Spotlight on postural control in patients with multiple sclerosis

Figures & data

Figure 1 Schematic of postural control and its alterations in MS.

Abbreviation: MS, multiple sclerosis.

Figure 2 Consequences of postural control deficit in multiple sclerosis.

Table 1 Case–control studies exploring the incidence of fall-related fractures and injuries in patients with multiple sclerosis

Study	Average age (years)	Cases	Controls	Outcome	Riska
Bazelier et al^Citation15	44.8	5,565	33,360	Any fracture	1.2
				Hip fractures	2.8
				Osteoporotic fractures	1.4
Cameron et al^Citation16	60.3	721	194,696	Injurious falls	1.9
Bazelier et al^Citation17	43.6	2,415	12,641	Any fracture	0.8
				Fall-related fractures	2.1
Bazelier et al^Citation18	36.9	2,963	15,436	Any fracture	1.0
				Femur/hip fractures	1.9
Ramagopalan et al^Citation19	~50	87,873	7,820,697	Any fracture	1.9
				Femoral fractures	2.8
Bhattacharya et al^Citation20	~65	2,631	1,063,773	Hip fractures	2.2

Notes:

a Values >1 indicate increased risk in patients with multiple sclerosis.

Table 2 Clinical scales currently used to assess postural control and balance in multiple sclerosis

Instrument	Brief description	Time of administration	Overall score	Direction
Activities-Specific Balance Confidence	16-item self-administered questionnaire	15 minutes	0–100	↓
Balance Evaluation System Test	36-item physician-rated scale	30 minutes	0–108	↓
Berg Balance Scale	14-item physician-rated scale	15 minutes	0–56	↓
Dizziness Handicap Inventory	Multidimensional 25-item self-administered questionnaire	15 minutes	0–100	↑
Dynamic Gait Index	8-item physician-rated scale	10 minutes	0–24	↓
Falls Efficacy Scale International	16-item self-reported questionnaire	10 minutes	0–100	↑
Four-Square Step Test	Stop-watch measurement	≤3 minutes	N/A	↑
Mini-BES Test	14-item physician-rated scale	10–15 minutes	0–28	↓
Timed Up-and-Go Test	Stop-watch measurement	≤3 minutes	N/A	↑
Tinetti Performance-Oriented Mobility Assessment	16-item physician-rated scale	10–15 minutes	0–48	↓

Note: Worse postural control indicated by lower (↓) or higher (↑) scores.

Abbreviation: N/A, not applicable.

Figure 3 Statokinesigrams collected by one healthy volunteer, one patient who did not report any fall and one patient who reported three accidental falls within the last 3 months.

Abbreviation: MS, multiple sclerosis.

Figure 4 Patterns of cognitive-postural interference based on the reciprocal DTC of balance and cognition.

Note: The asterisk indicates no interference.
Abbreviation: DTC, dual-task cost.

Table 3 List of medications potentially affecting postural control in multiple sclerosis

Deteriorating postural control	Improving postural control
Centrally acting muscle relaxants	Prolonged-release fampridine
Selective serotonin reuptake inhibitor	Riluzole
Serotonin-norepinephrine reuptake inhibitor	Dopamine agonists
Genitourinary compounds
Cannabis
Sexual hormones

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