J Neurol Sci 2001 Jul 15;188(1-2):37-41
de Seze J, Arndt C, Stojkovic T,
Ayachi M, Gauvrit JY, Bughin M, Saint Michel T, Pruvo JP, Hache JC, Vermersch
P
Autonomic nervous system disturbances
such as pupillary abnormalities have rarely been evaluated in multiple
sclerosis (MS).
However, pupillary impairment is
not uncommon in MS and its origin is still unclear.
The aim of this study was to investigate
pupillary disturbances in MS and to try to correlate pupillary defects
with spinal cord and brainstem magnetic resonance imaging (MRI) findings.
We prospectively studied 45 MS patients
and 30 normal subjects.
Methods: The pupillary contraction
latency and the amplitude of contraction were recorded by pupillometry.
We also determined afferent and efferent
pathway defects by comparing the direct and consensual pupillary reflexes.
We evaluated brainstem and spinal
cord demyelinating lesions and spinal cord cross-sectional area on MRI.
At least one pupillometric parameters
were significantly impaired in 60% of patients and in none of the controls.
We did not find any correlation between
pupillary defect and demyelinating lesions on MRI.
The most frequent abnormality was
efferent pathway shift and this was correlated with spinal cord atrophy
(P<0.02).
These results confirm that the autonomic
nervous system, and especially pupillary function, is frequently impaired
in MS.
The parasympathetic system is most
commonly affected and this is most likely linked to axonal loss (demonstrated
by spinal cord atrophy) rather than to demyelinating lesions.
PMID: 11489283, UI: 21382538
Department of Neurology, Hopital
R. Salengro, CHRU de Lille, 59037 Cedex, Lille, France