Vestibular dysfunction is common in people with multiple sclerosis (PwMS), but responses to optokinetic stimulation (OKS) across different vestibular conditions remain unclear. This study examined the immediate effects of VR-based OKS on balance and motion sickness in PwMS.

Forty-one PwMS and 23 matched healthy controls were included. Participants were classified by videonystagmography into MS with central vestibular involvement (n = 20, Group 1), MS without vestibular involvement (n = 21, Group 2) and healthy controls (n = 23, Group 3). Postural control was assessed with the FreeMED forceplate and VR sickness with the VR Sickness Questionnaire. Individually tailored OKS was delivered using Oculus Quest 2, with assessments immediately before and after stimulation.

Significant group × time interactions were found for sway length (open eyes [OE] monopodal left p = 0.024, closed eyes [CE] monopodal left p = 0.012, CE monopodal right p = 0.009), average speed (OE bipodal p = 0.004, OE monopodal left p = 0.017, CE monopodal right p = 0.026), mediolateral sway (CE bipodal p = 0.014, OE monopodal right p = 0.038) and anteroposterior sway (OE monopodal left p = 0.013). Post hoc analyses showed reduced sway length in G2 (p = 0.047), reduced average speed in G1 (p = 0.002), increased mediolateral sway in G1, G3 and G2 (p = 0.031, p = 0.026, p = 0.010) and opposite anteroposterior responses, decreasing in G1/G2 but increasing in G3, with differences between G1–G2 and G2–G3 (p = 0.007, p = 0.004). VR sickness scores did not differ between groups (p > 0.05).

VR-based OKS induced immediate, well-tolerated balance changes in PwMS, with group-specific responses across conditions. Greater destabilization was seen in those with central vestibular involvement. Individualized OKS may promote vestibular adaptation and improve postural control in MS rehabilitation.

Visual-vestibular mismatch patients experience persistent postural and perceptual dizziness. Previous studies have shown the benefit of vestibular rehabilitation for visual desensitisation using gaze stabilisation exercises and optokinetic stimulation. This study assessed the benefit of customised vestibular rehabilitation with visual desensitisation and virtual reality based therapy rehabilitation in the management of patients with persistent postural-perceptual dizziness.

This retrospective study included 100 patients with Situational Characteristic Questionnaire scores of more than 0.9. All patients received virtual reality based therapy along with usual vestibular rehabilitation using gaze stabilisation exercises with a plain background followed by graded visual stimulation and optokinetic digital video disc stimulation. Patients’ symptoms were assessed before and after vestibular rehabilitation using the Situational Characteristic Questionnaire, Generalised Anxiety Disorder Assessment-7, Nijmegen Questionnaire and Dizziness Handicap Inventory.

There were statistically significant improvements in Situational Characteristic Questionnaire scores, Nijmegen Questionnaire scores and Dizziness Handicap Inventory total score. However, there was a statistically insignificant difference in Generalised Anxiety Disorder Assessment-7 scores. There was a significant positive correlation between post-rehabilitation Situational Characteristic Questionnaire scores and other questionnaire results.

Incorporating virtual reality based therapy with customised vestibular rehabilitation exercises results in significant improvement in persistent postural-perceptual dizziness related symptoms.