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.

Case report: A disconjugate pattern in video head impulse testing hints toward a central cause of acute vertigo

“…We can, therefore, confirm a disconjugate VOR deficit originating from a CNS disease by using the binocular VHIT technique. Recently, Grove et al were able to show that multiple sclerosis (MS) patients with low VOR gain have reduced or absent compensatory saccades (CSs) ( 10 , 11 ). They further postulated that the lack of CS in correlation with reduced VOR in VHIT may be pathognomonic for INO.…”

Wearable sensor and smartphone assisted vestibular physical therapy for multiple sclerosis: usability and outcomes

“…Numerous studies of vestibular function in MS have shown abnormalities in vestibular evoked potentials, electronystanography, static posturography ( 3 , 4 ) and dynamic visual acuity ( 5 ). Furthermore, worse vestibular function is associated with greater disability ( 6 ). Vestibular dysfunction results in vertigo, dizziness, disequilibrium, and gait impairment and these are common and disabling symptoms of MS resulting in functional limitations, loss of independence, falls and an overall decreased quality of life ( 7 – 9 ).…”