Highlights
- •The prevalence of electrodiagnostic abnormalities, especially axonal polyneuropathy, in the MS population may be higher than previously considered.
- •The presence of a peripheral axonal polyneuropathy may be important in the context of central axonopathy and neurodegeneration in MS.
- •Sympathetic autonomic nervous system dysfunction is common in MS
Abstract
Background
Peripheral nervous system (PNS) abnormalities in Multiple Sclerosis (MS) have been
reported in case reports and small case series over the past several decades. Little
is known, however, about the prevalence of electrodiagnostic abnormalities in patients
with MS, including not only demyelinating neuropathies such as chronic inflammatory
demyelinating polyradiculoneuropathy (CIDP) but also axonal peripheral neuropathy
and sympathetic dysfunction.
Methods
This is an observational, cross-sectional study with the objective of identifying
the prevalence of the electrodiagnostic abnormalities in predominantly Hispanic MS
patients in Miami, Florida. Electrodiagnostic data including nerve conduction study
(NCS), electromyography (EMG) and sympathetic skin response (SSR) information was
prospectively collected in 18 patients (16 females; 43.7±15.2 years) with a diagnosis
of MS compared to 18 healthy (16 females; 39.9±11 years), age- and height-matched
controls. The study was offered to all-comers in the MS Clinic over a period of 3
months, regardless of clinical suspicion for an underlying neuropathic process, in
an effort to estimate the prevalence of abnormalities. Demographic data including
age, sex, race/ethnicity was evaluated in addition to MS-specific characteristics
including MS subtype, duration of disease, duration of therapy, clinical symptoms
and laboratory data.
Results
There were no significant differences in baseline characteristics of patients and
controls for age (p=0.4) and height (164.0±6.4 vs 162.3±4.6 centimeters; p=0.3). The
mean disease duration was 106±27 months (median 107 months; range 5-336 months). The
mean Expanded Disability Status Scale (EDSS) was 2.4±1.87 (median: 2.5; range 1.0-6.5).
The ethnicity of patients (15 Hispanic, 3 non-Hispanic) and controls (13 Hispanic,
5 non-Hispanic; p=0.56) was similar. The frequency of electrophysiological axonal
polyneuropathy (PN) was 77.8% (14/18 patients), and 85.6% of these patients had clinical
sensory symptoms. Interestingly, 1 patient had previously unrecognized CIDP. All 18
patients displayed prolonged SSR latencies consistent with autonomic dysfunction.
Thirteen patients (72.2%) reported autonomic symptoms such as bladder abnormalities
and blood pressure fluctuations.
Conclusion
The prevalence of electrodiagnostic abnormalities, especially axonal polyneuropathy,
in the MS population may be higher than traditionally considered. The relationship
between axonal polyneuropathy and central axonopathy in the context of neurodegeneration
in MS should be further explored. Analytic studies may identify common symptomatic
and pathophysiologic etiologies to further understanding and potentially guide treatment
of MS subtypes with PNS involvement.
Keywords
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Article info
Publication history
Published online: September 04, 2021
Accepted:
September 2,
2021
Received in revised form:
August 16,
2021
Received:
April 19,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
