Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Sagol School of Neurosciences, Tel-Aviv University, Tel-Aviv, Israel.
Eur J Neurol. 2018 Oct;25(10):1243-1249. doi: 10.1111/ene.13689. Epub 2018 Jun 15.
The aim was to investigate the association between step time variability and related brain structures in accordance with fall status in people with multiple sclerosis (PwMS).
The study included 225 PwMS. Whole-brain magnetic resonance imaging was performed with a high-resolution 3.0 T magnetic resonance scanner in addition to volumetric analysis based on 3D T1-weighted images using the FreeSurfer image analysis suite. Step time variability was measured with an electronic walkway. Participants were defined as 'fallers' (at least two falls during the previous year) and 'non-fallers'.
In all, 105 PwMS were defined as fallers and had a greater step time variability compared to non-fallers [5.6% (SD = 3.4) vs. 3.4% (SD = 1.5); P = 0.001]. MS fallers exhibited a reduced volume in the left caudate and both cerebellum hemispheres compared to non-fallers. On using a linear regression analysis no association was found between gait variability and related brain structures in the total cohort and the non-fallers group. However, the analysis found an association between the left hippocampus and left putamen volumes with step time variability in the faller group: P = 0.031, 0.048, respectively, controlling for total cranial volume, walking speed, disability, age and gender. Nevertheless, according to the hierarchical regression model, the contribution of these brain measures to predict gait variability was relatively small compared to walking speed.
An association between low left hippocampal, putamen volumes and step time variability was found in PwMS with a history of falls, suggesting that brain structural characteristics may be related to falls and increased gait variability in PwMS.
本研究旨在探讨多发性硬化症（MS）患者的步时变异性与相关脑结构之间的关系，并根据跌倒状态进行分析。
本研究纳入了 225 名 MS 患者。使用高分辨率 3.0 T 磁共振扫描仪进行全脑磁共振成像，并使用 FreeSurfer 图像分析套件对基于 3D T1 加权图像的容积分析。使用电子步道测量步时变异性。将参与者定义为“跌倒者”（过去一年至少跌倒两次）和“非跌倒者”。
共有 105 名 MS 患者被定义为跌倒者，其步时变异性明显大于非跌倒者[5.6%（SD=3.4）比 3.4%（SD=1.5）；P=0.001]。与非跌倒者相比，MS 跌倒者的左侧尾状核和双侧小脑半球体积较小。线性回归分析显示，总队列和非跌倒者组中，步态变异性与相关脑结构之间无相关性。然而，分析发现，跌倒者组中左海马体和左侧壳核体积与步时变异性之间存在相关性：分别为 P=0.031、0.048，校正总颅容、步行速度、残疾、年龄和性别后。然而，根据分层回归模型，与步行速度相比，这些脑测量值对预测步态变异性的贡献相对较小。
MS 跌倒史患者的左海马体和壳核体积较小与步时变异性有关，表明脑结构特征可能与 MS 患者的跌倒和步态变异性增加有关。
