Research Article| Volume 70, 104514, February 2023

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Multiple sclerosis-related heat sensitivity linked to absence of DMT prescription and subjective hand impairment but not autonomic or corticospinal dysfunction

  • Amber L. Critch
    Recovery & Performance Laboratory, Faculty of Medicine, Leonard A Miller Centre, Memorial University of Newfoundland, Rm. 400, 100 Forest Road, St. John's, Newfoundland and Labrador A1A 1E5, Canada
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  • Nicholas J. Snow
    Recovery & Performance Laboratory, Faculty of Medicine, Leonard A Miller Centre, Memorial University of Newfoundland, Rm. 400, 100 Forest Road, St. John's, Newfoundland and Labrador A1A 1E5, Canada
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  • Lynsey R. Alcock
    Recovery & Performance Laboratory, Faculty of Medicine, Leonard A Miller Centre, Memorial University of Newfoundland, Rm. 400, 100 Forest Road, St. John's, Newfoundland and Labrador A1A 1E5, Canada
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  • Arthur R. Chaves
    Recovery & Performance Laboratory, Faculty of Medicine, Leonard A Miller Centre, Memorial University of Newfoundland, Rm. 400, 100 Forest Road, St. John's, Newfoundland and Labrador A1A 1E5, Canada
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  • Syamala Buragadda
    Recovery & Performance Laboratory, Faculty of Medicine, Leonard A Miller Centre, Memorial University of Newfoundland, Rm. 400, 100 Forest Road, St. John's, Newfoundland and Labrador A1A 1E5, Canada
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  • Michelle Ploughman
    Corresponding author.
    Recovery & Performance Laboratory, Faculty of Medicine, Leonard A Miller Centre, Memorial University of Newfoundland, Rm. 400, 100 Forest Road, St. John's, Newfoundland and Labrador A1A 1E5, Canada
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Published:January 13, 2023DOI:


      • We explored plausible physiologic and subjective factors related to heat sensitivity (HS) in MS.
      • Subjective hand impairment in daily activities had the greatest association with HS.
      • Lack of DMT prescription and higher EDSS use were also associated with HS.



      Heat sensitivity (HS) describes a temporary worsening of multiple sclerosis (MS) symptoms with increased body temperature. The pathophysiology may relate to central nervous system conduction deficits and autonomic dysfunction. We conducted deep clinical phenotyping of a cohort of persons with MS to identify predictors of HS.


      We recruited 59 MS participants with HS or No HS. Participants self-reported symptom severity (Hospital Anxiety and Depression Scale, Multiple Sclerosis Impact Scale, and fatigue visual analog scale) and underwent maximal exercise and transcranial magnetic stimulation testing to characterize autonomic and corticospinal function. We examined associations with HS using binomial logistic regression.


      People with HS (36/59) had significantly greater disability, depression, fatigue, and physical and psychological functional effects of MS. They also had significantly lower corticospinal excitability but not conduction. After controlling for disease-modifying therapy (DMT), disability, and disease type, self-reported difficulty using hands in everyday tasks was significantly associated with a large increase in the odds of HS. Autonomic and corticospinal dysfunction were not associated with HS. Lack of DMT use alone was also associated with a large increase in the odds of HS.


      Following a comprehensive assessment of plausible contributors to HS, HS was most strongly associated with lack of a DMT prescription and self-reported hand dysfunction. Surprisingly, objective measurement of autonomic and corticospinal integrity did not contribute to HS.



      AMT (active motor threshold), AUC (area under the curve), EDSS (expanded disability status scale), EMG (electromyogram), FDI (first dorsal interosseus muscle), HADS (hospital anxiety and depression scale), HR (heart rate), HS (heat sensitivity), MEP (motor evoked potential), MET (metabolic equivalents of task), MS (Multiple Sclerosis), MSIS-29 (Multiple Sclerosis Impact Scale), NPV (negative predictive value), OR (odds ratio), PPV (positive predictive value), PrMS (Progressive Multiple Sclerosis), RMS (Relapsing Multiple Sclerosis), ROC (receiver operator characteristic), RPE (rating of perceived exertion), TMS (transcranial magnetic stimulation), VAS (visual analog scale), V̇O2 (volume of oxygen uptake)
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