AUTHOR=Findling Oliver , Rust Heiko , Yaldizli Özgür , Timmermans Dionne P. H. , Scheltinga Alja , Allum John H. J. 

TITLE=Balance Changes in Patients With Relapsing-Remitting Multiple Sclerosis: A Pilot Study Comparing the Dynamics of the Relapse and Remitting Phases

JOURNAL=Frontiers in Neurology

VOLUME=Volume 9 - 2018

YEAR=2018

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2018.00686

DOI=10.3389/fneur.2018.00686

ISSN=1664-2295

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 female, mean EDSS at baseline 2.45± 1.01) was examined every 3 months over 9 months and compared to that of 9 relapsing patients (age 42.0±12.7, all female, 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 female). 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. 

Keywords: Multiple sclerosis; Balance control; Trunk sway; Relapse-phase multiple sclerosis; remitting-phase multiple sclerosis, EDSS scores