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No 1131517
Multiple Sclerosis
It is important to remember that MS is only one part of a person and not the person.
MS does not represent them, it is not their identity, they are as normal as the next person.
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Vertigo
A severe sensation of the person, or room and surroundings spinning.
Acute vertigo
Sudden onset of continuous vertigo - is quite severe and disturbing for a person
with MS. The illusion and feeling of motion is very strong and unnerving sometimes
leading to nausea, headache and vomiting. Acute vertigo can worsen just by inclining
the head a particular way, making any sudden movement or by lying down. The sensation
is similar to acute sea-sickness. Although acute vertigo can be distressing, it usually
recedes over time, there may be left a residual tendency towards further, if less
severe, episodes usually accompanied by partial or complete loss of balance.
It is possible to have different types of vertigo, where the illusion of motion has a particular bias:
- Rushing sensation where the ground appears to suddenly rush upwards.
- Spinning sensation where the external environment seems to continually rotate.
- Semi-
spinning sensation where the rotation is only partial then returns to normal before a partial rotation occurs again.
Dizziness
Differs slightly to vertigo itself, being described as feelings of lightheadedness or feeling faint, dizziness that is not described as vertigo, but is often associated with MS may involve dysfunction of the eye muscles. Dizziness is common in people with MS, while vertigo appears to be is less so. One study considers that, real vertigo, is estimated to occur in about 20% of MS people.
In MS, these symptoms are caused by damage to areas that coordinate perception and response to visual and spatial information by damage to the pons region of the brainstem where the acoustic cranial nerve (CNV111) arises. CN VIII divides to serve both the acoustic and balance (vestibular) functions of the ear, and it is the balance portion of this nerve that is implicated in vertigo. Vertigo can also be caused by lesions in the cerebellum.
Where possible, an exact reason for any dizziness needs to be determined in order to ensure what, if any, underlying reason exists, as to its cause and to ensure the correct treatment is prescribed.
Some of the drugs used to treat the specific symptoms of MS, such as Baclofen for
spasticity and tricyclic anti-
Management
Anti motion-
- Meclizine -
Dramamine - Skin patches
- Scopolamine
- Hyoscine.
- Scopoderm.
Other anti-
- Prochloperazine -
Stemetil - Promethazine -
Phenargan - Chlorpromazine -
Thorazine - Largactil - Benzodiazepines such as
- Diazepam -
Valium
In very severe cases a short course of corticosteroids may be needed.
Drowsiness is a common side effect of some antihistamines, other medications should be monitored as they may cause dependence. Generally discontinuing drugs should be done gradually.
If vertigo effects to such an extent that it causes vomiting and a person is unable to take medication orally, then prochloperazine may be given in the form of Buccastem.
Another drug prescribed for vertigo and dizziness in MS is Betahistidine -
Manipulation
If vertigo is caused by an inner ear problem, physical manipulation of the neck and
head to restore the function of the semi-
Physiotherapy
A physiotherapist can determine if certain positions of the head cause the symptom to worsen, they can then work with the patient to help them build up a tolerance to the head being in those positions.
VRT
VRT (Vestibular Rehabilitation Therapy) attempts to retrain the brain to recognise and process signals from the vestibular system in coordination with information from vision and proprioception.
The therapist performs a thorough evaluation, observing the posture, balance, movement, and any compensatory strategies before recommending any treatment.
From the evaluation an individualised treatment plan -
VRT may include increasing activities and exercise in order to strengthen muscles and increase tolerance for certain stimuli.
Some of the exercises and activities initially may cause an increase in the symptoms, however, over time and consistent work, the coordination signals from the eyes, proprioception, and vestibular system will slowly begin to work again.
There are unrelated other causes of vertigo and dizziness, the symptom should be assessed by a health professional before starting any treatment to combat it.
Acute vertigo can also be caused by an infection or dysfunction of the inner ear and is also associated with other conditions; therefore although the condition may be a symptom of MS it should be determined whether it is an inner ear problem or a demyelination problem.
Patience and persistence is required for success
In some cases complementary therapy may act as an adjunct to treatments. Great care must be taken when using these therapies and should only be done in conjunction with advice from health professionals.