Vision-related Quality of Life in Patients With Multiple Sclerosis Can Be Improved After Therapeutic Electrical Stimulation
Visual impairments caused by optic neuritis are a key manifestation of multiple sclerosis. Restored vision after the acute phase, begins within 3-5 weeks of onset of visual symptoms. Unfortunately, the recovery following acute optic neuritis often is incomplete leaving deficits such as contrast vision, disturbed color vision and deteriorated visual acuity. 10–15% of patients are left with severe persistent visual deficits that are impacted by multiple sclerosis which are significantly limiting in their daily life. Such permanent vision deterioration additionally includes decreased visual acuity, low contrast sensitivity, blurred vision, binocular vision defects, reduced color vision and diplopia.
Some patients thought that their vision improved with rest, but there is evidence that such visual recovery is incomplete, leading to persistent vision deficits over time. Severe forms of vision loss affect the patient’s quality of life, interfering with their abilities such as reading, facial recognition and driving.
Finally these visual impairments taken together with developed visuomotor abnormalities like oscillopsia and diplopia significantly affects the success of the rehabilitation process for multiple sclerosis patients.
The work on electrical current stimulation in the visual system was first developed in Russia. Initially invasive and than non-invasive treatment was applied in patients with visual system damage. In a clinical observational study of 446 patients with optic nerve damage caused by trauma, ischemia, tumor, glaucoma, toxic injury and other vision-related impairments, visual acuity and visual fields were measured before and after 10 days of rtACS treatment. It was confirmed, that therapeutic electrical stimulation led to significant VA improvements and visual field enlargements. This work led to breakthroughs in the rehabilitation of patients with visual impairment, who were previously considered incurable.
To assess the effectiveness of the method of therapeutic electrical stimulation to improve eyesight in MS patients was analyzed and 43 visual impaired patients (21 men, 22 women) aged 20-51 years (mean age of 35,4 ± 1,5 years) with a confirmed diagnosis of multiple sclerosis with Poser Scale (1979) were treated. The disease duration ranged from 1 to 15 years (mean age 6,5 ± 1,1 years) and the Kurtzke Disability Status Scale (DSS) was used to measure the disability status of this group of patients (average score 3.4 ± 1,6). Ophthalmological examination revealed binocular visual impairments such as, decreased visual acuity, visual field abnormalities, low contrast, blurred vision, reduced color vision and diplopia were observed. More than half of patients (54.6%) in this study had high contrast visual acuity from below 2/20 as the results of advanced optic nerve atrophy. Visual field abnormalities included diffused visual field deficit, central absolute or relative scotoma, arcuate or double arcuate scotoma and hemianopic defects.
Treatment was carried out for two weeks using the electrical stimulator that generates square waves of alternating current. Parameters of therapeutic electrical stimulation were selected individually depending on the retinal phosphene and current intensity varied from 300 to 1200 mA. Conducted therapy did not lead to side effects and any negative development for multiple sclerosis. The study showed that 32 of 42 (76.2%) patients reported subjective improvement in vision as the result of increased visual acuity and contrast or/and enlargement visual field size. Statistical analysis revealed significant increases in visual acuity up to 18% from the baseline. Visual field enlargement, measured with the Goldman kinetic visual fields was 14-15% with maximum improvement up to 29% for patients with moderate visual impairments. Available follow up results (after 6-9 months) confirmed, that achieved improvement was stable for 78% of patients.
Who needs therapeutic electrical stimulation therapy?
Multiple sclerosis diagnosed patients who require this treatment have the following visual challenges:
- Decreased visual acuity with blurred vision
- Low contrast sensitivity and reduced color vision
- Visual field abnormalities adversely affect the patient’s ability to perform day-to-day activities such as personal hygiene, reading and driving
What outcomes on vision related quality of life can be expected?
- Increased vision performance
- Enhancement of the day-to-day activities
- Improvement of vision-related quality of life
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