Abstract
BackgroundSymptoms arising from vestibular system dysfunction are observed in 49–59% of people with Multiple Sclerosis (MS). Symptoms may include vertigo, dizziness and/or imbalance. These impact on functional ability, contribute to falls and significant health and social care costs. In people with MS, vestibular dysfunction can be due to peripheral pathology that may include Benign Paroxysmal Positional Vertigo (BPPV), as well as central or combined pathology. Vestibular symptoms may be treated with vestibular rehabilitation (VR), and with repositioning manoeuvres in the case of BPPV. However, there is a paucity of evidence about the rate and degree of symptom recovery with VR for people with MS and vestibulopathy. In addition, given the multiplicity of symptoms and underpinning vestibular pathologies often seen in people with MS, a customised VR approach may be more clinically appropriate and cost effective than generic booklet-based approaches. Likewise, BPPV should be identified and treated appropriately.Methods/ designPeople with MS and symptoms of vertigo, dizziness and/or imbalance will be screened for central and/or peripheral vestibulopathy and/or BPPV. Following consent, people with BPPV will be treated with re-positioning manoeuvres over 1–3 sessions and followed up at 6 and 12 months to assess for any re-occurrence of BPPV. People with central and/or peripheral vestibulopathy will be entered into a randomised controlled trial (RCT). Trial participants will be randomly allocated (1:1) to either a 12-week generic booklet-based home programme with telephone support or a 12-week VR programme consisting of customised treatment including 12 face-to-face sessions and a home exercise programme. Customised or booklet-based interventions will start 2 weeks after randomisation and all trial participants will be followed up 14 and 26 weeks from randomisation. The primary clinical outcome is the Dizziness Handicap Inventory at 26 weeks and the primary economic endpoint is quality-adjusted life-years. A range of secondary outcomes associated with vestibular function will be used.DiscussionIf customised VR is demonstrated to be clinically and cost-effective compared to generic booklet-based VR this will inform practice guidelines and the development of training packages for therapists in the diagnosis and treatment of vestibulopathy in people with MS.Trial registrationISRCTN Number: 27374299Date of Registration 24/09/2018Protocol Version 15 25/09/2019
Highlights
Symptoms arising from vestibular system dysfunction are observed in 49–59% of people with Multiple Sclerosis (MS)
Preliminary evidence suggests that people with MS may benefit from vestibular rehabilitation [38, 39]
In previous trials the exact cause of any dizziness has not been defined. This is important as recent work suggests that a substantial proportion of people with MS have Benign Paroxysmal Positional Vertigo (BPPV) which requires management through different techniques to vestibular rehabilitation (VR) [22, 23]
Summary
Symptoms arising from vestibular system dysfunction are observed in 49–59% of people with Multiple Sclerosis (MS). These impact on functional ability, contribute to falls and significant health and social care costs. [3,4,5,6,7,8,9] Vestibulopathy, combined with clinical signs of lower limb weakness, sensory loss, ataxia and spasticity, may result in balance and mobility impairment [10,11,12,13] This can result in falls and injuries, restriction in outdoor mobility and a subsequent impact on social participation and quality of life for individuals [14,15,16,17,18,19]. The balance dysfunction and reduced mobility seen in people with MS are further associated with significant health and social care costs [18, 20]
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