Dept. of Neurology and Psychiatry, Sapienza University, Rome, Italy.
J Neurol Sci. 2011 May 15;304(1-2):55-60. doi: 10.1016/j.jns.2011.02.014. Epub 2011 Mar 12.
The role of static posturography and magnetic resonance imaging (MRI) in identifying patients at high risk of falls was investigated. Relationships between static posturography measures and MRI metrics were also investigated.
A total of 31 ambulatory MS patients (EDSS ranging from 2.0 to 5.0) with a predominant balance disorder were recruited. Each patient underwent a static posturography with a monoaxial platform and a conventional 1.5 T brain MRI scan. Measurements of T1-hypointense and T2-hyperintense lesion volumes (LVs), focusing on lesions selectively located at infratentorial levels, were performed by two operators unaware of clinical data. The self-reported number of falls in the previous 6 months was considered as the main outcome measure.
Fourteen (45%) patients reported 1 or more falls over the past 6 months. When compared to non-faller patients, they had a higher EDSS score, poorer static standing balance, and greater brainstem and middle cerebellar peduncle (MCP) T2-LVs. A strength correlation between brainstem T2-LV and impaired static standing balance in an open eye condition was also found. In the multivariate analysis, the variables more strictly associated with recurrent falls were greater T2-LV at the MCP (beta: 6.2; p=0.01) and brainstem (beta: 5.8; p=0.001) levels, and a wider displacement of the body center of pressure in the closed eye condition (beta: 0.02; p=0.03).
Our data suggests that the damage of specific infratentorial areas negatively affect the static standing balance and may predispose MS patients to accidental falls. These findings might contribute in selecting patients requiring a proper rehabilitation intervention program.
研究静态姿势描记术和磁共振成像（MRI）在识别高跌倒风险患者中的作用。还研究了静态姿势描记术测量值与 MRI 指标之间的关系。
共招募了 31 名有平衡障碍的门诊 MS 患者（EDSS 范围为 2.0 至 5.0）。每位患者均接受了单轴平台的静态姿势描记术和常规 1.5 T 脑 MRI 扫描。由两名操作员对 T1 低信号和 T2 高信号病变体积（LV）进行了测量，重点是选择性位于颅后窝水平的病变。将过去 6 个月内报告的跌倒次数作为主要观察指标。
14 名（45%）患者在过去 6 个月内报告了 1 次或多次跌倒。与非跌倒患者相比，他们的 EDSS 评分更高，静态站立平衡更差，脑干和小脑中脑脚（MCP）T2-LV 更大。还发现脑干 T2-LV 与睁眼状态下静态站立平衡受损之间存在相关性。在多变量分析中，与复发性跌倒更密切相关的变量是 MCP（β：6.2；p=0.01）和脑干（β：5.8；p=0.001）水平的 T2-LV 更大，以及闭眼状态下身体重心的更大位移（β：0.02；p=0.03）。
我们的数据表明，特定颅后窝区域的损伤会对静态站立平衡产生负面影响，并可能使 MS 患者易发生意外跌倒。这些发现可能有助于选择需要适当康复干预计划的患者。
