Assessment and Treatment of Vestibular Dysfunction in Individuals with Multiple Sclerosis

Background:

Dizziness and imbalance are common findings among individuals diagnosed with multiple sclerosis. Demyelinating lesions affecting the brainstem and/or cerebellum can impair the function of the vestibulo-ocular (VOR) and vestibulo-spinal (VSR) pathways resulting in peripheral and/or central vestibular deficits. Vestibular rehabilitation has been used in individuals with either peripheral or central causes of dizziness to improve functional use of the VOR and VSR while reducing symptoms of vertigo and/or dizziness. The evidence for the effectiveness of vestibular rehabilitation is strong, however few studies to date have evaluated it’s effect on individuals with multiple sclerosis.

Objectives:

This presentation will highlight the prevalence of vestibular involvement in individuals with multiple sclerosis, identify key areas of the bedside vestibular examination, describe principles of evidence based treatment, and compare management of individuals with multiple sclerosis to those individuals with primary vestibular deficits. 

Methods: NA

Results:

A review of the literature identified several case series but only three randomized control trials assessing the effectiveness of vestibular rehabilitation on dizziness, functional mobility, and objective measure of balance in individuals with multiple sclerosis. Despite different treatment protocols and methods, all three randomized control trials found a significant improvement in measures of balance in comparison to traditional rehabilitation. Only two of the three studies evaluated perception of dizziness related handicap, however both found a significant improvement when compared to the groups receiving traditional rehabilitation. A single randomized control trial found a significant effect on multiple sclerosis related fatigue with the implementation of vestibular interventions.

Conclusions:

Current evidence supports the use of vestibular rehabilitation to manage vestibular system dysfunction. While recent studies have begun to demonstrate the effectiveness of structured vestibular rehabilitation in the management of vestibular dysfunction in individuals with multiple sclerosis, additional high quality randomized trials are needed to determine the optimal type, dosage and timing of these therapeutic interventions. Incorporating vestibular rehabilitation principles into current practice for individuals with multiple sclerosis may result in greater improvements in dizziness, functional mobility, balance, and quality of life.