Abstract
Aims: To compare balance changes over time during the relapse phase of relapsing-remitting multiple sclerosis (RRMS) with balance control during the remitting phase.Methods: Balance control during stance and gait tasks of 24 remitting-phase patients (mean age 43.7 ± 10.5, 15 women, mean EDSS at baseline 2.45 ± 1.01) was examined every 3 months over 9 months and compared to that of nine relapsing patients (age 42.0 ± 12.7, all women, mean EDSS at relapse onset 3.11 ± 0.96) examined at relapse onset and 3 months later. Balance was also compared to that of 40 healthy controls (HCs) (age 39.7 ± 12.6, 25 women). Balance control was measured as lower-trunk sway angles with body-worn gyroscopes. Expanded Disability Status Scale scores (EDSS) were used to monitor, clinically, disease progression.Results: Remitting-phase patients showed more unstable stance balance control than HCs (p < 0.04) with no worsening over the observation period of 9 months. Gait balance control was normal (p > 0.06). Relapsing patients had stance balance control significantly worse at onset compared to remitting-phase patients and HCs (p < 0.04). Gait tasks showed a significant decrease of gait speed and trunk sway in relapsing patients (p = 0.018) compatible with having increased gait instability at normal speeds. Improvement to levels of remitting patients generally took longer than 3 months. Balance and EDSS scores were correlated for remitting but not for relapse patients.Conclusions: Balance in remitting RRMS patients does not change significantly over 9 months and correlated well with EDSS scores. Our results indicate that balance control is a useful measure to assess recovery after a relapse, particularly in patients with unchanged EDSS scores. Based on our results, balance could be considered as additional measurement to assess recovery after a relapse, particularly in patients with unchanged EDSS.
Highlights
Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system (CNS) which can affect visual, sensory and motor systems
We investigated whether the balance control and Expanded Disability Status Scale (EDSS) scores of Relapsing-remitting MS (RRMS) patients during relapse diverge widely from those of RRMS patients during remission more than 3 months following a relapse onset
Relapsing RRMS patients showed decreased gait speed while walking 8 meters with eyes open (Figure 2) and a reduction in pitch and roll velocities compared to the remittingphase patients
Summary
Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system (CNS) which can affect visual, sensory and motor systems. Most RRMS patients will accumulate CNS damage over time due to relapses, causing their degree of disability to increase. Despite the fact that balance is one of the most prominent symptoms of MS, there is no specific functional system score for balance among the functional system scores from which the EDSS is calculated. For the EDSS score, balance is assessed by using the Romberg test, and an evaluation of gait ataxia during normal walking and during tandem gait. These clinical tests are part of the “cerebellar functional system score” [9] which contributes to the overall EDSS score. During balance changes, during improvement following a relapse, it might be worthwhile to examine whether, quantified balance scores are correlated with EDSS scores
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