Multiple Sclerosis (MS) is a chronic disease of the central nervous system where the immune system attacks the protective myelin sheath surrounding nerve fibers in the brain and spinal cord. This damage disrupts the flow of information between the brain and the body. This article clarifies the relationship between dizziness and MS, detailing its forms, causes, and management strategies.
Dizziness as a Recognized Symptom of MS
Dizziness is a commonly reported symptom among individuals with Multiple Sclerosis, confirming a recognized link between the sensation and the disease process. Studies suggest that between 49% and 59% of patients will experience some form of dizziness during their disease course. This symptom can be present early in the condition and may indicate new disease activity or a flare-up. For a subset of individuals, the symptom is severe, with nearly 38.5% classifying its impact as moderate or severe. The presence of dizziness or unsteadiness can significantly impact quality of life and increase the risk of falls, especially when combined with other MS issues like muscle weakness or fatigue.
Types and Causes of MS-Related Dizziness
Forms of Dizziness
Dizziness is an umbrella term describing several distinct sensations, typically manifesting in three main ways in MS.
- Vertigo: The intense sensation that you or your surroundings are spinning or moving, often accompanied by nausea.
- Lightheadedness (Presyncope): A feeling of faintness or as if one is about to pass out.
- Disequilibrium: Characterized by a feeling of unsteadiness or poor balance without the spinning sensation.
Neurological Causes
The underlying cause of MS-related dizziness is demyelination in specific areas of the central nervous system involved in balance control. MS lesions that develop in the brainstem or the cerebellum are particularly likely to cause these issues. The brainstem links the inner ear’s balance mechanisms to the brain, while the cerebellum coordinates movement and balance. When demyelination disrupts these nerve pathways, it causes a mismatch in signals, resulting in central vertigo. This central type of vertigo originates from the brain and is distinct from peripheral vertigo.
Treatment Strategies for Dizziness in MS
Treating MS-related dizziness involves addressing both acute symptoms and underlying balance dysfunction. For acute vertigo episodes, a healthcare provider may prescribe vestibular suppressants, such as anti-motion sickness medications, to temporarily alleviate the spinning sensation. If dizziness is severe and part of a clear MS relapse, a short course of corticosteroids may be administered to reduce inflammation. For chronic unsteadiness, Vestibular Rehabilitation Therapy (VRT) is often the most beneficial approach. VRT is a structured exercise program designed by a specialized physical therapist to help the brain compensate for disrupted balance signals.
Causes of Dizziness Beyond Multiple Sclerosis
Dizziness is a common complaint with numerous possible causes unrelated to MS.
Common Non-MS Causes
- Inner ear disorders, such as Benign Paroxysmal Positional Vertigo (BPPV) caused by dislodged calcium crystals, or infections like vestibular neuritis.
- Vestibular migraine, which can cause episodes of vertigo even without a headache.
- Systemic issues, including orthostatic hypotension (sudden drop in blood pressure upon standing), dehydration, or low blood sugar.
- Medication side effects from drugs like anti-seizure medications, antidepressants, and blood pressure medications.
- Anxiety disorders and stress.
If a person experiences new, persistent, or worsening dizziness, or if it is accompanied by other concerning symptoms like severe headache, chest pain, numbness, or slurred speech, a prompt medical evaluation is necessary. A healthcare provider can perform an assessment to determine the cause and ensure the most appropriate treatment is initiated.