Autonomic dysfunction in amyotrophic lateral sclerosis: A neurophysiological and neurosonology study. Issue 4 (28th March 2022)

• Record Type: Journal Article
• Authors: Papadopoulou, Marianna; Bakola, Eleni; Papapostolou, Apostolos; Stefanou, Maria Ioanna; Moschovos, Christos; Salakou, Stavroula; Zis, Panagiotis; Zouvelou, Vasiliki; Kimiskidis, Vasilios K.; Chroni, Elisabeth; Tsivgoulis, Georgios
• Is Part Of: Journal of neuroimaging. Volume 32:Issue 4(2022)
• Page Start: 710
• Page End: 719
• Publication Date: 2022-03-28
• Subjects: ALS -- autonomic nervous system -- cross‐sectional area -- sympathetic skin response -- vagus nerve; Diagnostic imaging -- Periodicals; Nervous system -- Diseases -- Diagnosis -- Periodicals; Imagerie pour le diagnostic -- Périodiques; Système nerveux -- Maladies -- Diagnostic -- Périodiques; Imagerie médicale; Neuroimagerie; Neurologie; Système nerveux; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.804754
• DOI: 10.1111/jon.12993
• Languages: English
• ISSNs: 1051-2284

Abstract

Abstract: Background and Purpose: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting upper and lower motor neurons. Some ALS patients exhibit concomitant nonmotor signs, and thus ALS is considered a multisystem disorder. The aim of this study is to investigate autonomous nervous system involvement in ALS. Methods: We investigated 21 ALS patients and 28 age‐matched controls. ALS patients were assessed for disease severity with the Revised‐ALS Functional Rating Scale (ALSFSR) and for the presence of autonomic symptoms with the Composite Autonomic Symptom Score scale. Sympathetic nervous system was evaluated by sympathetic skin response (SSR) and parasympathetic nervous system by ultrasonography of vagus nerve (VN) at the level of the thyroid gland. Results: SSR latencies were shorter and SSR amplitudes were higher in controls compared to ALS patients. The cross‐sectional area (CSA) of the VN was significantly smaller in ALS patients (mean CSA right/left: 1.73±0.62 mm 2 /1.47±0.53 mm 2 ) compared to controls (mean CSA right/left: 2.91±0.79 mm 2 /2.30±0.80 mm 2 ), right: p <. 001, left: p <. 001. There was a significant negative correlation between disease duration and CSA of left‐VN ( r = –0.493, p = .023). This correlation was attenuated between disease duration and CSA of right‐VN ( r = –0.419, p = .059). ALSFSR‐R was positively correlated to CSA of right‐VN ( p = .006, r = 0.590). CSA of VN did not correlate with bulbar involvement. Conclusions: This study confirms the presence of autonomic dysfunction in ALS patients and provides evidence of VN atrophy that correlates with disease severity and duration and is independent of bulbar involvement. Degeneration of dorsal nucleus neurons of the VN is hypothesized.