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Open AccessReview

Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies

1
Department of Neurology, Kantonsspital Aarau, 5001 Aarau, Switzerland
2
Department of Neurology, University Hospital Tulln, Karl-Landsteiner-University, 3420 Tulln, Austria
3
Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria
4
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
5
Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria
6
Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, 2130 Mistelbach, Austria
7
Department of Neurology, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany
8
Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(2), 335; https://doi.org/10.3390/jcm9020335
Received: 21 December 2019 / Revised: 14 January 2020 / Accepted: 19 January 2020 / Published: 24 January 2020
(This article belongs to the Special Issue Autonomic Nervous System: From Bench to Bedside)
Cardiac autonomic dysfunction (CAD) has been reported in patients with multiple sclerosis (MS). This systematic review summarizes the evidence for the types and prevalence of CAD in MS patients, as well as its association with MS type, disease characteristics, fatigue and immunotherapies used to treat MS. The analysis revealed that CAD is correlated with pathophysiological processes of MS, can trigger serious cardiovascular complications that may reduce life expectancy, and may have implications for treatment with immunotherapies, especially fingolimod. Numerous mainly small case–control or cohort studies have reported various measures of CAD (particularly heart rate variation) in MS patients, showing higher rates of abnormality versus controls. A smaller number of studies have reported on cardiac autonomic symptoms in MS, including orthostatic intolerance/dizziness in around 50% of patients. CAD also appears to be associated with disease duration and to be more common in progressive than relapsing–remitting MS. However, although a substantial evidence base suggests that assessing CAD in people with MS may be important, standardised methods to evaluate CAD in these patients have not yet been established. In addition, no studies have yet looked at whether treating CAD can reduce the burden of MS symptoms, disease activity or the rate of progression. View Full-Text
Keywords: cardiac autonomic dysfunction; fingolimod; heart rate variability; multiple sclerosis; orthostatic intolerance cardiac autonomic dysfunction; fingolimod; heart rate variability; multiple sclerosis; orthostatic intolerance
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MDPI and ACS Style

Findling, O.; Hauer, L.; Pezawas, T.; Rommer, P.S.; Struhal, W.; Sellner, J. Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies. J. Clin. Med. 2020, 9, 335.

AMA Style

Findling O, Hauer L, Pezawas T, Rommer PS, Struhal W, Sellner J. Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies. Journal of Clinical Medicine. 2020; 9(2):335.

Chicago/Turabian Style

Findling, Oliver; Hauer, Larissa; Pezawas, Thomas; Rommer, Paulus S.; Struhal, Walter; Sellner, Johann. 2020. "Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies" J. Clin. Med. 9, no. 2: 335.

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