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The case of a 32-year old female patient recently diagnosed with relapsing-remitting multiple sclerosis (MS) is presented. Magnetic resonance imaging (MRI) indicated deep cortical demyelination but no cerebellar or brainstem involvement. Electrooculographic (EOG) testing indicated horizontal, spontaneous nystagmus on lateral gaze, which increased in frequency and amplitude in darkness. Posturographic testing, using an electronic balance platform, indicated an impairment of balance with eyes closed or when somatosensory and proprioceptive feedback was reduced by using a foam surface. These results further support the hypotheses that vestibular dysfunction develops early in MS.
Multiple sclerosis (MS) is a chronic, demyelinating, autoimmune disease whose precise aetiology is unknown. Although many clinical reports have indicated that MS patients exhibit vestibular dysfunction (Stahl et al 1996, Starck et al 1997), several recent reports have suggested that vestibular symptoms develop early in the disease process and that electrooculography (EOG) and posturography may provide some of the most useful early diagnostic information (Williams et al 1997). The recognition of vestibular symptoms in MS may be important both for early diagnosis and initiation of drug therapy (e.g., beta-interferon), and because some oculomotor symptoms, such as spontaneous ocular nystagmus, may be treatable with drugs such as gabapentin, clonazepam or memantine (McConnell et al 1990, Stahl et al 1996, Stack et al 1997, Smith and Darlington, in press).
Case Report
A 32-year old, recently diagnosed with relapsingremitting MS, underwent oculomotor, optokinetic and posturographic testing in the Vestibular Rehabilitation Programme at the Dept. of Psychology, University of Otago, Dunedin, New Zealand. Her clinical symptoms included paraesthesias of the limbs, muscle weakness, neuralgic facial...