Aa
MS and autonomic dysfunction
How often does autonomic dysfunction occur in MS and can it improve after the relapse that set it off?
ren, don't you just love it when your docs tell you how unique and special you are?
This link brings you to the study that is cited as 5
http://www.docstoc.com/docs/20979026/Autonomic-nervous-system-dysfunction-in-multiple-sclerosis-patients
You can download this once it loads, but I didn't want to sign-in to grab the pdf. Least you can read it, only 4 pages
http://www.docstoc.com/docs/20979026/Autonomic-nervous-system-dysfunction-in-multiple-sclerosis-patients
You can download this once it loads, but I didn't want to sign-in to grab the pdf. Least you can read it, only 4 pages
Maybe they think it's rare because it's so underreported? Surely the literature and study seems to be scarce.
Think all who are dealing with this will find this informative.
http://www.hindawi.com/journals/ad/2011/803841/
Think all who are dealing with this will find this informative.
http://www.hindawi.com/journals/ad/2011/803841/
To Beema and Ess,
I, too, have a broken thermostat. Usually I am cold no matter what the room temperature is but recently, with the cardio onset, I have the sweating issue now as well. Miserable is the best adjective I can think of.
I also have urination and GI issues as well , all tied to the vagal nerve and it's dysfunction in my body.
@Beema - I did research baroreceptor failure and found that is just one piece of my body's puzzle. Thanks for the suggestion as it is spot on.
@JJ- Thank you for the wonderful link!!!! I don't know how I missed this wonderful article!!! It is literally my life described on paper. I plan on presenting all of my docs a copy of this research collected.
Thanks to all of you for chiming in and making me feel less of an abnormality,lol. My docs keep saying it's so rare yet here on the forum it appears to be different. Actually, the literature does say it is a rare occurrence in MS. Perhaps because we have a concentrated group of MS sufferers it seems more common.
Best,
Ren
I, too, have a broken thermostat. Usually I am cold no matter what the room temperature is but recently, with the cardio onset, I have the sweating issue now as well. Miserable is the best adjective I can think of.
I also have urination and GI issues as well , all tied to the vagal nerve and it's dysfunction in my body.
@Beema - I did research baroreceptor failure and found that is just one piece of my body's puzzle. Thanks for the suggestion as it is spot on.
@JJ- Thank you for the wonderful link!!!! I don't know how I missed this wonderful article!!! It is literally my life described on paper. I plan on presenting all of my docs a copy of this research collected.
Thanks to all of you for chiming in and making me feel less of an abnormality,lol. My docs keep saying it's so rare yet here on the forum it appears to be different. Actually, the literature does say it is a rare occurrence in MS. Perhaps because we have a concentrated group of MS sufferers it seems more common.
Best,
Ren
COMMUNITY LEADER
You'd think autonomic dysfunctions would be more commonly seen by MS specialists, especially considering gastrointestinal issues of MSers being so common within the community, though not sure cardio issues are as common but i thought it was still quite recognised in MS. I did find this comment interesting
"The most common autonomic symptoms in MS are disorders of micturation, impotence, sudomotor and gastrointestinal disturbances, orthostatic intolerance as well as sleep disorders. " published in the neurology journal 2006
Not sure if you've read this 20011 article called "Autonomic disorders in Multiple Sclerosis" http://www.hindawi.com/journals/ad/2011/803841/ only bringing it to your attention because it specifically discusses both the issues you've mentioned and might lead to more info :o)
I do find autonomic dysfunctions to be fascinating but a tad confusing, i have more than a few but thankfully none as scary as whats going on with your heart. I'm "tootling along" as my son like to say, if you do ever get your hands on an answer, please let us know!
HUGS...........JJ
"The most common autonomic symptoms in MS are disorders of micturation, impotence, sudomotor and gastrointestinal disturbances, orthostatic intolerance as well as sleep disorders. " published in the neurology journal 2006
Not sure if you've read this 20011 article called "Autonomic disorders in Multiple Sclerosis" http://www.hindawi.com/journals/ad/2011/803841/ only bringing it to your attention because it specifically discusses both the issues you've mentioned and might lead to more info :o)
I do find autonomic dysfunctions to be fascinating but a tad confusing, i have more than a few but thankfully none as scary as whats going on with your heart. I'm "tootling along" as my son like to say, if you do ever get your hands on an answer, please let us know!
HUGS...........JJ
My autonomic dysfunction comes in the form of inability to regulate my body temperature properly. What feels normal to most people is horribly hot to me, and my heat tolerance has gone way down.
This is not the same as a bad reaction to heat that many MSers experience. It's not a question of symptoms being worse when I'm out in hot weather and then getting back to relative normal after cooling down. For me, it can be like a continuing hot flash, with sweat pouring off and all that attractive stuff. I used to be a winter hater, but now it's the only time I'm comfortable. I like afternoon temps in the 50s and low 60s--after that I'm too hot.
I would say I'm 'overheated' pretty much all the time, and as I look back, it's been that way for a good 4 or 5 years, gradually getting worse, so that part doesn't go away for me.
I do have intermittent problems with urination, at least part of which must be autonomic, and others here have malfunctioning peristalsis. If this kind of thing really doesn't qualify as autonomic, I hope someone more knowledgable will correct me. But for me and for others, these symptoms do remit, so there's comfort in that.
ess
This is not the same as a bad reaction to heat that many MSers experience. It's not a question of symptoms being worse when I'm out in hot weather and then getting back to relative normal after cooling down. For me, it can be like a continuing hot flash, with sweat pouring off and all that attractive stuff. I used to be a winter hater, but now it's the only time I'm comfortable. I like afternoon temps in the 50s and low 60s--after that I'm too hot.
I would say I'm 'overheated' pretty much all the time, and as I look back, it's been that way for a good 4 or 5 years, gradually getting worse, so that part doesn't go away for me.
I do have intermittent problems with urination, at least part of which must be autonomic, and others here have malfunctioning peristalsis. If this kind of thing really doesn't qualify as autonomic, I hope someone more knowledgable will correct me. But for me and for others, these symptoms do remit, so there's comfort in that.
ess
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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