Balance Declines may Predict Relapse Onset in Multiple Sclerosis—A Case Study

The goal of the present case study was to track balance performance during a videogame-based training intervention, and prior to a clinically-significant relapse of Multiple Sclerosis. A 28 year old male volunteer with relapsing-remitting Multiple Sclerosis since childhood was recruited. Balance was tracked using custom software and a Nintendo Wii Balance Board at weekly intervals during a videogame-based balance intervention. The intervention was planned for three, 30 min sessions a week, over 6 weeks. However, at week five, the participant had a relapse of his MS and had to be withdrawn from the study till remittance. Based on body sway measured as center of pressure from the balance tracking system, balance showed improvement during the first 2 weeks of intervention, with a 12 % reduction in body sway. In contrast, balance performance decreased in the following 2 weeks (i.e. weeks three and four), despite continued training. This balance decline anticipated a clinically-relevant relapse event, which occurred at week five of the intervention. This balance decline remained at follow-up (i.e. upon remittance). Balance tracking at regular time intervals may serve as a useful bio-indicator of intervention efficacy and as a predictor of relapse onset. The latter finding has clear implications for the mitigation of relapse events in Multiple Sclerosis.