Multiple Sclerosis (MS) is a chronic condition that affects the central nervous system. Dizziness and balance problems are extremely common symptoms, affecting up to 60% of people with MS at some point during their disease course. These sensations range from mild unsteadiness to a severe spinning feeling, often causing significant disruption. The duration of these symptoms varies widely, depending on the specific cause and whether the symptom is part of an acute flare-up or a persistent, long-term issue.
Understanding the Types of MS Dizziness
The term “dizziness” encompasses several distinct sensations, each with a different cause and prognosis in MS. The most distinct type is true vertigo, which is the intense sensation that you or your surroundings are spinning or moving, even when you are perfectly still. This feeling often occurs when MS lesions damage specific areas in the brainstem or cerebellum that process balance signals from the inner ear and eyes, leading to a mismatch of sensory information.
A separate and often more common experience is disequilibrium, described as a feeling of unsteadiness, poor balance, or being wobbly while walking. This is usually caused by demyelination in the nerve pathways responsible for coordinating movement and gait, making it difficult to maintain upright postural control. Disequilibrium typically does not involve the spinning sensation associated with vertigo but increases the risk of falls and general instability.
A third type of sensation is lightheadedness, which is a feeling of wooziness or feeling like one might pass out or faint. This symptom is less often a direct result of MS lesions damaging balance centers. Instead, it frequently relates to secondary factors, such as medication side effects, dehydration, or autonomic dysfunction that affects blood pressure regulation.
Factors Determining Symptom Duration
The duration of MS dizziness depends on whether it is an acute symptom of a relapse or a chronic, persistent issue. When dizziness, particularly vertigo, is part of an acute relapse, it is caused by new or active inflammation and demyelination in the brain’s balance centers. These flare-ups must last for at least 24 hours to be classified as a true relapse and usually resolve as the inflammation subsides.
A typical acute relapse of dizziness or vertigo usually lasts for several days to a few weeks, though it can persist for a month or two in some cases. Symptoms often reach their peak severity within a few days before gradually improving. While some people report their relapses lasting less than a month, others can experience symptoms for several months before reaching a new baseline.
Chronic or persistent symptoms, most often manifesting as disequilibrium or unsteadiness, tend to be long-lasting. This ongoing imbalance is frequently due to accumulated residual damage or scarring in the central nervous system from previous relapses, or long-term gait impairment. This persistent unsteadiness may fluctuate in severity day to day but does not resolve completely on its own, unlike the acute vertigo of a relapse.
The specific location and size of the MS lesion significantly influence the duration and severity of the symptom. A larger lesion or one located in a highly sensitive area like the brainstem will likely lead to more severe symptoms that take longer to resolve. Underlying factors like fatigue, which is a common MS symptom, can also worsen and prolong the feeling of unsteadiness.
Treatment and Management Strategies
The strategy for managing MS dizziness depends on whether the symptom is acute or chronic. For acute vertigo that is severe enough to cause significant disability, treatment aims to reduce the inflammation quickly. This often involves a short course of high-dose intravenous corticosteroids, which can speed recovery and shorten the duration of the relapse.
Specific medications can also be used to manage the symptoms of vertigo itself, such as vestibular suppressants or anti-motion sickness drugs like meclizine. These medications are recommended for short-term use during the acute phase, as prolonged use can interfere with the brain’s natural ability to compensate for the balance disturbance.
For chronic disequilibrium and persistent balance issues, the primary intervention is non-pharmacological, focusing on rehabilitation. Vestibular Rehabilitation Therapy (VRT) is a specialized form of physical therapy that uses targeted exercises to help the brain adapt to altered balance signals. VRT exercises work to improve gaze stabilization, strengthen postural control, and enhance the body’s ability to adjust to movement challenges.
Physical therapy can address gait and coordination problems, which are often the root cause of chronic unsteadiness. Simple lifestyle adjustments can also help manage the daily impact of dizziness, including avoiding sudden head movements, using assistive devices like canes for stability, and prioritizing fatigue management.