Reader response: Is MS affecting the CNS only? Lessons from clinic to myelin pathophysiology
MarioHabek, Neurologist, University of Zagreb, School of Medicine, Zagreb, Croatia
MagdalenaKrbot Skoric, Clinical Engineer, University Hospital Center Zagreb, Zagreb, Croatia
IvanAdamec, Neurologist, University Hospital Center Zagreb, Zagreb, Croatia
Submitted January 07, 2021
It is with great interest that we have read the article by Oudejans et al.1 As the authors point out, recent studies have revealed frequent involvement of the peripheral nervous system (PNS) in persons with multiple sclerosis (MS) demonstrated by MRI as well as by neurophysiological studies.2,3 This is of great importance as it expands our understanding of MS pathophysiology and incites further research in this area. We would like to add that PNS involvement in MS can also be demonstrated by testing the autonomic nervous system (ANS). Recent findings have shown that sudomotor function is frequently affected in persons with MS, demonstrated by quantitative sudomotor axon reflex testing, and furthermore, with disease duration and progression.4 As loss of sweating can lead to overheating and to transient MS symptoms worsening, such as Uhthof's phenomenon, the affection of PNS is not solely of research interest but may also contribute to overall symptom burden in MS.5 Therefore, it is paramount that further research is performed in this area to obtain a more complete understanding of the consequences of PNS affection in MS.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Oudejans E, Luchicchi A, Strijbis EMM, Geurts JJG, van Dam AM. Is MS affecting the CNS only? Lessons from clinic to myelin pathophysiology. Neurol Neuroimmunol Neuroinflamm. 2020 Nov 24;8(1):e914. doi: 10.1212/NXI.0000000000000914. PMID: 33234720; PMCID: PMC7803330.
Jende JME, Hauck GH, Diem R, Weiler M, Heiland S, Wildemann B, Korporal-Kuhnke M, Wick W, Hayes JM, Pfaff J, Pham M, Bendszus M, Kollmer J. Peripheral nerve involvement in multiple sclerosis: Demonstration by magnetic resonance neurography. Ann Neurol. 2017 Nov;82(5):676-685. doi: 10.1002/ana.25068. Epub 2017 Oct 26. PMID: 29023976.
Misawa S, Kuwabara S, Mori M, Hayakawa S, Sawai S, Hattori T. Peripheral nerve demyelination in multiple sclerosis. Clin Neurophysiol. 2008 Aug;119(8):1829-1833. doi: 10.1016/j.clinph.2008.04.010. Epub 2008 May 20. PMID: 18495530.
Adamec I, Crnošija L, Junaković A, Krbot Skorić M, Habek M. Progressive multiple sclerosis patients have a higher burden of autonomic dysfunction compared to relapsing remitting phenotype. Clin Neurophysiol. 2018 Aug;129(8):1588-1594. doi: 10.1016/j.clinph.2018.05.009. Epub 2018 Jun 4. PMID: 29885648.
Davis SL, Jay O, Wilson TE. Thermoregulatory dysfunction in multiple sclerosis. Handb Clin Neurol. 2018;157:701-714. doi: 10.1016/B978-0-444-64074-1.00042-2. PMID: 30459034.
It is with great interest that we have read the article by Oudejans et al.1 As the authors point out, recent studies have revealed frequent involvement of the peripheral nervous system (PNS) in persons with multiple sclerosis (MS) demonstrated by MRI as well as by neurophysiological studies.2,3 This is of great importance as it expands our understanding of MS pathophysiology and incites further research in this area. We would like to add that PNS involvement in MS can also be demonstrated by testing the autonomic nervous system (ANS). Recent findings have shown that sudomotor function is frequently affected in persons with MS, demonstrated by quantitative sudomotor axon reflex testing, and furthermore, with disease duration and progression.4 As loss of sweating can lead to overheating and to transient MS symptoms worsening, such as Uhthof's phenomenon, the affection of PNS is not solely of research interest but may also contribute to overall symptom burden in MS.5 Therefore, it is paramount that further research is performed in this area to obtain a more complete understanding of the consequences of PNS affection in MS.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References