Balance in multiple sclerosis: relationship to central brain regions
Dizziness, postural instability, and ataxia are among the most debilitating symptoms of multiple sclerosis (MS), reflecting, in large part, dysfunctional integration of visual, somatosensory, and vestibular sensory cues. However, the role of MS-related supratentorial lesions in producing such symptoms is poorly understood. In this study, motor control test (MCT) and dynamic sensory organization test (SOT) scores of 58 MS patients were compared to those of 72 healthy controls; correlations were determined between the MS scores of 49 patients and lesion volumes within 26 brain regions. Depending upon platform excursion direction and magnitude, MCT latencies, which were longer in MS patients than controls (p < 0.0001), were correlated with lesion volumes in the cortex, medial frontal lobes, temporal lobes, and parietal opercula (r’s ranging from 0.20 to 0.39). SOT test scores were also impacted by MS and correlated with lesions in these same brain regions as well as within the superior frontal lobe (r’s ranging from − 0.28 to − 0.40). The strongest and most consistent correlations occurred for the most challenging tasks in which incongruent visual and proprioceptive feedback were given. This study demonstrates that supratentorial lesion volumes are associated with quantitative balance measures in MS, in accord with the concept that balance relies upon highly convergent and multimodal neural pathways involving the skin, muscles, joints, eyes, and vestibular system.
KeywordsMultiple sclerosis Balance Vision Vestibular system Proprioception
Supported by grants from the National Institute on Deafness and Other Communication Disorders (RO1 DC 02974), National Institute of Neurological Disorders and Stroke (RO1 NS0709060), National Multiple Sclerosis Society (RG-1507-05243), and the Department of Defense (USAMRAA W81XWH-09-1-0467). We thank Crystal Wylie and Fidas E. Leon-Sarmiento for their comments on a previous version of the manuscript and are grateful to Jennifer Rotz for testing a number of the subjects of this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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