Impact of the autonomic dysfunction on the quality of life in people with NMOSD and MS: An international cross-sectional study

Marko Andabaka; Tatjana Pekmezovic; Luka Crnosija; Nikola Veselinovic; Anamari Junakovic; Olivera Tamas; Maja Budimkic Stefanovic; Vanja Jovicevic; Nikola Momcilovic; Milovan Roganovic; Gorica Maric; Aleksa Jovanovic; Tereza Gabelic; Magdalena Krbot Skoric; Sarlota Mesaros; Ljiljana Radulovic; Mario Habek; Jelena Drulovic

doi:10.1016/j.msard.2023.104953

Impact of the autonomic dysfunction on the quality of life in people with NMOSD and MS: An international cross-sectional study

Mult Scler Relat Disord. 2023 Nov:79:104953. doi: 10.1016/j.msard.2023.104953. Epub 2023 Aug 21.

Authors

Marko Andabaka¹, Tatjana Pekmezovic², Luka Crnosija³, Nikola Veselinovic⁴, Anamari Junakovic³, Olivera Tamas⁴, Maja Budimkic Stefanovic⁴, Vanja Jovicevic¹, Nikola Momcilovic¹, Milovan Roganovic⁵, Gorica Maric², Aleksa Jovanovic², Tereza Gabelic³, Magdalena Krbot Skoric³, Sarlota Mesaros⁴, Ljiljana Radulovic⁵, Mario Habek⁶, Jelena Drulovic⁷

Affiliations

¹ Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia.
² Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
³ Department of Neurology, University Hospital Center of Zagreb, Zagreb, Croatia.
⁴ Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
⁵ Clinic of Neurology, University Clinical Center of Montenegro, Podgorica, Montenegro.
⁶ Department of Neurology, University Hospital Center of Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
⁷ Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia. Electronic address: drulovicjelena@gmail.com.

PMID: 37688928
DOI: 10.1016/j.msard.2023.104953

Abstract

Background: A substantial autonomic nervous system (ANS) dysfunction has been described in multiple sclerosis (MS) and recently, also in neuromyelitis optica spectrum disorder (NMOSD). The prevalence of ANS symptoms contributes to the chronic symptom burden in both diseases. The aim of our study was to assess ANS dysfunction in people with (pw) NMOSD and MS, using the Composite Autonomic Symptom Score-31 (COMPASS-31), and additionally, to evaluate if ANS dysfunction have impact on the quality of life of these patients.

Methods: We conducted cross-sectional study at three national referral neurological clinics in Serbia, Croatia, and Montenegro. A total of 180 consecutive subjects, 80 pwNMOSD and 100 pwMS, followed-up at these clinics, were enrolled in the study. Subjects included in the study completed: the validated versions of the COMPASS-31 and the Multiple Sclerosis Quality of Life-54 (MSQoL-54), and the Beck Depression Inventory (BDI).

Results: This study demonstrated that the total COMPASS-31 score > 0.0, implicating the presence of ANS dysfunction, was detected in almost all NMOSD and MS study participants tested (80/80, and 97/100, respectively). Our findings showed that autonomic symptom burden was statistically significantly correlated with decreased quality of life, in both NMOSD and MS cohorts. The independent predictors of the better quality of life in pwNMOSD were lower autonomic burden, particularly the absence of the orthostatic intolerance (p = 0.005), along with lower EDSS and BDI score (p ≤ 0.001). Similarly, in pwMS, independent predictors were EDSS, BDI, orthostatic intolerance, and the total COMPASS-31 (p ≤ 0.001).

Conclusion: Our study demonstrated that a significant proportion of persons with both NMOSD and MS have considerable dysautonomic symptom burden which is correlated with the decreased quality of life. Further investigations are warranted in order to optimize treatment interventions in MS and NMOSD.

Keywords: Autonomic nervous system dysfunction; COMPASS-31; Multiple sclerosis; Neuromyelitis optica spectrum disorder; Quality of life.

MeSH terms

Autonomic Nervous System Diseases* / epidemiology
Autonomic Nervous System Diseases* / etiology
Cross-Sectional Studies
Humans
Multiple Sclerosis* / complications
Multiple Sclerosis* / epidemiology
Neuromyelitis Optica* / complications
Neuromyelitis Optica* / epidemiology
Orthostatic Intolerance*
Quality of Life