Amyotrophic lateral sclerosis (ALS), considered a pure motor disease, can affect the autonomic nervous system, with sudomotor, cardiovagal, adrenergic, bladder and gastrointestinal (GI) dysfunction. Patients with ALS (PALS) report high rates of GI dysfunction; constipation, but its extent, severity, and relationship to autonomic dysfunction is not well understood.

Autonomic dysfunction, constipation’s impact on quality of life, and constipation symptoms in 44 PALS were assessed with Scales for Outcomes in Parkinson’s Disease-Autonomic (SCOPA-AUT), Patient Assessment of Constipation- Quality of Life (PAC-QOL), and Patient Assessment of Constipation- Symptoms (PAC-SYM) respectively. Scores were compared to previously reported disease-free subjects’(DFS) scores. 

PALS had higher rates of constipation on PAC-SYM; higher means for abdominal (3.44 vs. 1.59), rectal (2.6 vs. 1.06) and stool (5.47 vs. 2.07) symptoms

SCOPA-AUT results; 86% with GI dysfunction, vs 17% DFS. Other autonomic symptoms were urinary (81% vs. 46%), thermoregulatory (59% vs. 37%), and cardiac (31% vs. 9%).

PALS had greater negative effects on PAC-QOL; higher medians for physical discomfort (4.31 vs. 2.09), psychosocial discomfort (6.4 vs. .93), worries/concerns (9.26 vs. 1.69), and satisfaction (12.05 vs. 3.49).

Negative correlation exists between ALS-FRS, SCOPA-AUT, PAC-QOL and PAC-SYM scores. No significant correlation noted between disease duration or site of onset.

PALS on tricyclic antidepressants, narcotics, anticholinergics, antihistamines, antipsychotics, or Edaravone, had higher median SCOPA-AUT (13 vs. 6) and PAC-SYM scores (8 vs. 2).

We report higher rates of GI dysfunction in PALS and propose possible relationship to dysautonomia.  This study is ongoing, to ascertain extent/association of autonomic dysfunction, fluid intake, and medications.  This can pave way for individualizing treatment for GI dysfunction in PALS.