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      Postural Control in Relapsing-Remitting Multiple Sclerosis

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          Abstract

          Introduction  Postural instability is considered one of the most disabling symptoms of relapsing-remitting multiple sclerosis (RRMS).

          Objective  To evaluate postural control in patients with RRMS.

          Method  A total of 79 individuals between 18 and 65 years old, of both genders, were distributed into an experimental group composed of patients with RRMS ( n  = 51) and in a control group composed by healthy individuals ( n  = 28). The evaluation consisted of anamnesis, Dizziness Handicap Inventory (DHI), visual vertigo analog scale (VVAS), and static posturography (Tetrax IBS).

          Results  Patients with RRMS presented mild degree in the DHI and in the VVAS; in Tetrax IBS, they presented higher or lower values of the indices of general stability, weight distribution, synchronization of postural oscillation, fall risk, and frequency bands of postural oscillation in two, five or all eight sensory conditions, in relation to the control group. Vestibular, visual and/or somatosensory dysfunction of peripheral type (51.0%) prevailed over the central type. The RRMS group, with an expanded scale of disability status > 3 points, presented a higher fall risk than with a score ≤ 3 points ( p  = 0.003). There was a positive correlation of the Fall Risk Index with the total DHI Score (s = 0.380; p  = 0.006) and with the VVAS score (s = 0.348; p  = 0.012).

          Conclusion  Patients with RRMS may present with inability to maintain postural control due to general instability, desynchronization and increased postural oscillation at frequencies that suggest deficiencies in the vestibular, visual, and somatosensory systems; as well as fall risk related to the state and intensity of functional disability and self-perception of the influence of dizziness on quality of life.

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          Most cited references60

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          Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).

          J. Kurtzke (1983)
          One method of evaluating the degree of neurologic impairment in MS has been the combination of grades (0 = normal to 5 or 6 = maximal impairment) within 8 Functional Systems (FS) and an overall Disability Status Scale (DSS) that had steps from 0 (normal) to 10 (death due to MS). A new Expanded Disability Status Scale (EDSS) is presented, with each of the former steps (1,2,3 . . . 9) now divided into two (1.0, 1.5, 2.0 . . . 9.5). The lower portion is obligatorily defined by Functional System grades. The FS are Pyramidal, Cerebellar, Brain Stem, Sensory, Bowel & Bladder, Visual, Cerebral, and Other; the Sensory and Bowel & Bladder Systems have been revised. Patterns of FS and relations of FS by type and grade to the DSS are demonstrated.
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            Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria

            New evidence and consensus has led to further revision of the McDonald Criteria for diagnosis of multiple sclerosis. The use of imaging for demonstration of dissemination of central nervous system lesions in space and time has been simplified, and in some circumstances dissemination in space and time can be established by a single scan. These revisions simplify the Criteria, preserve their diagnostic sensitivity and specificity, address their applicability across populations, and may allow earlier diagnosis and more uniform and widespread use. Ann Neurol 2011
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              Multiple sclerosis

              The Lancet, 372(9648), 1502-1517
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                Author and article information

                Journal
                Int Arch Otorhinolaryngol
                Int Arch Otorhinolaryngol
                10.1055/s-00025477
                International Archives of Otorhinolaryngology
                Thieme Revinter Publicações Ltda. (Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil )
                1809-9777
                1809-4864
                09 February 2022
                October 2022
                1 February 2022
                : 26
                : 4
                : e592-e604
                Affiliations
                [1 ]Department of Otolaryngology and Head and Neck Surgery, Otology and Neurotology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
                [2 ]Department of Neurology and Neurosurgery, Demyelinating Diseases Outpatient Clinic, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
                Author notes
                Address for correspondence Flavia Salvaterra Cusin, PhD Fonoaudiologia, Praça Samuel Sabatini 238, ap. 1101 – Centro, São Bernardo do Campo, São Paulo 09750-700Brazil flaviacusin@ 123456yahoo.com.br
                Author information
                http://orcid.org/0000-0003-3597-6145
                http://orcid.org/0000-0002-9451-5421
                http://orcid.org/0000-0003-4483-8502
                http://orcid.org/0000-0002-4939-7200
                http://orcid.org/0000-0003-4534-1637
                http://orcid.org/0000-0003-4157-8995
                Article
                210611
                10.1055/s-0041-1741026
                9668432
                d0e39b5d-2910-44b8-93a8-6942ffb117b9
                Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ )

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

                History
                : 28 June 2021
                : 11 November 2021
                Categories
                Original Research

                multiple sclerosis,relapsing-remitting,postural balance,dizziness,quality of life

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