Multiple sclerosis (MS) is one of the most-feared causes of vertigo. Virtually everyone with vertigo worries about having this at some point. However, most of the time, this will not turn out to be the case. MS is a disabling neurologic disease affecting young adults. It affects about one in every 1,000 people in the United States, so it is rare compared to other causes of dizziness. For example, migraine affects about one in 10 people, is also frequent in young adults, and is the most common cause of dizziness in this age group.
It is uncommon for MS to begin with a vertigo spell; only one of every 20 MS patients experiences the onset of the disease in this way. Even in cases that begin with vertigo, there are usually other neurologic abnormalities already present or that become obvious shortly thereafter. For example, MS often begins with optic neuritis, which causes blurred vision and eye pain. People with repeated spells of dizziness without other neurologic symptoms are very unlikely to have MS.
Electrical impulses are conducted from the neurons of the brain through long tendrils called axons. These are insulated to allow electrical impulses to pass through them, much like a wire coated with rubber, by a lining called the myelin sheath. In MS, an autoimmune process is believed to attack the myelin lining, which prevents the neurons from communicating information within the brain and out to the body. If this demyelination process affects the neurons of the vestibular system, vertigo, nystagmus, and loss of balance can occur.
MS usually begins with loss of vision and pain on eye movement, changes in sensation to one arm or leg, or double vision. Severe fatigue is common. It is typical for symptoms to fluctuate and migrate randomly about the body. For example, there may be loss of vision followed by a recovery, then months later the individual may have trouble moving an arm or leg. Vertigo can occur anytime in the course of MS, and blurred vision from various kinds of nystagmus or eye movement abnormalities are common. These can be transient or progressive.
If MS is suspected, a neurologist should evaluate you. An MRI of the brain can reveal demyelinating lesions that help make the diagnosis. There have been many breakthroughs in treatment in the past several years, many of which target the immune system. Treatment can help delay damage to the nervous system. If permanent damage to vestibular neurons or nerves results, vestibular rehabilitation can assist in restoring balance.
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