The autonomic nervous system maintains homeostasis of heart rate, blood pressure, respiration and bowel and bladder control as well as sexual and sudomotor function. Autonomic Dysfunction is common in multiple scelerosis patients and probably present years before diagnosis , even as early as ten years , making it the most prominent symptom in the prodromal phase of MS. Among these disorders are Cardiovascular autonomic dysfunction(CAD) that has been reported in up to 20 % of patients with multiple sclerosis and may occur years before typical symptoms and signs of MS. CAD may contribute to dizziness, falling or other orthostatic symptoms in patients and affect quality of life and reduce the life expectancy. Both inflammation and neurodegeneration are thought to contribute to the development of CAD. Some disease-modifying drugs (DMDs) especially S1P receptor modulators and the most popular of them, fingolimod can cause disturbances in the cardiovascular autonomic system. The most important indices of cardiovascular autonomic funtions are impedance cardiography parameters , heart rate and blood pressure variablitiy during head up tilt test . The most common abnormality related to CAD in MS is reduced heart rate variability. This is postulated that CAD is correlated with MS type(progressive more than relapsing types ), disease duration (long-standing disease more than early MS) ,disease progression and disability level(both physical and cognitive), MS characteristic and fatigue severity. Neuromodulation with acupuncture could be an interesting tool to change heart rate variability in these population.