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Introduction <p>The Quantitative Sudomotor Axon Reflex Test (QSART) is the gold standard for evaluating sudomotor function in the Composite Autonomic Scoring Scale (CASS). Sudoscan® has been proposed as a potential alternative. This study investigated whether Sudoscan®-derived indices could replace QSART within the CASS framework and provide reliable sudomotor evaluation in people with multiple sclerosis (pwMS).</p> Methods <p>This study included 99 pwMS. Subjective autonomic symptoms were assessed with the Composite Autonomic Symptom Score-31 (COMPASS-31), and objective autonomic testing was performed with the CASS, which includes QSART for sudomotor assessment. Additionally, all pwMS underwent Sudoscan® testing, and a modified CASS score was derived from adrenergic, cardiovagal, and Sudoscan®-based sudomotor measures.</p> Results <p>A strong correlation was observed between CASS and modified CASS (r = 0.795, p &lt; 0.001). Autonomic dysfunction (CASS ≥ 1) was present in 72.7% of participants, while 77.7% had modified CASS ≥ 1. However, no correlation was found between QSART- and Sudoscan®-based sudomotor indices (r = 0.043, p = 0.672).CASS did not correlate with COMPASS-31 or its subdomains, whereas modified CASS correlated with the gastrointestinal domain of COMPASS-31 (r = 0.228, p = 0.027). Additionally, modified CASS correlated with age (r = 0.204, p = 0.048) and the Expanded Disability Status Scale (EDSS) score (r = 0.207, p = 0.043).</p> Conclusions <p>The modified CASS, including Sudoscan® sudomotor testing, showed a strong overall correlation with the standard CASS and meaningful associations with age and disability level. More long-term studies are needed to assess its effectiveness in monitoring sudomotor dysfunction over time.</p>

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Sudoscan® and QSART in the composite autonomic severity scale: complementary approaches to sudomotor assessment in multiple sclerosis

  • 期刊论文

  • 发表日期：

    2026年3月28日

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  • Katarina Tešija,
  • Mašan Sredanović,
  • Katy Jerčinović,
  • Magdalena Krbot Skorić,
  • Mario Habek

摘要

Introduction

The Quantitative Sudomotor Axon Reflex Test (QSART) is the gold standard for evaluating sudomotor function in the Composite Autonomic Scoring Scale (CASS). Sudoscan® has been proposed as a potential alternative. This study investigated whether Sudoscan®-derived indices could replace QSART within the CASS framework and provide reliable sudomotor evaluation in people with multiple sclerosis (pwMS).

Methods

This study included 99 pwMS. Subjective autonomic symptoms were assessed with the Composite Autonomic Symptom Score-31 (COMPASS-31), and objective autonomic testing was performed with the CASS, which includes QSART for sudomotor assessment. Additionally, all pwMS underwent Sudoscan® testing, and a modified CASS score was derived from adrenergic, cardiovagal, and Sudoscan®-based sudomotor measures.

Results

A strong correlation was observed between CASS and modified CASS (r = 0.795, p < 0.001). Autonomic dysfunction (CASS ≥ 1) was present in 72.7% of participants, while 77.7% had modified CASS ≥ 1. However, no correlation was found between QSART- and Sudoscan®-based sudomotor indices (r = 0.043, p = 0.672).CASS did not correlate with COMPASS-31 or its subdomains, whereas modified CASS correlated with the gastrointestinal domain of COMPASS-31 (r = 0.228, p = 0.027). Additionally, modified CASS correlated with age (r = 0.204, p = 0.048) and the Expanded Disability Status Scale (EDSS) score (r = 0.207, p = 0.043).

Conclusions

The modified CASS, including Sudoscan® sudomotor testing, showed a strong overall correlation with the standard CASS and meaningful associations with age and disability level. More long-term studies are needed to assess its effectiveness in monitoring sudomotor dysfunction over time.