Störungen des autonomen Nervensystems und erhöhtes Fatigueerleben bei Multipler Sklerose

Introduction: MS patients frequently suffer from autonomic dysfunctions and fatigue. Therefore, the question arises whether these symptoms are intrinsically associated, and if so, why. Methods: We conducted a systematic analysis of the available international literature. Specifically, we recorded and compared the number of included patients, age, gender distribution, expanded disability status scale (EDSS), disease type, study design and assessment methods for autonomic dysfunctions and fatigue. Results: A total of 14 studies were included. The results of these questionnairebased studies indicate a significant association between autonomic dysfunctions and fatigue. In addition, studies including standardized autonomic tests (e.g., the Valsava manoeuvre) showed an association between autonomic dysfunctions and fatigue. This was confirmed by studies using heart rate variability to measure the activity of the autonomic nervous system, as evidence of increased parasympathetic nervous system activity related to fatigue. Discussion: Autonomic dysfunctions and fatigue are significantly associated with each other. The results support a common third cause of this association and the central importance of the vagal nerve, which controls autonomous functions and is involved in the feeling of fatigue due to inflammatory processes. Long-term studies are needed to validate this hypothesis.