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This study looks to characterize gradients of dysfunction in the autonomic nervous system in patients with clinically diagnosed multiple sclerosis. The autonomic nervous system plays key roles in regulation of blood pressure, skin blood flow, and bladder health- all issues that individuals with multiple sclerosis typically suffer. Focusing on blood pressure regulation, the most precise metric with broad clinical applicability, the investigators will perform laboratory-based tests to probe the body's ability to generate autonomic responses. For both individuals with multiple sclerosis and uninjured controls, laboratory-based experiments will utilize multiple parallel recordings to identify how the autonomic nervous system is able to inhibit and activate signals. The investigators anticipate that those with autonomic dysfunction with multiple sclerosis will exhibit abnormalities in these precise metrics. The investigators will look to see if any substantial connections exist between different degrees of preserved autonomic function and secondary autonomic complications from multiple sclerosis. In accomplishing this, the investigators hope to give scientists important insights to how the autonomic nervous system works after multiple sclerosis and give physicians better tools to manage these secondary autonomic complications.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Individuals with multiple sclerosis | Experimental |
| |
| Individuals without multiple sclerosis | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Tests of sympathetic inhibition | Diagnostic Test | Bolus phenylephrine infusion using the Oxford technique will generate the need to inhibit sympathetic activity. Similarly, resting state Mayer waves will be assessed with regard to heart rate and blood pressure responses. |
| Measure | Description | Time Frame |
|---|---|---|
| Valsalva Maneuver Phase II | Presence or absence of phase II on Valsalva maneuver testing, which takes approximately 15 seconds to complete. This will be repeated x3. | During single laboratory diagnostic testing session, on average 30 minutes after start of laboratory testing session |
| Measure | Description | Time Frame |
|---|---|---|
| Beat-to-beat heart rate | Electrocardiogram will record continuous measures with changes in R-R interval (ms) quantified and compared to baseline. | Continuous recording during single laboratory diagnostic testing session, from baseline to lab session end, average of 3 hours in duration |
| Beat-to-beat blood pressure |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Erin Lund | Contact | 507-284-9298 | lund.erin@mayo.edu |
| Name | Affiliation | Role |
|---|---|---|
| Ryan J. Solinsky, MD | Mayo Clinic | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Mayo Clinic | Recruiting | Rochester | Minnesota | 55902 | United States |
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| ID | Term |
|---|---|
| D009103 | Multiple Sclerosis |
| D020211 | Autonomic Dysreflexia |
| ID | Term |
|---|---|
| D020278 | Demyelinating Autoimmune Diseases, CNS |
| D020274 | Autoimmune Diseases of the Nervous System |
| D009422 | Nervous System Diseases |
| D003711 | Demyelinating Diseases |
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| Tests of sympathetic activation | Diagnostic Test | Cold pressor test of the hand will be used to cause sympathetic activation. Valsalva's maneuver will assess the ability to buffer against blood pressure fall (phase II). |
|
| Testing of autonomic dysreflexia | Diagnostic Test | Cold pressor test of the foot and bladder pressor response will be tested. |
|
Non-invasive continuous blood pressure monitors will be used, with changes in systolic and diastolic pressure (in mmHg) from resting baseline measured. |
| Continuous recording during single laboratory diagnostic testing session, from baseline to lab session end, average of 3 hours in duration |
| Quantify autonomic dysreflexia and orthostatic hypotension | Participants will be given the Autonomic Dysfunction Following Spinal Cord Injury questionnaire (score range 0-436, with higher scores indicating more autonomic dysfunction). | Baseline, prior to laboratory diagnostic testing session |
| Quantify secondary autonomic complications | Participants will be given the Composite Autonomic Symptom Score (range 0-100, with higher scores indicating more autonomic dysfunction). | Baseline, prior to laboratory diagnostic testing session |
| Serum Catecholamines | A series of 3 serum catecholamine draws will occur during the study visit at baseline, pre-pressor test, and post-pressor test to evaluate change in stress hormone. | 3x during single laboratory diagnostic testing session - collected at Baseline, pre-pressor test, post-pressor test - pre-pressor & post-pressor timepoint labs collected on average 2.5 & 3 hours post-baseline, respectively |
| Serum Cortisol | A series of 3 serum cortisol draws will occur during the study visit at baseline, pre-pressor test, and post-pressor test to evaluate change in stress hormone. | 3x during single laboratory diagnostic testing session - collected at Baseline, pre-pressor test, post-pressor test - pre-pressor & post-pressor timepoint labs collected on average 2.5 & 3 hours post-baseline, respectively |
| T-Cell Exhaustion Markers | Blood will be drawn at start of laboratory testing to assess T-cell exhaustion markers by incidence of surface markers including PD-1, TIM-3, LAG3, and CTLA-4 per individual. | During single laboratory diagnostic testing session - Baseline |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| D001342 | Autonomic Nervous System Diseases |
| D013119 | Spinal Cord Injuries |
| D020196 | Trauma, Nervous System |