hands and feet, which may be a failure of the ANS to regulate the dilation of the blood vessels in the extremities.
I got a book called "Multiple Sclerosis: Diagnosis, Medical Management, and Rehabilitation" from the library. It has a chapter on autonomic disorders by Benjamin H. Eidelman. Eidelman argues that ANS problems in MS are underappreciated because they are often "insidious and subtle in nature" compared to the more blatant symptoms like motor or balance problems. They aren't really looked for in the typical neuro exam. All the time gets used up on more in your-face-problems.
He discusses the following areas:
BLOOD PRESSURE CONTROL
"An important feature of autonomic failure is orthostatic hypotension [or postural hypotension, where your blood pressure drops abruptly when you stand up or change posture], which results in wide-ranging symptoms. Patients may describe dizziness, lightheadedness, or syncope [fainting] when adopting a sitting or standing position."
CUTANEOUS VASOMOTOR FUNCTION
This seems to mean impaired control of the blood vessels serving the skin and can lead to altered skin appearance, such as changes in color or temperature changes where the skin feels hot or cold. He says the neuro should also ask about "changes in skin texture, development of indolent ulcers, and disturbances of hair and nail growth."
SUDOMOTOR FUNCTION
ANS dysfunction can lead to little or no sweating.
TEMPERATURE REGULATION
The hypothalamus, centers in the brainstem, and descending pathways in the spinal cord are important for maintaining normal body temperature.
" Thermoregulation is a finely controlled function, which in essence requires a balance between heat production and heat loss. Temperature regulation essentially is controlled by the hypothalamus and other components of the ANS, but metabolic and endocrine responses also play a role in thermoregulation. Temperature homeostasis thus relies on a central control mechanism affected by the hypothalamus and the AND and a peripheral system where heat is generated or lost. Skeletal-muscle activity is a major source of heat production. Heat is dissipated to the environment by cutaneous vasodilation, and this can be increased by sweating, which promotes heat loss by evaporation. In MS, both the central control mechanism, namely, the hypothalamus and its autonomic components, and the peripheral components may be defective. Multiple sclerosis patients are thus at risk for the development of both hypothermia and hyperthermia."
BLADDER FUNCTION
"Disturbances may include detrusor instability, resulting in marked frequency and urgency of micturition, as well as detrusor-external sphincter dyssynergia, which may affect the ability to adequately void. Sphincter control may be impaired, resulting in incontinence."
SEXUAL FUNCTION
"Erectile function is under control of the ANS and thus may be a symptom of disturbed ANS function."
BOWEL FUNCTION
"The gastrointestinal tract is innervated by autonomic nerves, and the ANS plays an important role in maintaining normal gastrointestinal function." MS can mess up your bowel function. It usually leads to severe constipation, but can also cause diarrhea. "The upper portion of the gastrointestinal tract may be involved and gastroparesis may occur, presenting as anorexia, bloating, nausea, and vomiting. Loss of secretomotor function may result in decreased saliva production presenting as dryness of the mouth."
OCULAR FUNCTION
Dysfunction of the ANS can cause problems with the lacrimal glands that keep the eyes moist, thus leading to dry eyes. There can be other eye problems. For example, "pupil reactions may be disturbed, giving rise to photophobia, glare intolerance, and impairment of focusing."
He discusses things that neuros should look for on the exam and things they should ask patients about. He also talks about lab testing for ANS problems.
Not sure how helpful this is, but I thought the point that neuros aren't usually actively looking for autonomic problems might help explain the perception that autonomic problems are so uncommon. Plus neuros and other outsiders can't see ANS problems.. You should be able to see some of this chapter on google books at http://books.google.com/books?id=iUt_BdDDBHoC.
Some other info that may be of use if you haven't seen it:
"The hypothalamus controls autonomic functions, temperature, sleep, and sexual activity. Cortical, brainstem, and spinal cord plaques often interrupt the sympathetic nervous system. This causes slow colonic transit, bladder hyperreflexia, and sexual dysfunction. Less-recognized phenomena from sympathetic nervous system disruption are vasomotor dysregulation (cold, purple feet), cardiovascular changes (orthostatic changes in blood pressure, blood pressure response to straining, and poor variation of the EKG R-R interval on Valsalva maneuver, possibly increasing risk of surgery), poor pilocarpine-induced sweating, poor sympathetic skin responses—especially in progressive multiple sclerosis (Karaszewski et al 1990; Acevedo et al 2000), pupillary abnormalities, and possibly fatigue. Rarely, plaques in brainstem autonomic pathways cause atrial fibrillation or neurogenic pulmonary edema, sometimes preceded by multiple sclerosis lesion-induced cardiomyopathy. Cold hands and feet often precede the diagnosis of multiple sclerosis, raising the possibility that undetected spinal cord lesions have already affected the autonomic nervous system.
"Sixty percent of patients have pupillary reactions that are abnormal in rate and degree of constriction (de Seze et al 2001). Pupillary defects do not correlate with visual-evoked potentials or history of optic neuritis.
"Autonomic dysfunction does correlate with axonal loss and spinal cord atrophy, yet not with cord MRI lesions. It is possible that plaques in the insular cortex, hypothalamus, and cord all disrupt sympathetic pathways. Parasympathetic and sympathetic dysfunction correlates with duration of multiple sclerosis, but not with disability (Gunal et al 2002). Parasympathetic dysfunction (eg, heart rate variation with respiration, abnormal pupillary reactions) is most pronounced in primary progressive disease. Sympathetic dysfunction can worsen during exacerbations. It is tied to dysregulated immunity (Flachenecker et al 2001); worse autoimmune disease in animal models and worse multiple sclerosis (Karaszewski et al 1991); less response to the beta-adrenergic agonist, isoproterenol (Giorelli et al 2004); and conversion to progressive multiple sclerosis…"
http://www.medmerits.com/index.php/article/multiple_sclerosis/P2
sho