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Severe dysautonomic symptoms in patients suffering from neuromyelitis optica spectrum disorder are associated with poor quality of life. Management of these symptoms can facilitate a better quality of life for these patients.

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory condition that involves the central nervous system (CNS), and its pathogenesis is based on the development of antibodies against aquaporin 4 (AQP4). 

This study aimed to assess the risk factors pertaining to the dysautonomic burden in patients suffering from NMOSD and the quality of life outcomes. The study concluded that there is a correlation between dysautonomic symptom burden and reduced quality of life in NMOSD patients. The management of these symptoms may aid in improving patients’ quality of life. The study findings are published in the journal BMC Neurology.

Characteristics of Study Participants

The study included 63 healthy controls (HCs) and 63 patients diagnosed with NMOSD. Regarding the clinical phenotype of NMOSD patients, 15 had optic neuritis only, 22 had transverse myelitis only, and 30 patients reported both optic neuritis and transverse myelitis. Moreover, 42 patients utilized immunosuppressants, 17 were given rituximab, and 4 were administered other therapies.

COMPASS-31 Score in NMOSD Patients vs. Healthy Controls

The Composite Autonomic Symptoms Score 31 (COMPASS-31) was significantly higher among NMOSD patients than HCs, particularly in the bladder, orthostatic intolerance, secretomotor, pupillomotor, and vasomotor domains. All the NMOSD patients in this study exhibited dysautonomic symptoms, as indicated by a COMPASS-31 score > 0. The relevant domains were bladder symptoms (49 patients), pupillomotor symptoms (58 patients), orthostatic intolerance (40 patients), vasomotor symptoms (42 patients), secretomotor symptoms (57 patients), and gastrointestinal symptoms (60 patients).

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COMPASS-31 Score and Associated Factors in NMOSD Patients

The total COMPASS-31 scores differed significantly across the clinical phenotypes. Based on the COMPASS-31 subscores, the vasomotor symptom score varied significantly among patients with different preventive therapies. Furthermore, female NMOSD patients demonstrated significantly higher gastrointestinal symptom scores than their male counterparts. 

Factors associated with higher COMPASS-31 scores included a greater number of attacks, a greater number of thoracic cord lesions, higher Hospital Anxiety and Depression Scale – Anxiety score, higher Fatigue Severity Scale score, longer duration of the disease, greater number of total spinal cord lesions, higher Expanded Disability Status Scale score (EDSS), and higher Pittsburgh Sleep Quality Index score.

Factors Associated With the Quality of Life in NMOSD Patients

The independently correlated factors affecting the quality of life of NMOSD patients included the body mass index and COMPASS-31 score.

This study reported that NMOSD patients exhibited severe dysautonomic symptoms compared to HCs when the gender and age of the study participants were matched. The independent risk factors included the EDSS score, fatigue, and the number of spinal cord lesions in the NMOSD patients. Managing dysautonomic symptoms can contribute substantially to improving the quality of life of NMOSD patients.


Yang, L., Li, W., Xie, Y., Ma, S., Zhou, X., Huang, X., & Tan, S. (2023). Impact of dysautonomic symptom burden on the quality of life in Neuromyelitis optica spectrum disorder patients. BMC Neurology, 23(1). https://doi.org/10.1186/s12883-023-03162-1