Objective: To assess the progression of postural control impairments in patients with HSP and identify the most sensitive COP parameter to change during a three-year follow-up.

Background: The degeneration of motor and somatosensory tracts contributes to an altered control of balance in patients with hereditary spastic paraplegias (HSP). However, the progression of these deficits remains largely unknown. The center of pressure (COP) parameters obtained from the static balance assessment on the force platform could serve as digital health technology markers for detecting motor and proprioceptive deficits in individuals with HSP. Nevertheless, the sensitivity to changes in the center of pressure parameters for capturing the progression of HSP in longitudinal studies still needs to be characterized.

Method: This prospective cohort study evaluated static balance on force platform with eyes open (EO) and eyes closed (EC) in 19 HSP individuals at baseline (Subtypes: 11 SPG4, 4 SPG5A, 1 SPG7, 2 SPG3A, 1 cerebrotendinous-xanthomatosis). After three years, 11 patients were reassessed. The clinician-reported outcome Spastic Paraplegia Rating Scale was applied.

Results: After three years of follow-up, significant progression was observed in the velocity of anteroposterior, as well as in its anteroposterior and mediolateral amplitudes of displacements of COP, irrespective of eye conditions for the overall HSP group (p < 0.05). There was significant progress in the difference between eyes closed and open (Dif. EC-EO) on velocity of anteroposterior of COP, indicative of proprioceptive dysfunction, it was observed in the overall HSP and SPG4 subgroup (p < 0.05). The Spastic Paraplegia Rating Scale did not show significant progression. Finally, 3/11 patients were unable to complete the test with eyes closed after 3 years of follow-up, and their follow-up data were not included in the analyses.

Conclusion: Static balance assessment detected the progression of postural control abnormalities in HSPs over three years. The main alterations are attributed to the deterioration of somatosensory pathways than motor pathways. There was higher sensitivity to change of various COP parameters compared to Spastic Paraplegia Rating Scale suggests that COP parameters should be further explored as an endpoint for clinical trials in HSPs.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/three-year-progression-of-the-postural-control-alterations-in-hereditary-spastic-paraplegias/