Autonomic dysfunction (sweating responses) in multiple sclerosis.

Bladder disturbances and sexual impotence are common and distressing disorders occurring in multiple sclerosis. Miller, Simpson, and Yeates (1965) found bladder complaints occurring at some time of the disease in 78% of 297 patients, and in 52% of them it had persisted for over six months, while sexual impotence due to physical disease occurred in 44% of their patients. Although these disturbances are known to arise from involvement of peripheral or central autonomic pathways (Kuntz, 1947; Bors and Comarr, 1960), the lesions of multiple sclerosis are restricted to the central nervous system and consequently they must arise from disruption of central pathways. To our knowledge no specific study has been made on autonomic dysfunction occurring in multiple sclerosis. We have, accordingly, investigated the sympathetic nervous system in this disease by means of eliciting the sweating responses to heat, to drugs, and to distension of the urinary bladder, since these procedures are easy to carry out and can be repeated with consistent results. METHOD Practically all the subjects studied were already in our controlled trial which has been going on for over three years, and in which we are investigating the therapeutic value of the long-term administration of A.C.T.H. Gel in multiple sclerosis. No patient was known to have suffered from any generalized skin disease which may have affected their sweating responses (Sulzberger and Herrmann, 1954). THERMOREGULATORY SWEATING This procedure has been described by Guttmann (1947) and was used routinely to induce sweating in 60 patients of whom 45 were female and 15 male. After the patient had ingested hot fluids (a cup of tea) and 10 gr. acetylsalicylic acid, the trunk was heated by means of a heat cradle. The subject and heat cradle were covered with blankets leaving only the head and neck exposed. The patient was sprayed with quinzarin powder in order to detect the area of sweating. This powder, normally grey in colour, changes to a deep blue when sweating occurs. The intensity and the distribution of the change in colour gives a rough estimate of the amount of perspiration that has taken place. The procedure was carried out with the subject lying in the supine position, since it is known that postural reflexes can modify the sweating responses (Kuno, 1956). Skin temperatures of the forehead, trunk, and proxi-mal and distal limbs were registered with an electric universal thermometer, and oral temperatures with an ordinary clinical thermometer, …