Greater Disability Is Associated with Worse Vestibular and Compensatory Oculomotor Functions in People Living with Multiple Sclerosis.

Abstract

Globally, there are nearly three million people living with multiple sclerosis (PLW-MS). Many PLW-MS experience vertigo and have signs of vestibular dysfunction, e.g., low vestibulo-ocular reflex (VOR) gains or the presence of compensatory saccades (CSs), on video head impulse testing (vHIT). We examined whether the vestibular function and compensatory oculomotor behaviors in PLW-MS differed based on the level of MS-related disability. The VOR gain, CS frequency and latency, and gaze position error (GPE) were calculated from the individual traces obtained during six-canal vHIT for 37 PLW-MS (mean age 53.4 ± 12.4 years-old, 28 females) with vertigo and/or an imbalance. The subjects were grouped by their Expanded Disability Status Scale (EDSS) scores: PLW-min-MS (EDSS = 1.0-2.5, n = 8), PLW-mild-MS (EDSS = 3.0-4.5, n = 23), and PLW-moderate-MS (EDSS = 5.0-6.0, n = 6). The between-group differences were assessed with Kruskal-Wallis tests. The VOR gains for most of the canals were higher for PLW-min-MS compared to PLW-mild- and mod-MS, respectively. CS occurred less often in PLW-min-MS versus PLW-mild- and mod-MS, respectively. No clear trend in CS latency was found. The GPE was often lower for PLW-min-MS compared to PLW-mild- and mod-MS, respectively. Thus, our data demonstrate that worse VOR and compensatory oculomotor functions are associated with a greater MS-related disability. PLW-MS may benefit from personalized vestibular physical therapy.