Predicting Hypothermia in Multiple Sclerosis Isn't All That Easy

For patients with multiple sclerosis (MS), disturbances in the thermoregulation can result in episodic hypothermia. It’s believed that this is caused by hypothalamic lesions from the disease, however, the specifics are not fully understood.

M. Toledano and colleagues from the University of Utah set out to uncover more in a poster session that will be presented at the 31^st Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS 2015) in Barcelona, Spain.

The analysis included 156 patients gathered from Mayo Clinic electronic medical records from 1996 to May 2015. Out of the 32 patients with both MS and hypothermia, 22 (69%) were women. At the point of hypothermia onset, 24 (75%) had relapsing disease and 29 (91%) had progressive disease. Patients had a median disease duration of 19.9 years and an average Expanded Disability Status Scale (EDSS) score of eight.

The lowest temperature found among the group was 30 to 35 C°, but 81% (26 patients) had intermittent hypothermic manifestations. Consciousness, however, did not appear to have a connection with the severity of hypothermia. Infections were suspected to be the drive behind hypothermia in 56% (18 patients), but it was only clinically confirmed in 28% (9 patients). Another notable finding magnetic resonance imaging (MRI) revealed lesions within the brainstem in 66% (21 patients) — 12% (4 patients) of which were in the hypothalamus.

So what does this all mean?

Since consciousness did not have a strong role in hypothermia associated with MS, it appears that other factors influence consciousness. In addition, infections are often suspected to be the force behind it but little data is available.

“MS-related hypothermia occurs predominantly in patients with advanced secondary progressive MS,” the authors explained, “although in other respects the distribution of gender and age is consistent with the profile of patients with this stage and course of MS.”