M. ARATA1, S. Cen2;
BACKGROUND: The FDA recently stated, “the criteria used to diagnose CCSVI have not been adequately established. Therefore, data to support CCSVI as a clinical entity on its own or its relationship with MS are inconclusive and at times, contradictory.” Patients seeking treatment for CCSVI present with a number of symptoms that vary from patient to patient. However, after extensive review of patients’ symptoms, an observation was made that there are symptoms reliably present which are consistent with autonomic dysfunction.
METHODS: Prior to consultation, patients were asked for the presence of seven symptoms associated with autonomic dysfunction. The symptoms were fatigue, interrupted sleep, thermal intolerance, bladder/bowel dysfunction, cognitive impairment, and headache upon awakening. A total of 489 patient questionnaires were evaluated. Relative prevalence of each symptom and exploratory factor analysis was carried out.
|
FACTOR 1 |
FACTOR 2 |
FACTOR 3 |
|
|---|---|---|---|
|
FATIGUE |
.27548 | .01788 | .09542 |
|
INTERRUPTED SLEEP |
.02449 | .32008 | .08998 |
|
BOWEL/ BLADDER |
.02449 | .32008 | .08998 |
|
THERMAL |
-.02892 | .21826 | .05541 |
|
COGNITIVE |
.58326 | -.04135 | -.04477 |
|
AWAKENING HEADACHE |
.06089 | .034099 | -.39293 |
RESULTS: Among these symptoms, brain fog cognitive impairment is highly related to fatigue and headache, with the presence of cognitive impairment, the odds of having fatigue and headache are OR (95% CI) 4.88 (7.44, 3.2) and 2.98 (4.49, 1.97) time higher than those without cognitive impairment. When having headache, the chance of having fatigue, poor sleep, cold hand and/or feet are significantly higher than those not with OR of 1.88 (2.88, 1.23), 2.14 (3.14, 1.45), and 1.66 (2.54, 1.08) respectively. When having poor sleep, the chance of having fatigue, cognitive impairment and cold hand and/or feet are significantly higher than those not with OR of 1.76 (2.62, 1.18), 1.84 (2.67, 1.26) and 1.86 (2.79, 1.24) respectively. Bladder bowel disturbances is more likely a stand along symptom which is only related to poor sleep with OR of 1.66 (2.53, 1.08). The prevalence rate of symptomatic dysautonomia are the following: bladder bowel disturbances: 76.89%, brain fog cognitive impairment: 63.6%, fatigue: 72.19%, headache: 39.06%, poor sleep: 59.92%, cold hand and/or feet: 73.21%. Exploratory factor analysis suggests three latent factors based on dysautonomia symptoms. Factor 1 has heavy weight on presence of fatigue and cognitive impairment; factor 2 has heavy weight on presence of poor sleep, cold hand and/or feet and headache; factor 3 has heavy weight on bladder bowel disturbances and absence of headache. The result from factor analysis suggests that the symptom grouped within each latent factor may share common physiological/pathological mechanism.
CONCLUSIONS: Based on presenting symptoms, dysautonomia appears highly prevalent among patients undergoing CCSVI treatment. Further study of the condition and its treatment should include assessment of autonomic dysfunction.
