Postural Control in Relapsing-Remitting Multiple Sclerosis

Flavia Salvaterra Cusin; Andreza Tomaz; Maurício Malavasi Ganança; Enedina Maria Oliveira; Alessandra Billi Falcão Gonçalves; Heloisa Helena Caovilla

doi:10.1055/s-0041-1741026

International Archives of Otorhinolaryngology, Table of Contents

CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2022; 26(04): e592-e604
DOI: 10.1055/s-0041-1741026

Original Research

Postural Control in Relapsing-Remitting Multiple Sclerosis

Flavia Salvaterra Cusin

¹Department of Otolaryngology and Head and Neck Surgery, Otology and Neurotology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil

,

Andreza Tomaz

¹Department of Otolaryngology and Head and Neck Surgery, Otology and Neurotology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil

,

Maurício Malavasi Ganança

¹Department of Otolaryngology and Head and Neck Surgery, Otology and Neurotology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil

,

Enedina Maria Oliveira

²Department of Neurology and Neurosurgery, Demyelinating Diseases Outpatient Clinic, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil

,

Alessandra Billi Falcão Gonçalves

²Department of Neurology and Neurosurgery, Demyelinating Diseases Outpatient Clinic, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil

,

Heloisa Helena Caovilla

¹Department of Otolaryngology and Head and Neck Surgery, Otology and Neurotology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil

› Author Affiliations

Abstract

Introduction Postural instability is considered one of the most disabling symptoms of relapsing-remitting multiple sclerosis (RRMS).

Objective To evaluate postural control in patients with RRMS.

Method A total of 79 individuals between 18 and 65 years old, of both genders, were distributed into an experimental group composed of patients with RRMS (n = 51) and in a control group composed by healthy individuals (n = 28). The evaluation consisted of anamnesis, Dizziness Handicap Inventory (DHI), visual vertigo analog scale (VVAS), and static posturography (Tetrax IBS).

Results Patients with RRMS presented mild degree in the DHI and in the VVAS; in Tetrax IBS, they presented higher or lower values of the indices of general stability, weight distribution, synchronization of postural oscillation, fall risk, and frequency bands of postural oscillation in two, five or all eight sensory conditions, in relation to the control group. Vestibular, visual and/or somatosensory dysfunction of peripheral type (51.0%) prevailed over the central type. The RRMS group, with an expanded scale of disability status > 3 points, presented a higher fall risk than with a score ≤ 3 points (p = 0.003). There was a positive correlation of the Fall Risk Index with the total DHI Score (s = 0.380; p = 0.006) and with the VVAS score (s = 0.348; p = 0.012).

Conclusion Patients with RRMS may present with inability to maintain postural control due to general instability, desynchronization and increased postural oscillation at frequencies that suggest deficiencies in the vestibular, visual, and somatosensory systems; as well as fall risk related to the state and intensity of functional disability and self-perception of the influence of dizziness on quality of life.

Keywords

multiple sclerosis - relapsing-remitting - postural balance - dizziness - quality of life

