Balance problems in MS

Background: MS’ers often have poor control of their balance. Knowledge of problems with balance control in mildly affected MS’ers with normal neurological examinations is is limited.

Aims: This study analysed differences in the sway of the body between mildly disabled MS’ers with and without subjective balance impairment with normal clinical examination. 
Results: 8 of 21 patients (38%) with an EDSS of 1.0-3.0 (low EDSS) complained of subjective balance impairment when performing normal daily activities. 
When standing on both legs with their eyes closed on a normal and on a foam surface, MS’ers with no subjective balance impairment group showed significant differences in the range of body movement compared to normal subjects. 
Similarly, sway when standing on one leg on foam was also greater in the MS’ers with subjective balance impairment. 
Conclusion: These findings explain the subjective symptoms MS’ers have with balance problems despite a normal neurological examinations.
“Balance problems is another common symptom that impacts on the ability of MS’ers to function normally. For example, I have several patients who feel uncomfortable cycling due to this problem.”

“Poor balance may account for unexplained falls and the sensation of being on a rocking ship when you walk in the dark or with your eyes closed.”

“MS’ers with balance problems may have difficulty standing on either leg unsupported (The Flamingo Test) or walking heel-to-toe (tightrope walking). Unfortunately, we have no pharmacological treatment for this symptom, but it may respond to physical therapy.”

“If you have balance problems that are affecting your day-to-day activities let your neurologist or MS specialist nurse know; they should be able to refer you to the physiotherapist for help.” 
Additional reading: EDSS

2 thoughts on “Balance problems in MS”

  1. Prof G, thanks so much for this post. You raise a very important point about subjective symptoms which aren't markedly evident on neurological examination. Balance can be a real problem and it is unfortunate when certain neurologists dismiss such symptoms because they do not affect the formal neurological examination of patients.

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