Other possible causes of balance difficulties

Balance difficulties are also common in people who do not have MS, and if you do have MS, that might not always be the cause. It is important to have any symptoms properly investigated and not to assume that everything is down to MS.
The Brain and Spine Foundation produces a free publication which looks at the more common causes of balance problems, including BPPV and inner-ear infections. To order 'Dizziness and balance problems. A guide for patients and carers', visit www.brainandspine.org.uk

Infections in the inner ear can upset the body’s balance, often accompanied by vertigo and sometimes vomiting. Drug treatments may help in the early days of an infection like this. Sometimes, feelings of vertigo come back from time to time in the weeks after the first problems have gone away and a physiotherapist or ear, nose and throat (ENT) specialist may show you physical exercises that can help manage these occasional episodes (exercises with names such as the Epley or Semont manoeuvres).  

Your doctor or a physiotherapist might also teach you movements that can help if your experience vertigo caused by ‘benign paroxysmal positional vertigo’, or BPPV. This causes a short-lived (‘paroxysmal’) spinning feeling, normally lasting for one or two minutes, or less, usually brought on by particular head movements.  BPPV is caused by tiny particles trapped in the inner ear.  Movements such as the ‘Brandt-Daroff exercises’ can help to remove these particles.  Just like vertigo caused by MS, it can be accompanied by nausea.  Some people find short-term relief from nausea and vertigo with drugs such as prochlorperazine or betahistine.  

Some drug treatments can have side effects involving balance. For example, treatments for muscle spasms and stiffness, and for some sorts of pain, can make people feel dizzy or disorientated.  Medications that relax muscles, such as baclofen or gabapentin, can cause temporary weakness in the muscles which could make balancing more difficult.  As with all treatments, it can be a case of weighing the benefits against side effects and finding the best compromise. Over time, you and your doctor or MS nurse might make many adjustments to the drugs you use or the dose you take, to find the best for you.  

What can I do to improve my balance?

Unfortunately, there is no single treatment for ‘MS balance problems’. Suitable therapies and drugs will depend on the individual and the causes of the balance problem.

Because there are so many different possible causes for balance difficulties it is important that the issue is investigated properly. There may be a combination of causes and these may not all be directly due to MS, so treating one factor alone might not bring about the best results.  Treatments for other symptoms, such as muscle stiffness or weakness, fatigue, pain or anxiety might also have benefits for your balance.  

There may be more than one health or social care professional involved.  For example, an MS nurse, physiotherapist, or occupational therapist, can all help find the probable causes and the most appropriate way to manage the issue. And they may refer you to an ear, nose and throat (ENT) specialist, or to a specialist rehabilitation team.

A health care professional can help you set achievable, practical goals for improving and managing your balance, so that you can see the benefits, or adjust the plan accordingly. You may notice improvements only very gradually – managing balance problems is a long-term project, but one which can have results.  

Your balance might get worse during a relapse (an attack of symptoms that lasts for more than 24 hours).  Steroid treatment, either by injection or tablets, can speed up recovery from the symptoms of a relapse.  Your balance might also be affected if your body temperature rises because of an infection – this is sometimes known as a ‘pseudorelapse’ because it has the appearance of a relapse but has a different cause.  It is important that infection is ruled out as a cause of any attack of symptoms.  Steroid treatment is not used to treat pseudo-relapses.  

Identifying the causes of balance problems can help find the best solutions.  Regular assessments by a physiotherapist or other health care professional can help monitor your progress and highlight improvements.  They can also reveal adjustments that could be made if your circumstances, or the causes of balance difficulties, change.

They may ask you about the details of how, where, and when it affects you.  For example, if you have more trouble balancing when out in the open and whether you experience vertigo at the same time.  This can help reveal if the inner ear and the ‘proprioceptive’ (sensory) inputs are likely to be involved.

A health professional may ask you to stand still and upright with your eyes open, then closed.  Judging how your body moves and sways can give clues about how far your vision might be involved in balance problems.  They may also check your vision for any unusual eye movement which could have an effect on balance.

Another balance test looks at the ‘vestibular’ system (the involvement of the inner ear and its messages).  This painless test sends a clicking sound to one ear at a time.  Electrical sensors placed on the skin record responses in the central nervous system.  If signals are weaker than expected, or do not get through at all, it indicates that messages from the inner ear may be involved in balance problems.

An assessment may also highlight other symptoms that could be treated or managed differently to improve balance, such as muscle stiffness, tremor, weakness, or fatigue.  It can also show where physiotherapy might help, or reveal any necessary adjustments to physiotherapy you already do.  Drug treatments you take or any equipment you use can also be looked at and adjusted if necessary.