Highlights
- •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.
Abstract
Objectives
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.
Methods
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.
Results
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.
Discussion
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.
Keywords
Abbreviations:
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 13, 2023
Accepted:
January 12,
2023
Received in revised form:
December 28,
2022
Received:
September 13,
2022
Identification
Copyright
© 2023 Published by Elsevier B.V.
