Almost all patients with neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) experience autonomic nervous system dysfunction, according to a new study published in the journal Multiple Sclerosis and Related Disorders. This is correlated with decreased quality of life and a lower autonomic burden is an independent predictor of better quality of life in both diseases.

“Further investigations are warranted in order to optimize treatment interventions in MS and NMOSD,” the authors said.

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To assess autonomic nervous system dysfunction in patients with NMOSD and MS and whether this has an impact on quality of life, a team of researchers from Serbia, Montenegro, and Croatia conducted a cross-sectional study at 3 national referral neurological clinics in these countries. 

There were 180 people at these clinics. Of these, 80 had NMOSD and 100 had MS.

The researchers found the total Composite Autonomic Symptom Score-31 (COMPASS-31) was above 0, which indicates that the presence of autonomic nervous system dysfunction was seen in all patients with NMOSD and in 97% of patients with MS. 

“Our findings showed that autonomic symptom burden was statistically significantly correlated with decreased quality of life, in both NMOSD and MS cohorts,” the researchers wrote. 

The independent predictors of a better quality of life in patients with NMOSD were lower autonomic burden and lower Expanded Disability Status Scale (EDSS) and Beck’s Depression Inventory (BDI) scores. 

Similarly, independent predictors of a better quality of life in patients with MS were lower EDSS and BDI scores, orthostatic intolerance, and the total COMPASS-31.

NMOSD is a rare chronic disease affecting the brain and spinal cord, which shares features of MS but is a separate entity. Most patients with NMOSD have autoantibodies against the aquaporin-4 water channel found in astrocytes.


Andabaka M, Pekmezovic T, Crnosija L, et al. Impact of the autonomic dysfunction on the quality of life in people with NMOSD and MS: an international cross-sectional study. Mult Scler Relat Disord. Published online August 21, 2023. doi:10.1016/j.msard.2023.104953