Multiple Sclerosis (MS) is a chronic neurological condition that affects the brain, spinal cord, and optic nerves, collectively known as the central nervous system (CNS). This autoimmune disease disrupts the flow of information within the brain and between the brain and body. Vertigo is a sensation of spinning, either of oneself or the surroundings, which can lead to feelings of unsteadiness and potential falls. Yes, MS can indeed cause vertigo, and it is a symptom experienced by a notable percentage of individuals living with the condition.
How MS Affects Balance and Causes Vertigo
Multiple Sclerosis impacts balance and can lead to vertigo primarily through the process of demyelination and the formation of lesions within the central nervous system. Myelin is a protective covering around nerve cells that facilitates the rapid transmission of signals throughout the brain and spinal cord. In MS, the immune system mistakenly attacks and damages this myelin, disrupting normal nerve signal transmission. This damage, known as demyelination, can lead to the formation of scar-like tissues or plaques, also called lesions.
When these lesions develop in specific areas of the brain that are important for balance and spatial orientation, they can directly cause vertigo. The brainstem and cerebellum are two such areas that play a key role in coordinating balance and processing information from the vestibular system, which is located in the inner ear and senses head movements. Damage to the brainstem, which connects the brain to the spinal cord and controls many automatic functions, can interfere with the coordination of messages important for equilibrium. Similarly, the cerebellum is responsible for fine-tuning movements, coordination, and maintaining posture and balance.
Lesions in these regions can disrupt the network of signals that integrate visual, sensory, and inner ear information, leading to a mismatch in the data sent to the brain. This conflicting information can result in the sensation of spinning or unsteadiness characteristic of vertigo. The severity and location of these lesions dictate the nature and intensity of the vertigo experienced. Approximately 20% of people with MS report experiencing vertigo, with some studies suggesting this number could be as high as 49-59% when including general dizziness.
Recognizing Vertigo and Other Dizziness in MS
It is important to differentiate true vertigo from other forms of dizziness or imbalance in Multiple Sclerosis. While “dizziness” is a general term that can encompass feelings of lightheadedness, unsteadiness, or feeling off-balance, vertigo specifically refers to the sensation that you or your surroundings are spinning or moving when they are not. Vertigo can be intense and may also be accompanied by nausea, vomiting, vision problems, or hearing disturbances.
MS causes a type of vertigo known as “central vertigo,” which originates from issues within the central nervous system, particularly the brainstem or cerebellum. This is distinct from “peripheral vertigo,” which is caused by problems with the inner ear or vestibular nerve. While peripheral vertigo often presents with sudden spinning sensations that can be triggered by head movements and may include hearing changes, central vertigo from MS might have different characteristics. Central vertigo can be more persistent or less responsive to positional changes.
Other balance issues in MS include disequilibrium, a feeling of unsteadiness, or lightheadedness, a sensation of feeling faint. These can arise from various MS-related factors beyond specific lesions, such as muscle weakness, impaired vision, or fatigue, all contributing to balance challenges. Accurately describing the sensation to a healthcare professional is important, as it helps determine whether the symptom is true vertigo, another form of dizziness, or a combination, guiding appropriate diagnosis and management.
Strategies for Managing Vertigo in MS
Managing vertigo in Multiple Sclerosis involves medical treatments and non-pharmacological interventions to alleviate symptoms and improve daily functioning. For acute episodes of vertigo, especially those linked to an MS exacerbation, a healthcare provider may prescribe corticosteroids to reduce inflammation. Medications to address the sensation of spinning and associated symptoms include anti-nausea drugs and vestibular suppressants. Over-the-counter options like dimenhydrinate and meclizine help manage motion sickness and dizziness. For more persistent or severe vertigo, prescription medications such as scopolamine or promethazine may be used.
Beyond medication, non-pharmacological strategies offer benefits. Vestibular rehabilitation therapy (VRT) is a specialized physical therapy involving exercises to retrain the brain’s balance system. These exercises include eye, head, and body movements performed in various positions, helping the brain adapt to and compensate for impaired vestibular input. VRT has demonstrated effectiveness in improving balance, reducing fatigue, and decreasing the disability associated with dizziness in individuals with MS.
Physical therapy also plays a role, focusing on improving overall balance, coordination, strength, and gait. A physical therapist can develop a personalized exercise program to enhance stability and reduce fall risk. Lifestyle adjustments contribute to managing vertigo symptoms.
These include avoiding sudden head movements, ensuring good lighting, and using assistive devices like canes or walkers when needed to enhance safety and reduce fall risk. Maintaining physical activity through gentle exercises like yoga or Tai Chi, staying hydrated, and managing stress can help mitigate dizziness symptoms. Consulting with a healthcare professional is important to determine the most appropriate and personalized management plan for MS-related vertigo.