A disturbed processing of graviceptive pathways may be involved in the pathophysiology of balance disorders in patients with multiple sclerosis

Bruna Antinori Vignola da Fonseca; Cristiana Borges Pereira; Frederico Jorge; Renata Simm; Samira Apostolos-Pereira; Dagoberto Callegaro

doi:10.1590/0004-282X20160004

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(02): 106-111
DOI: 10.1590/0004-282X20160004

ARTICLE

A disturbed processing of graviceptive pathways may be involved in the pathophysiology of balance disorders in patients with multiple sclerosis

O processamento incorreto das informações graviceptivas pode estar envolvido na fisiopatologia dos distúrbios do equilíbrio em pacientes com esclerose múltipla

Bruna Antinori Vignola da Fonseca

¹Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Sao Paulo SP, Brazil;

,

Cristiana Borges Pereira

²Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Ambulatório de Distúrbios Vestibulares e do Equilíbrio, Sao Paulo SP, Brazil;

,

Frederico Jorge

³Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Ambulatório de Doenças Desmielinizantes, Sao Paulo SP, Brazil.

,

Renata Simm

³Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Ambulatório de Doenças Desmielinizantes, Sao Paulo SP, Brazil.

,

Samira Apostolos-Pereira

³Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Ambulatório de Doenças Desmielinizantes, Sao Paulo SP, Brazil.

,

Dagoberto Callegaro

³Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, Ambulatório de Doenças Desmielinizantes, Sao Paulo SP, Brazil.

› Author Affiliations

Abstract

ABSTRACT

The purpose of this study was to determine the relationship between perception of verticality and balance disorders in multiple sclerosis patients. We evaluated patients and healthy controls. Patients were divided into two groups according to their risk of fall, with or without risk of fall, measured by a Dynamic Gait Index scale. Graviceptive perception was assessed using the subjective visual vertical test. Patients with risk of fall showed worse perception than those without risk of fall, p < 0.001. Misperception of verticality was correlated with the dynamic gait index scores (p < 0.001), suggesting that the larger the error for verticality judgment, the greater risk for falling. Considering that the perception of verticality is essential for postural control, our results suggested that the disturbed processing of graviceptive pathways may be involved in the pathophysiology of balance disorders in these patients.

RESUMO

Nosso objetivo foi determinar a relação entre percepção de verticalidade e alterações do equilíbrio em pacientes com esclerose múltipla (EM). Foram avaliados pacientes e sujeitos saudáveis. Pacientes foram divididos em dois grupos de acordo com o risco de queda, mensurado pelo Índice de marcha dinâmica, formando os grupos com risco e sem risco de quedas. A percepção da verticalidade foi medida através do teste vertical visual subjetiva (VVS). Pacientes com risco de queda apresentaram pior percepção da verticalidade quando comparados aos sem risco, p < 0,001. O desempenho no teste da VVS foi pior em pacientes quando comparado aos controles (p < 0,001). O erro no julgamento da verticalidade foi correlacionado aos índices de risco de queda (p < 0,001), sugerindo que quanto maior o erro no julgamento da verticalidade, maior o risco de queda dos pacientes. Nossos resultados sugerem que alterações das informações em vias graviceptivas podem estar envolvidas nas alterações de equilíbrio dessa população.

postural balance - multiple sclerosis - vestibular function tests - gravity sensing - sensation disorders - accidental falls

equilíbrio postural - esclerose múltipla - testes da função vestibular - percepção gravitacional - alterações sensoriais - risco de quedas

Full Text

References

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