Autonomic Dysfunction in Multiple Sclerosis

Autonomic dysfunction in multiple sclerosis encompasses a spectrum of disturbances arising from inflammatory demyelination of central nervous system pathways that regulate involuntary bodily functions. Patients may experience cardiovascular irregularities such as orthostatic intolerance, abnormal heart rate variation and impaired baroreflex function, alongside gastrointestinal symptoms including constipation, faecal incontinence and delayed gastric emptying. Bladder, sexual and sudomotor disturbances further compound clinical burden, contributing to fatigue, reduced mobility and diminished quality of life. The severity of autonomic impairment often correlates with disease duration, disability status and progressive phenotypes. Underlying mechanisms involve lesions within the central autonomic network, spinal cord involvement and vagal nerve alterations triggered by inflammatory mediators. Early recognition through targeted assessment and implementation of interdisciplinary management strategies is essential to mitigate complications, guide immunotherapy choices and optimise patient outcomes on a global scale.

Research from Nature Portfolio

In a large Italian cohort study, over half of people with multiple sclerosis exhibited bowel dysfunction as measured by a neurogenic bowel dysfunction score, with significant differences between relapsing–remitting and progressive subtypes. Detailed subscores from validated questionnaires revealed that severity of constipation and faecal incontinence rises in parallel with disease duration, disability scales and overall neurological impairment. These findings underscore the value of systematic gastrointestinal screening and the need to integrate bowel management into routine multidisciplinary care pathways.

Autonomic Dysfunction in Multiple Sclerosis publication trend

The graph below shows the total number of articles in autonomic dysfunction in multiple sclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

Neurogenic bowel dysfunction score (NBDS): A quantitative tool assessing severity of bowel dysfunction in neurological conditions.

Wexner constipation scale: A validated questionnaire measuring frequency and impact of constipation symptoms.

Orthostatic intolerance: Inability to maintain stable blood pressure and heart rate upon standing, causing dizziness or syncope.

Heart rate variability (HRV): The fluctuation in intervals between successive heartbeats, indicative of autonomic balance.

Composite Autonomic Symptom Score-31 (COMPASS-31): A self-report instrument evaluating autonomic symptoms across six functional domains.

References

1. A multiscale assessment of bowel impairment in an Italian multiple sclerosis cohort. Scientific Reports (2023).
2. Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies. Journal of Clinical Medicine (2020).
3. Frequency and characteristics of dysautonomic symptoms in multiple sclerosis: a cross-sectional double-center study with the validated Italian version of the Composite Autonomic Symptom Score-31. Neurological Sciences (2020).
4. Autonomic Dysregulation in Multiple Sclerosis. International Journal of Molecular Sciences (2015).