Author Of 2 Presentations
P0698 - Clinical and MRI correlates of autonomic dysfunction in neuromyelitis optica spectrum disorder (ID 279)
Abstract
Background
Dysautonomia is common and associated with disease disability or activity in multiple sclerosis. However, in neuromyelitis optica spectrum disorder (NMOSD), the clinical and MRI correlates of autonomic dysfunction are unknown.
Objectives
The aim of this study was to investigate the relationship of autonomic dysfunction and clinical findings in patients with NMOSD.
Methods
A total of 27 patients (mean age, 44.4±12.26 years; female: male=22:5) were enrolled in this study. For the assessment of autonomic dysfunction, hear rate variability (HRV) and blood pressure (BP) measurement to deep breathing, Valsalva maneuver or head tilt-table test, with quantitative sudomotor axon reflex test (QSART) were used and interpreted in the form of the composite autonomic scoring scale (CASS). Clinical and radiological correlates with autonomic profiles were analyzed.
Results
Among the 27 patients, 74.1% (N=20) showed autonomic dysfunction, involving the adrenergic, cardiovagal, and sudomotor domains. Demographics and MRI findings were associated with each index of CASS. The number of attacks showed the association with cardiovagal index (B=0.197, S.E. 0.070, 95% CI 0.051-0.342, p=0.010), corticospinal tract lesion with adrenergic index (B=2.780, S.E. 0.970, 95% CI 0.783-4.777, p=0.008), the involvement of brain and/or spinal cord with total CASS score (B=1.258, S.E. 0.566, 95% CI 0.081-2.434, p=0.037) and male gender with sudomotor index (B=1.317, S.E. 0.425, 95% CI 0.376-2.259, p=0.008). In multivariable analysis, delayed pressure recovery time in the Valsalva maneuver, onset age, and disease activity showed a significant positive association with EDSS score (B=2.177, S.E. 0.758, 95% CI 0.553-3.802, p=0.011; B=0.061, S.E. 0.023, 95% CI 0.014-0.107, p=0.013; B=1.369, S.E. 0.593, 95% CI 0.142-2.596, p=0.030, respectively).
Conclusions
Cardiovascular and sudomotor autonomic dysfunction are common in NMOSD. Several clinical and MRI characteristics of patients may warrant the investigation of autonomic dysfunction and its proper management.
P0756 - Subcortical structures shape analysis of fatigue in neuromyelitis optica spectrum disorder (ID 1672)
Abstract
Background
Fatigue has been reported to be a common symptom and a major burden in neuromyelitis optica spectrum disorder (NMOSD). However, structural MRI substrates of fatigue in NMOSD are not well studied.
Objectives
Herein, we explored brain subcortical structures and investigated their relationships with fatigue severity in patients with seropositive NMOSD using a surface-based shape analysis.
Methods
We prospectively studied patients with NMOSD who were in remission and seropositive for anti-aquaporin-4 antibody. All enrolled patients completed self-reported fatigue assessment using the Functional Assessment of Chronic Illness Therapy-fatigue (FACIT-fatigue) score and the demographic and clinical characteristics were also collected. MRI examination and analysis were done in all patients; the overall process of this study follows MR image processing for extracting subcortical shapes for each individual and registering them to template subcortical surface. After local shape volume extraction, together with demographic information, we implemented statistical analysis of subcortical regions with partial correlation computation and extracted significant sub-clusters via multiple comparison correction using cluster-based statistics.
Results
A total of 28 patients were enrolled (mean age, 47.2±11.2 years; female:male=21:7). Their median disease duration was 2.9 years (IQR 1.3-8.9) and mean FACIT-fatigue score was 36.6±11.6. The volume of subcortical structures were significantly correlated with FACIT-fatigue score including caudate (r = 0.388, p = 0.050), pallidum (r = 0.391, p = 0.048), putamen (r = 0.511, p = 0.008), and thalamus (r = 0.393, p = 0.047). And subcortical local shape volume analysis using cluster-based statistics showed that the fatigue severity was correlated with both caudate and right thalamus (threshold 0.3; left caudate 0.006; right caudate 0.039; right thalamus 0.006) when controlling age, gender, intracranial volume.
Conclusions
The present study suggested that fatigue was common in patients with NMOSD, and local shape volume of subcortical structures in the caudate and thalamus might serve as a biomarker for fatigue in NMOSD.