Cardiovascular autonomic function in patients with relapsing remitting multiple sclerosis: a new surrogate marker of disease evolution?

Twenty patients with active relapsing remitting multiple sclerosis (MS) wer e examined annually for 2 years with a set of autonomic function tests (AFT ) consisting of heart rate variability during deep breathing (IE), standing -up, and ratios of Valsalva manoeuvre (VR). Disease characteristics, includ ing T2-weighted magnetic resonance imaging (MRI) of the brain and the expan ded disability status scale (EDSS) score were documented each year within 1 week of the AFT. The EDSS score, MRI: load lesion and VR did not change si gnificantly over the follow-up period. The IE and initial heart-rate on sta nding during the first 30 s (Delta HRMAX) showed significant worsening duri ng follow-up. No relationship was found between deterioration of AFT and ED SS score, number of exacerbations, duration of disease, gender, age, size a nd number of lesions on MRT. Ne conclude that patients with active relapsin g remitting RIS show progression of autonomic dysfunction over a relatively short time. Therefore, in the absence of changes in clinical disability or brain MRI lesion load, AFT might be useful as a sensitive surrogate outcom e measure for demonstrating subclinical change in MS. Eur J Neurol 6:29-33 (C) 1999 Lippincott Williams & Wilkins.