{
  "abstract": "Background Due to the lack of long-term studies, this research aimed to explore the changes and predictors of autonomic dysfunction (AD) in people with multiple sclerosis (pwMS) over a 6-year period from disease onset.Methods Among the 121 pwMS cohort, 75 underwent autonomic function tests at baseline and year 6. Autonomic symptoms were assessed using the Composite Autonomic System Score-31 (COMPASS-31), while the results of autonomic tests were recorded using the Composite Autonomic Scoring Scale (CASS) at baseline and biennially over 6 years. Symptomatic dysautonomia was identified by a COMPASS-31 score greater than 7.913 and a CASS score greater than 0.Results No significant changes were noted in the COMPASS-31 and CASS scores from baseline to year 6. However, there was a significant decline in the cardiovagal index (p=0.001) and the sudomotor index (p=0.036 and p=0.001, respectively) at years 4 and 6, compared with baseline. The number of participants with symptomatic dysautonomia increased significantly from year 0 to 6 (14 (20.9%) vs 29 (39.2%), respectively; p=0.049). Multivariable logistic regression analysis revealed that experiencing a relapse during the 6 years increased the likelihood of symptomatic dysautonomia (Exp(B) 3.886, 95% CI 1.019 to 14.825, p=0.047). Conversely, transitioning to high-efficacy disease-modifying therapy (HET) reduced the probability of having a CASS score greater than 0 at year 6 (Exp(B) 0.221, 95% CI 0.067 to 0.734, p=0.014).Conclusions Dysfunction of the cardiovagal and sudomotor systems progresses alongside disease duration in pwMS. The early initiation of HET may help mitigate the risk of developing AD.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, University Hospital “Sveti Duh”, Zagreb, Croatia"
      ],
      "name": "Berislav Ruška"
    },
    {
      "affiliations": [
        "Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia",
        "Department of Neurology, University of Zagreb, School of Medicine, Zagreb, Croatia"
      ],
      "name": "Ivan Adamec"
    },
    {
      "affiliations": [
        "Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia"
      ],
      "name": "Luka Crnosija"
    },
    {
      "affiliations": [
        "Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia",
        "Department of Neurology, University of Zagreb, School of Medicine, Zagreb, Croatia"
      ],
      "name": "Tereza Gabelić"
    },
    {
      "affiliations": [
        "Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia",
        "Department of Neurology, University of Zagreb, School of Medicine, Zagreb, Croatia"
      ],
      "name": "Barbara Barun"
    },
    {
      "affiliations": [
        "Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia"
      ],
      "name": "Anamari Junakovic"
    },
    {
      "affiliations": [
        "Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia",
        "Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia"
      ],
      "name": "Magdalena Krbot Skoric"
    },
    {
      "affiliations": [
        "Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia",
        "Department of Neurology, University of Zagreb, School of Medicine, Zagreb, Croatia"
      ],
      "name": "Mario Habek"
    }
  ],
  "title": "Evolution of autonomic nervous system abnormalities in multiple sclerosis: a 6-year follow-up",
  "uid": "760a4a21-dc0d-5fab-b771-51630e67abe0"
}