“This study demonstrates a point I have made on numerous occasions that despite having little, or no, disability on the EDSS, a physician-rated scale, when you do more challenging and detailed assessments MSers have subtle deficits. The so called hidden, early burden, of this disease is not detected using the EDSS. These deficits are not noticed or ignored as most MSers have compensatory mechanisms to cope with them. The problem starts when these compensatory mechanisms, or the so called brain reserve, is exhausted; this is when fixed disability or progressive disease starts. The so called MS iceberg just got a whole lot bigger.”
Nogueira et al. Gait characteristics of multiple sclerosis patients in the absence of clinical disability. Disabil Rehabil. 2013 Aug;35(17):1472-8
Purpose: Motor deficits in lower extremities and gait abnormalities are a major feature of MS. MSers with minimal clinical disability have subtle gait changes. The aim of this study was to analyze the gait characteristics of MSers in the absence of clinical disability.
Method: A case-control study was carried out with 12 MSers and 12 matched healthy controls. The subjects underwent a clinical neurological evaluation to determine their disability level (EDSS ≤ 1.5). Then, the subjects were referred for completion self-report questionnaires (gait, perceived balance confidence, physical activity and fatigue), gait clinical trials, and 3D kinematic analysis.
Results: MSers showed more impairment of perceived fatigue, perceived of walking impact and perceived balance confidence, despite having no disability. Gait characteristics showed no differences when they were determined by clinical observation. The 3D kinematic analysis of gait showed slight but significant changes in ankle movement.