Comprehensive Clinical Assessment of Vestibular Function in Multiple Sclerosis.
Graham D Cochrane, Jennifer B Christy, Robert W Motl
PMID 33867456WHAT IT FOUND
People with MS showed impaired central vestibular integration on VOR cancellation and SVV variance tests, correlating with disease severity.
Peripheral reflex tests like vHIT and VEMPs were normal. This suggests central processing deficits, not peripheral damage, drive balance issues in mild-to-moderate MS.
Key findings
01Participants with MS had significantly lower VOR cancellation gain compared to controls, despite normal reflexive VOR gains.
02People with MS demonstrated significantly larger variances in subjective visual vertical/horizontal responses, but no difference in absolute deviation from true alignment.
03VOR cancellation and SVV variance were significant predictors of disease severity (EDSS), whereas peripheral measures like vHIT gains and VEMP latencies were not.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample had mild-to-moderate MS (median EDSS 2.5), with only 25% having an EDSS of 4.0-6.5, so results may not apply to more severe cases. Participants were under 55 years old, excluding age-related vestibular changes that might compound MS deficits in older adults. Recruitment from a single clinic and research participants may limit generalizability due to potential socioeconomic or treatment biases. The study was exploratory with a false discovery rate threshold of 0.10, which is less stringent than the typical 0.05.
Declared interests
One author developed the smartphone application used for the SVV bucket test, which was not FDA-approved for clinical use. The study was supported by NIH and non-U.S. government grants.
The easy way to misread this
Do not assume normal peripheral vestibular tests (vHIT, VEMPs) rule out vestibular dysfunction in MS. The deficits found were in central integration (VOR cancellation, SVV variance), which standard peripheral tests miss. A patient can have normal reflexes but significant balance issues due to central processing errors.