Evaluation of cardiovascular autonomic functions in relapsing remitting multiple sclerosis patients receiving first-line immunomodulatory treatment

ABSTRACT Evaluation of Cardiovascular Autonomic Functions in RRMS Patients Receiving First-Line Immunomodulatory Therapy Dr. Yakup GÖNÜLAL, Department of Neurology, Tokat Gaziosmanpasa University Faculty of Medicine, Tokat, 2024 Multiple Sclerosis (MS), is an autoimmune chronic disease of the central nervous system characterized by inflammation, demyelination and axon damage, some of which often occur in young adults, leading to attacks and remiston, progressive progression to a lesser extent, leading to severe disability and job loss, presumed to occur through complex interactions of genetic and environmental factors (1). Motor weakness, sensory symptoms, ataxia, bladder problems, fatigue, diplopia, visual symptoms such as blurred vision, cognitive complaints such as dysarthria, memory-concentration-attention disorders are common symptoms. Although it has not surfaced much, it leads to autonomous dysfunction in MS in various ways. As is known, cardiac follow-up has been extremely important during treatment, since some MS medications, such as fingolimod, lead to cardiac adverse effects. However, the positive/negative effects of other immunomodulatory agents on the autonomic nervous system or cardiac autonomic functions have not been well elucidated. Although all the signs and symptoms associated with SSS damage may occur in MS patients, some occur very often, and some occur rarely enough to be considered a red flag. Visual symptoms such as weakness in the extremities, sensory symptoms, ataxia, bladder problems, fatigue, diplopia, blurred vision, cognitive complaints such as dysarthria, memory-concentration-attention disorders are common symptoms. On the other hand, movement disorders, epileptic seizures, headaches, cognitive destruction at the dementia level, cortical symptoms, hearing loss, amyotrophy are rare signs and symptoms. In this study, we aim to investigate the effects of first-line immunomodulatory agents used in the treatment of RRMS, especially on cardiac autonomic functions. The results obtained from our study will contribute to the understanding of the factors that should be taken into account in terms of cardiac health when creating and managing treatment plans for MS patients. In addition, this study will be one of the few studies to evaluate the potential effects of immunomodulatory therapies on cardiac health from a broader perspective. In this context, our research will serve as an example of new studies that will investigate the potential effects of immunomodulatory therapies on the autonomic nervous system. Although it is known that MS primarily leads to autonomous dysfunction, it will be evaluated how effective the drugs used in the treatment of MS can be in reversing this autonomous dysfunction and whether the drugs will lead to a deterioration in possible autonomous findings. There are a large number of methods used to evaluate an autonomous system. Some of them have been abandoned due to usage and application difficulties. Autonomic dysfunction diagnostic methods, which are currently finding application, provide reliable results. Selected, safe test methods can be divided into four groups: Cardiovascular tests, pupil reaction tests, lacrimal secretion test,skin potential recording. 93 patients diagnosed with MS according to McDonald criteria were included in the study. RRMS Patients who have received any of the Interferon-beta 1a or dimethylfumarate treatments for the last 1 year, with an EDSS score below 5; patients who have had an MS clinic and diagnosis for at least 1 year and have not received any treatment were included to study. A total of 94 patients were enrolled in the study, including 32 patients using dimethylfumarate, 32 patients using Interferon-beta 1 a and 30 patients not receiving immunomodulatory therapy. In our study, a relationship was found between sympathetic skin response latency and Decibility, which is an indicator of high disease activity. The SSR latency was prolonged as the dizability(EDSS) increased. In particular, this difference was found statistically significant between those using Interferon beta-1a with a high EDSS score and an average age and Decontaminated(stable) patients. An association has been found between a Decrement in the parameters of heart rate variability and high disease activity. When looking at the decreased HRV values, it is understood that the autonomous dysability of the patient group using dimethylfumarate is more pronounced than the group not using drugs. This difference can be explained by the high dizability of the patient group using Dimethylfumarate and the high average age. This suggests a potential association where more severe autonomic dysfunction is associated with greater overall disability in Ms. As a result, the use of high-efficacy drugs in the treatment of RRMS will interfere with the dysability of patients, as well as prevent autonomic dysfunction, in this sense, early initiation of high-efficacy treatments after diagnosis of RRMS is important for the protection of the autonomic nervous system. Keywords: Multiple sclerosis, autonomic dysfunction, immunomudulatory therapies.