Background and Objectives: Early-onset MS (EOMS) and late-onset MS (LOMS) differ in terms of symptom presentation, disease progression, and disability outcomes. This study aims to evaluate the clinical characteristics of patients with EOMS and LOMS in Lithuania. Materials and Methods: A retrospective analysis of patients’ medical records was conducted at the Lithuanian University of Health Sciences, Kaunas Clinics Department of Neurology. This study included 97 patients with multiple sclerosis, of which 34 were diagnosed with EOMS and 63 with LOMS. Results: The female/male ratio did not differ significantly in the EOMS group (1.26:1), while in the LOMS group, the female-to-male ratio was 2:1. All EOMS patients were diagnosed with relapsing–remitting multiple sclerosis (RRMS), while in the LOMS group, RRMS was observed in 55.6%, secondary progressive multiple sclerosis (SPMS) was observed in 27%, and primary progressive multiple sclerosis (PPMS) was observed in 17.4% of patients (p < 0.001). The most common initial symptoms in the EOMS group were brainstem dysfunction (50%), and sensory (38.2%) and visual (26.5%) disorders, whereas LOMS patients predominantly experienced brainstem dysfunction (50.8%) and motor impairments (47.6%). The EOMS group experienced more clinical relapses in the first year after diagnosis, along with more frequent radiological signs of disease activity compared to LOMS (p < 0.001). Both groups demonstrated a significant increase in Expanded Disability Status Scale (EDSS) score at the last follow-up visit compared to the baseline, while the LOMS group had higher EDSS scores both at the baseline and at the last follow-up compared to the EOMS group (p < 0.001). Only LOMS patients had an increase in Multiple Sclerosis Severity Score (MSSS) at the last follow-up compared to the baseline (p = 0.028), and MSSS was higher than in EOMS patients both at the baseline (p = 0.004) and the last follow-up (p < 0.001). Conclusions: There was no significant gender difference in the EOMS group, whereas in the LOMS group, females were predominant. Both groups had RRMS as the most common disease course. At the onset of MS, brainstem dysfunction was the most common symptom in both patient groups. EOMS patients had a more active disease course, in contrast to LOMS patients, who exhibited higher levels of disability, suggesting a progressive disease.

Background and Objectives: Decreased balance function in multiple sclerosis (MS) patients is influenced by impaired gravity perception, which can be measured by the subjective visual vertical (SVV) test. The value of this test can be increased by executing it in a moving visual background (i.e., dynamic SVV). However, clinicians and researchers use varying dynamic stimulus properties due to the lack of consensus on optimal parameters for reliably distinguishing between health and disease. Materials and Methods: To evaluate how dynamic visual stimulus intensity affects the perception of verticality in patients with MS and healthy individuals. Materials and Methods: We assessed static and dynamic SVV in 31 MS patients with dizziness and 32 age- and sex-matched controls using the virtual reality application VIRVEST. We evaluated the effects of modifying two parameters in dynamic SVV testing: rotation velocity (10°/s, 30°/s, and 60°/s) and visual field coverage (small vs. large). Results: The median of static SVV deviations was significantly greater in the MS group (1.8° vs. 0.9°). The mildest dynamic stimulus intensity of 10°/s, with a small visual field coverage, yielded the greatest discriminatory capacity to differentiate between the groups (AUC = 0.897; p < 0.001). This stimulus elicited a median SVV deviation of 4.3° in the MS group and 2.1° in the control group (p < 0.001) while also inducing significantly lower test-induced dizziness compared with stronger stimuli. Median visual dependence values measured at 10°/s with a small visual field coverage were 4.2 in the MS group and 2.02 in the control group (p < 0.001), also yielding the greatest AUC values compared to stronger stimuli (AUC = 0.828; p < 0.001). Conclusions: Our results support the use of relatively mild dynamic stimulus intensity. Future studies are encouraged to evaluate different dynamic stimulus parameters and patient populations.

Dizziness and balance disturbances are common in patients with MS. Subjective visual vertical (SVV) is a test of vestibular perception that allows clinicians to evaluate the integration of multiple sensory inputs for spatial orientation in the CNS. We hypothesize that central vestibular impairment caused by active MS lesions may be reflected in the modified SVV testing. To evaluate the applicability of dynamic and head-tilt SVV for detecting spatial orientation disturbances in MS patients and compare it with conventional SVV testing. The SVV test was conducted using the virtual reality application VIRVEST. SVV was measured in static and dynamic conditions during head upright, and 30° right and left lateral head tilts. The study group comprised 36 patients with active MS and 40 controls. Greater SVV errors were found in MS patients during upright testing; however, dynamic conditions increased the test's sensitivity. Lateral head tilts affected the perception of verticality in both groups; however, the absolute values of SVV biases were paradoxically greater in controls. Potentially pathological A-effect was found in 75 % of MS patients and 17,5 % of controls (p < 0,001), as SVV was more likely to shift towards the side of the head tilt in the MS group. Lateral head tilts and dynamic conditions are valuable additions to the SVV test for detecting disturbances in spatial orientation during active MS. The direction of SVV shifts during lateral head tilts may be more clinically significant than the magnitude of SVV errors for this patient group.

Background and Objectives: Non-invasive biomarkers reflecting neurodegeneration are increasingly important in multiple sclerosis (MS). Optical coherence tomography (OCT) provides quantitative measures of retinal structure, most commonly peripapillary retinal nerve fiber layer (pRNFL) thickness. However, the potential clinical relevance of optic nerve head morphology, including cup-to-disc ratio (CDR), remains insufficiently explored. We investigated associations between OCT-derived parameters, subjective visual vertical (SVV), and disability in MS. Materials and Methods: In this retrospective study, 100 patients with MS were included. OCT parameters (pRNFL thickness and area-based CDR) were analyzed at baseline and follow-up. Clinical disability was assessed using the Expanded Disability Status Scale (EDSS). Detailed optic neuritis history was not consistently available in the retrospective clinical records and therefore could not be systematically accounted for in the analyses. SVV was evaluated in 37 patients using a virtual reality–based protocol. Associations were assessed using Spearman correlation and linear regression analyses. Multivariable regression models were adjusted for age, sex, and follow-up duration. Results: pRNFL thickness was not associated with baseline EDSS (rho = −0.06, p = 0.55) or annualized EDSS change. Baseline CDR correlated with both baseline EDSS (rho = 0.30, p = 0.0065) and follow-up EDSS (rho = 0.46, p < 0.0001). In univariable regression analysis, baseline CDR was associated with follow-up EDSS (B = 3.33, R² = 0.23, p < 0.0001), remaining significant after adjustment for age, sex, and follow-up duration (B = 2.59, 95% CI 1.26–3.92, p = 0.0002). No significant associations were observed between OCT parameters and SVV measures. Conclusions: Higher CDR values, but not pRNFL thickness, were associated with disability measures in this exploratory MS cohort. However, these findings should be interpreted cautiously because optic neuritis history could not be systematically accounted for and physiological optic disc variability may substantially influence CDR measurements.