What causes dizziness and vertigo in Multiple Sclerosis?

Multiple Sclerosis is defined by the presence of demyelinating plaques that can occur anywhere in the nervous system which in turn causes an interruption to the messaging system relaying information around the body.  Our ability to stay balanced within our environment relies on a complex process of messaging from various systems in our body to our brains. If for any reason that is interrupted then the brain receives or processes that information incorrectly and can cause us to feel dizzy. Dizziness and vertigo can also be caused when the lesions affect particular parts of the brain, nervous system and vestibular apparatus directly associated with balance, for example, the balance organ in your inner ear, the brainstem and the cerebellum. This can upset the body’s sense of its position in space. This misleading information creates the symptoms of dizziness.

People affected by dizziness with MS often assume that it is just another inevitable part of the disease process but they are also just as likely as anyone else to have a problem purely with the balance organ (the vestibular apparatus) ie from an infection.

It is important to establish what is causing the dizziness so that you get the most appropriate treatment to alleviate symptoms.

What are the common symptoms?

Vertigo (a sensation of the environment moving around you)

Nausea or vomiting

Alterations in balance

Muzzy headedness

Veering to the side when walking

Dizziness brought on by certain movements

Feeling anxious or overwhelmed in busy environments

Symptoms can vary person to person and may be exacerbated by the other problems relating directly to MS for example, visual changes, decreased sensation in your limbs and generalised weakness and fatigue. These all have the potential to affect your balance and mobility and increase your risk of falling. Sometimes they are difficult to separate out from your long-standing MS symptoms.

So, what do I do if I have these symptoms?

Any new symptoms are best investigated by your GP, neurologist or nurse specialist in the first instance. They may recommend some more specific tests to establish what is causing your dizziness and may give you some medication to help reduce your symptoms. A referral to a physiotherapist trained in the treatment of dizziness is recommended if symptoms do not resolve on their own.

How can physiotherapy help with vertigo and dizziness?

Physiotherapists trained in “vestibular rehabilitation” can identify whether your dizziness is a result of changes to your nervous system from the MS, whether you simply have a problem with the balance organ in your inner ear or a combination of both. Once the cause has been identified following a thorough assessment, your therapist can provide you with a variety of exercises tailored specifically for your problems to help reduce the vertigo and improve your balance and mobility. These exercises can involve a combination of head and eye movements, balance and walking exercises.

Sometimes the exercises can initially cause you to feel a little more symptomatic, but this is normal and it is important that you try and stick with them in order to maximise your recovery.

Occasionally you may be prescribed medication by your neurologist or GP to minimise the dizzy symptoms but many of these are usually only effective in the short term and can potentially hinder longer-term recovery and make the exercises less effective.

What can I do to help?

The most important thing you can do is to try and keep moving around as normally as possible. A study showed that a large percentage of people with MS who experience dizziness actually have a problem just with their inner ear that is not related to the disease at all. This type of dizziness is very amenable to rehabilitation with resolution of dizzy symptoms in most cases. Maintaining normal activity is advocated in these cases to maximise recovery.

If symptoms are treated and resolve they may never recur, others may never completely clear but most people respond positively to treatment. Occasionally symptoms may rear up again in periods of stress or illness. If this is the case do talk to your health care professional about a referral back to your physiotherapist.