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BACKGROUND: Multiple Sclerosis (MS) is a neurodegenerative and inflammatory disease that impacts both visual and postural control. It is currently unknown how the integration between visual and postural control is affected in people with MS (PwMS). It has been shown in healthy individuals that saccadic eye movements can decrease body sway as result as the integration of eye and postural movements. OBJECTIVE: Investigate the effect of saccadic eye movement on postural control in PwMS and compare with neurologically healthy people. METHODS: Thirteen mildly affected PwMS (1.53 ± 1.03 on Expanded Disability Status Scale - EDSS) and 12 healthy neurologically people participated in this study. Postural control was assessed on a force platform under two eye movement conditions: fixation on a central target and saccadic eye movement. The dependent variables assessed were the displacement, velocity, root-mean-square (RMS) and area of postural center of pressure and the number, duration, variability, fixations errors and eye response time. A mobile eye tracker was used to record eye movement. Two-way ANOVA (group and eye movement) for postural variables was performed. For the eye variables, one-way ANOVA with factor to group was performed. The p-value was maintained at 0.05 for all statistical analysis and the effect sizes were based on Cohen's d. RESULTS: No group or interaction effects (group*eye movement) were found for postural and eye variables. However, the saccadic eye movement attenuated the postural displacement in anteroposterior (AP) direction (p < 0.001, Cohen's d = 4.677), RMS AP (p < 0.001, Cohen's d = 4.399) and area (p < 0.013, Cohen's d = 2.163) in comparison with the central fixation condition in both groups. The Cohen's d showed a large effect between groups for fixation errors (d = 0.741). CONCLUSION: Both groups presented similar postural control performance in both eye movement conditions. Moreover, PwMS could attenuate body sway similarly to the control group, showing that the central integration of dynamic eye movements and postural control is preserved in mildly affected PwMS.

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BACKGROUND: The objective of this study was to estimate costs to society and patients' quality of life (QoL) at all levels of disease severity (measured with the Expanded Disability Status Scale, EDSS) in Brazil. METHODS: The study was part of an international, cross-sectional burden-of-illness study carried out in collaboration with national MS patient organizations. All information was collected directly from patients using a validated questionnaire. Direct costs were estimated both from societal and payer perspectives, while total costs are presented as societal costs. RESULTS: The survey included 694 patients (response rate 21%; mean age 40.8 years). 95% of patients were of working age, and around half were working. The mean EDSS score was 3.2 (62.5% of patients with EDSS <3). Relapses were reported by 18.9% of patients. Fatigue affected almost all patients (94%) regardless of EDSS level, and cognitive difficulties were reported by 69.1% of patients. Mean utility ranged from 0.77 at EDSS 0 to negative values at EDSS 9, with a mean score of 0.58; utility was affected by relapses. Total mean annual cost was R$33,872 (€ 8,000) per patient in the societal perspective, with direct costs representing 81% (R$ 27,355, € 6,500). Direct costs for the payer amounted to R$ 16,793 (€ 4,000)/patient. CONCLUSIONS: This study included a population with relatively mild and early disease, with a majority of patients with relapsing disease and thus on DMD treatment. It is not possible to conclude directly on the total cost of MS in Brazil. Nevertheless, resource quantities used, QoL and MS symptoms are very similar to what was seen in the European survey.

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