The sensation of feeling dizziness in people afflicted with multiple sclerosis is quite common.  A person may feel off balance or even lightheaded.  Significantly less often the sensation or feeling vertigo might occur.  Vertigo is a sensation that the person or their current surroundings are spinning.  The dizziness that defines vertigo is caused by one of two causes – disturbance in either the balance organs of the inner ear, or parts of the brain or sensory nerve pathways. Peripheral vertigo is a term that collects together the inner ear causes. Central vertigo is a term that collects together the central nervous system. Vertigo is a symptom rather than a medical condition.

Overview:

If you’ve been on your share of amusement park rides, you probably know what vertigo is like and the feeling that the world is spinning around you.

In multiple sclerosis vertigo is caused due to lesions or damaged areas in the neurological pathways which provide coordination of visual, spatial and other inputs into the brain that are necessary to create and maintain equilibrium.

According to a study by the University of Texas, about 20 percent of MS patients experience vertigo.

Types of Vertigo:

There are two types of vertigo, peripheral and central vertigo.

Peripheral vertigo is due to a problem in the part of the inner ear that controls balance. These areas are called the vestibular labyrinth or semicircular canals. The problem may also involve the vestibular nerve, which connects the inner ear to the brain stem.

Peripheral vertigo may be caused by:

  • Benign positional vertigo (benign paroxysmal positional vertigo)
  • Certain medicines such as aminoglycoside antibiotics, cisplatin, diuretics, or salicylates
  • Injury (such as head injury)
  • Inflammation of the vestibular nerve (neuronitis)
  • Labyrinthitis
  • Meniere’s disease
  • Pressure on the vestibular nerve, usually from a noncancerous tumor such as a meningioma or schwannoma

Central vertigo is due to a problem in the brain, usually in the brain stem or the back part of the brain (cerebellum).

Central vertigo may be caused by:

  • Blood vessel disease
  • Certain drugs such as anticonvulsants, aspirin, and alcohol
  • Migraine
  • Multiple sclerosis
  • Seizures (rarely)
  • Stroke
  • Tumors (cancerous or noncancerous)
Vertigo Chart
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Symptoms of Vertigo:

The main sensation most people experience with vertigo is the environment spinning or moving.

  • A sensation of movement accompanied by nausea, vomiting, and sweating.
  • A feeling the the room or you is moving or spinning.
  • Dizziness.
  • Ringing in the ears and changes in hearing.
  • Abnormal eye movement.
  • Spinning
  • Tilting
  • Swaying
  • Loss of balance
  • Pulled to one direction

If you have vertigo due to problems in the brain (central vertigo), you may have other symptoms, including:

  • Difficulty swallowing
  • Double vision
  • Eye movement problems
  • Facial paralysis
  • Slurred speech
  • Weakness of the limbs

Coping with Dizziness and/or Vertigo:

Precautions:

Make your home as safe as you can should you experience dizziness or vertigo as a result of MS:

  • Clear your home of tripping hazards.
  • Use a cane or a walker.
  • Install handrails and grab bars.
  • Use a shower chair.
  • Consider a wheelchair.
  • Get a lift chair for seated to standing assistance.
  • Do not drive when experiencing vertigo.
  • Use common sense.

Short Term Coping:

  • Should you experience vertigo its a good idea to sit down until the sensation subsides.
  • Turn down any forms of bright lighting, avoid moving your head or body position once comfortably seated.
  • Avoid stairs
  • DO NOT attempt to drive until you are certain that the vertigo has passed.
  • When you are feeling better begin moving very slowly.
  • If you experience vertigo during the evening make sure that any lighting is soft lighting, sit up straight and remain still until it passes.
  • A recliner or power assist recliner (lift chair) can be quite comfortable and assist you in gently standing up once the feeling has subsided.

To prevent worsening of symptoms during an episode of vertigo, try the following:

  • Keep still. Sit or lie down when symptoms occur.
  • Gradually resume activity.
  • Avoid sudden position changes.
  • Do not try to read when symptoms occur.
  • Avoid bright lights.

Should the dizziness and/or vertigo continue and not subside it is probably a wise idea to call emergency services as something else might be going on.  If dizziness and/or vertigo becomes a more frequent event for you contact your neurologist so he or she may assist you with getting the symptom under control.

Medications:

In most cases symptoms of dizziness or vertigo respond well to anti motion-illness medications such as Dramamine®, Bonine® and others.  Anti-nausea medication such as Zofran®.  Skin patch medications also exist to help cope with these conditions.  Severe cases might have a short term corticosteroid be prescribed.

Therapies:

Physical therapy may help improve balance problems.

Vestibular rehabilitation. This is a type of physical therapy aimed at helping strengthen the vestibular system. The function of the vestibular system is to send signals to the brain about head and body movements relative to gravity.
Generic vestibular rehabilitation in which individuals are provided with a series of tasks to perform that require them to use their eyes while their head is moving, and possibly when their body is also moving.

  • Plasticity — changes in central connections to compensate for peripheral disturbances. It would be nice if plasticity could handle everything. Unfortunately, there appear to be limits on how much the brain can compensate. Although conventional wisdom holds that older persons adapt less well than younger, a recent study suggests that there is no difference in benefit of vestibular rehabilitation according to age
  • Formation of internal models — a cognitive process where one learns what to expect from ones actions. Internal models are critical for predictive motor control, which is essential when one is controlling systems that have delays. Much of the benefit of vestibular therapy may depend on internal models. An example of this is a recent study by Herdman et al (2007) showing recovery of better vision in persons with bilateral vestibular loss was attributed to “centrally programmed eye movements”.
  • Learning of limits — another cognitive process involved with learning what is safe and what is not. Someone who does not know their limits may be overly cautious and avoid dangerous situations. Someone who does not realize that, for example, they can’t figure out which way is up, may drown in a swimming pool.
  • Sensory weighting — a cognitive process in which one of several redundant senses is selected and favored over another. Classically, selection occurs between vision, vestibular and somatosensation inputs when one is attempting to balance. People with unreliable vestibular systems, such as those in Meniere’s disease, sometimes seem to unable to switch off their visual reliance, causing them distress in certain situations where vision is an incorrect reflection of body movement (i.e. in the movies). (Lacour et al, 1997)

Other Conditions:

Just because you are feeling dizzy or sensations of vertigo does not necessarily mean they are related to multiple sclerosis.  Ear infections, acoustic nerves that connect the brain and auditory (ear) system or benign tumors can result in MS like symptoms in respect to dizziness and vertigo.

Inform your doctor if you have been diagnosed with MS and experience frequent episodes of dizziness or vertigo.  There are numerous reasons as noted above that either of these sensations can occur including certain medications, medication interactions, blood vessel disease, migraine and even stroke.

Once other causes have been ruled out, your doctor can advise you on the best way to deal with symptoms.