Full Text

References

References
1 Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology 1996; 46 (04) 907-911
2 Compston A, Coles A. Multiple sclerosis. Lancet 2008; 372 (9648): 1502-1517
3 McDonald WI, Compston A, Edan G. et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 2001; 50 (01) 121-127
4 Polman CH, Reingold SC, Banwell B. et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011; 69 (02) 292-302
5 Riley CS, Tullman M. Esclerose múltipla. In: Rowland LP, Pedley TA. Tratado de neurologia. Rio de Janeiro: Guanabara Koogan; 2010: 1342-60
6 Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33 (11) 1444-1452
7 Morales RR, Morales NMO, Rocha FCG, Fenelon SB, Pinto RMC, Silva CHM. Health-related quality of life in multiple sclerosis. Arq Neuropsiquiatr 2007; 65 (2B) 454-460
8 Cattaneo D, De Nuzzo C, Fascia T, Macalli M, Pisoni I, Cardini R. Risks of falls in subjects with multiple sclerosis. Arch Phys Med Rehabil 2002; 83 (06) 864-867
9 Muller R. Studies on disseminated sclerosis with special reference to symptomatology, course and prognosis. Acta Med Scand 1949; 133 (Suppl 222): 1-124
10 Martyn C. Symptoms and signs in the course of disease. In: Elsevier health Sciences. McAlpine's multiple sclerosis. 4th ed.. Oxford, England: Churchill Livingstone; 2005
11 Cameron MH, Lord S. Postural control in multiple sclerosis: implications for fall prevention. Curr Neurol Neurosci Rep 2010; 10 (05) 407-412
12 Sosnoff JJ, Socie MJ, Boes MK. et al. Mobility, balance and falls in persons with multiple sclerosis. PLoS One 2011; 6 (11) e28021
13 Prosperini L, Fortuna D, Giannì C, Leonardi L, Pozzilli C. The diagnostic accuracy of static posturography in predicting accidental falls in people with multiple sclerosis. Neurorehabil Neural Repair 2013; 27 (01) 45-52
14 Finlayson ML, Peterson EW, Cho CC. Risk factors for falling among people aged 45 to 90 years with multiple sclerosis. Arch Phys Med Rehabil 2006; 87 (09) 1274-1279 , quiz 1287
15 Cameron MH, Asano M, Bourdette D, Finlayson ML. People with multiple sclerosis use many fall prevention strategies but still fall frequently. Arch Phys Med Rehabil 2013; 94 (08) 1562-1566
16 Nilsagård Y, Gunn H, Freeman J. et al. Falls in people with MS–an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States. Mult Scler 2015; 21 (01) 92-100
17 Alpini D, Caputo D, Pugnetti L, Cesarani A, Capobianco S. Contribution of neuro-otology to differential diagnosis of vertigo in multiple sclerosis. Neurol Sci 2001; 22 (Suppl 2): S84-S87
18 Fjeldstad C, Pardo G, Bemben D, Bemben M. Decreased postural balance in multiple sclerosis patients with low disability. Int J Rehabil Res 2011; 34 (01) 53-58
19 Jacobson GP, Newman CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990; 116 (04) 424-427
20 Castro AS, Gazzola JM, Natour J, Ganança FF. Versão brasileira do dizziness handicap inventory [Brazilian version of the dizziness handicap inventory]. Pro Fono 2007; 19 (01) 97-104
21 Whitney SL, Wrisley DM, Brown KE, Furman JM. Is perception of handicap related to functional performance in persons with vestibular dysfunction?. Otol Neurotol 2004; 25 (02) 139-143
22 Whitney SL, Herdman SJ. Physical therapy assessment of vestibular hypofunction. In: Herdman SJ. (ed). Vestibular rehabilitation. 3rd ed.. Philadelphia: FA. Davis; 2007: 272-99
23 Tetrax. Guida per operatore clinico. Italia: Sunlight Medical Ltd; 2004: 34
24 Kohen-Raz R. Application of tetra-ataxiametric posturography in clinical and developmental diagnosis. Percept Mot Skills 1991; 73 (02) 635-656
25 Siegel S, Castellan NJ, Carmona SIC, Damacena C, Silva D, Accorsi A. Estatística não-paramétrica para ciências do comportamento. Porto Alegre: Artmed 2006; 448p
26 Agresti A. Categorical data analysis. New York: Wiley Interscience; 1990: 558 p.
27 Jacobson GP, Calder JH. A screening version of the Dizziness Handicap inventory (DHI-S). Am J Otol 1998; 19 (06) 804-808
28 Matsuda PN, Shumway-Cook A, Ciol MA, Bombardier CH, Kartin DA. Understanding falls in multiple sclerosis: association of mobility status, concerns about falling, and accumulated impairments. Phys Ther 2012; 92 (03) 407-415
29 Cattaneo D, Jonsdottir J. Sensory impairments in quiet standing in subjects with multiple sclerosis. Mult Scler 2009; 15 (01) 59-67
30 Alpini D, Berardino FD, Mattei V, Caputo D, Schalek P, Cesarani A. Characteristics of multiple sclerosis patient stance control disorders, measured by means of posturography and related to brainstem lesions. Audiol Res 2012; 2 (01) e9
31 Nilsagård Y, Lundholm C, Denison E, Gunnarsson LG. Predicting accidental falls in people with multiple sclerosis – a longitudinal study. Clin Rehabil 2009; 23 (03) 259-269
32 Peterson EW, Cho CC, Finlayson ML. Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis. Mult Scler 2007; 13 (09) 1168-1175
33 Frzovic D, Morris ME, Vowels L. Clinical tests of standing balance: performance of persons with multiple sclerosis. Arch Phys Med Rehabil 2000; 81 (02) 215-221
34 Nelson SR, Di Fabio RP, Anderson JH. Vestibular and sensory interaction deficits assessed by dynamic platform posturography in patients with multiple sclerosis. Ann Otol Rhinol Laryngol 1995; 104 (01) 62-68
35 Williams NP, Roland PS, Yellin W. Vestibular evaluation in patients with early multiple sclerosis. Am J Otol 1997; 18 (01) 93-100
36 Kessler N, Ganança MM, Ganança CF. et al. Balance Rehabilitation Unit (BRU™) posturography in relapsing-remitting multiple sclerosis. Arq Neuropsiquiatr 2011; 69 (03) 485-490
37 Prosperini L, Sbardella E, Raz E. et al. Multiple sclerosis: white and gray matter damage associated with balance deficit detected at static posturography. Radiology 2013; 268 (01) 181-189
38 Kalron A, Nitzani D, Achiron A. Static posturography across the EDSS scale in people with multiple sclerosis: a cross sectional study. BMC Neurol 2016; 16 (70) 70
39 Fjeldstad C, Pardo G, Frederiksen C, Bemben D, Bemben M. Assessment of postural balance in multiple sclerosis. Int J MS Care 2009; 11 (11) 1-5
40 Fanchamps MH, Gensicke H, Kuhle J, Kappos L, Allum JH, Yaldizli O. Screening for balance disorders in mildly affected multiple sclerosis patients. J Neurol 2012; 259 (07) 1413-1419
41 Coote S, Hogan N, Franklin S. Falls in people with multiple sclerosis who use a walking aid: prevalence, factors, and effect of strength and balance interventions. Arch Phys Med Rehabil 2013; 94 (04) 616-621
42 Cameron MH, Huisinga J. Objective and subjective measures reflect different aspects of balance in multiple sclerosis. J Rehabil Res Dev 2013; 50 (10) 1401-1410
43 Farid AS, Shabana MI, Hosni HS, Thabet EM. Assessment of the vestibular function in patients with multiple sclerosis. Egypt J Neurol Psychiat Neurosurg 2004; 41 (01) 151-159
44 Cattaneo D, Regola A, Meotti M. Validity of six balance disorders scales in persons with multiple sclerosis. Disabil Rehabil 2006; 28 (12) 789-795
45 Garg H, Dibble LE, Schubert MC, Sibthorp J, Foreman KB, Gappmaier E. Gaze stability, dynamic balance and participation deficits in people with multiple sclerosis at fall-risk. Anat Rec (Hoboken) 2018; 301 (11) 1852-1860
46 White LJ, Dressendorfer RH. Exercise and multiple sclerosis. Sports Med 2004; 34 (15) 1077-1100
47 Kasser SL, Jacobs JV. Understanding and treating balance impairment in multiple sclerosis. JCOM 2014; 21 (09) 419-432