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    You are here : Home » About MS » Symptoms » Dizziness and Vertigo

    Dizziness and Vertigo

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    Dizziness & VertigoWhat is dizziness and vertigo?

    These are both common symptoms of MS. The two terms imply that they are one and the same; however they each apply to two specific types of symptom.

    Vertigo is referred to as a severe sensation of the person, or room and surroundings spinning. Acute vertigo i.e. sudden onset of continuous vertigo is often quite severe and alarming to the person with MS. The illusion of motion is very powerful and unnerving and can sometimes lead to nausea and vomiting.

    It is often made worse by inclining the head a particular way or by lying down. Also when the other senses such as sight are unable to be used, for example, in a darkened room, it often aggravates things and makes vertigo much worse. The sensation is similar to acute sea-sickness or having drunk much too much alcohol.

    Although acute vertigo can be distressing, it usually recedes over time, typically a few weeks, although it can be as long as several months before it passes entirely and there may be left a residual tendency towards further, if less severe, episodes and is usually accompanied by partial or complete loss of balance which is aggravated by fast turning movements.

    Vertigo is associated with several other conditions apart from MS, some of these are conditions are associated with dysfunction of the vestibular nerve and others are conditions of the balance organs in the inner ear, therefore people often undergo investigations by an Ear, Nose and Throat Consultant to determine whether it is in fact an inner ear problem or a demyelination problem.

    Types of Vertigo:

    It is possible to have different types of vertigo, where the illusion of motion has a particular bias. These can of course, occur simultaneously or individually.

    • Spinning sensation where the external environment seems to continually rotate, usually clockwise.
    • Rushing sensation where the ground appears to suddenly rush upwards.
    • Semi-spinning sensation where the rotation is only partial and keeps returning to normal before a partial rotation occurs again.

    Dizziness, being slightly different to vertigo itself, can be described as feelings of lightheadedness or feeling faint. Forms of dizziness that are not described as vertigo, but are also often associated with MS usually involve dysfunction of the eye muscles implying damage to cranial nerves III, IV and VI.

    While dizziness is common in people with MS, vertigo is less so. One study suggests that, ‘true vertigo’ is estimated to occur in about 20% of MS patients.

    What causes dizziness and vertigo?

    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.

    If possible, an exact reason for the dizziness needs to be identified in order to receive the best treatment because some of the drugs used to treat the specific symptoms of MS, such as Baclofen® for spasticity and tricyclic anti-depressants for neuropathic pain can aggravate vertigo.

    How can vertigo and dizziness be treated?

    1. Drug options

    Usually, the symptoms respond to anti motion-sickness or anti-histamine drugs such as meclizine (Dramamine®), also the newer skin patches that deliver scopolamine or hyoscine. Although hyoscine is also available in tablets or capsules, it is typically prescribed for motion sickness or vertigo in the form of a skin disc that is placed behind the ear (Scopoderm®). In very severe cases of dizziness or vertigo, a short course of corticosteroids may be needed.

    Other anti-emetic drugs are often prescribed e.g. Phenothiazine derivatives such as Prochloperazine (Stemetil®), Promethazine (Phenargan®) or Chlorpromazine (Thorazine®,Largactil®)and Benzodiazepines such as diazepam (Valium®)

    Drowsiness is a common side effect of most antihistamines and medications such as Benzodiazepines must be carefully monitored as they may cause dependence. If someone has been taking any of these drugs regularly for a period of time, discontinuing the drug will need to be done gradually.

    Occasionally a person with MS may experience vertigo to an extent that he or she is vomiting and is unable to take medication orally. In such cases prochloperazine can be given in the form of Buccastem ®, a tablet place in the mouth between the gums and lips or in very extreme cases administered intravenously by injection.

    A newer drug often prescribed for vertigo and dizziness in MS is Betahistidine (Serc ®-16) an analogue of histamine and is claimed to reduce endolymphatic pressure by improving the microcirculation.

    2. Non – drug therapies

    a) Repositioning manoeuvres

    These are used in the first instance just in case the vertigo is caused by an inner ear problem. They involve physical manipulation of the neck and head to restore the function of the semi-circular canals of the inner ear. Cranial osteopathy or some other manipulative therapy and perhaps a course of acupuncture is recommended. If this fails then the patient may require the following:

    b) Physiotherapy

    A physiotherapist will determine if certain positions of the head make the symptom worse and then work to build up a tolerance to the head being in those positions.

    Although common in MS, there are unrelated other causes of dizziness and the symptom should be assessed by a health professional before starting this treatment.

    The goal of VRT (Vestibular Rehabilitation Therapy) is to retrain the brain to recognise and process signals from the vestibular system in coordination with information from vision and proprioception. This often involves desensitising the balance system to movements that provoke symptoms.

    What happens during vestibular therapy?

    A qualified therapist will first perform a thorough evaluation. This includes observing posture, balance, movement, and compensatory strategies.

    Using the result of this evaluation, the therapist will develop an individualised treatment plan that will include exercises to be performed both in the therapy department and at home and that combine specific head and body movements with eye exercises. Many times, treatment may also include increasing activities and exercise in order to strengthen muscles and increase tolerance for certain stimuli.

    Some physiotherapists work using a set pattern of exercises known as the Cawthorn – Cooksey exercises named after the two people responsible for devising them.

    Some of the exercises and activities may at first cause an increase in symptoms, as the body and brain attempt to sort out the new pattern of movements. But with time and consistent work, the coordination signals from the eyes, proprioception, and vestibular system will start to work again.

    In most cases VRT is so successful that no other treatment is required.

    c) Complementary therapies

    • Homeopathy: it is always best to consult a qualified practitioner of homeopathy but some of the following are known to be helpful in the treatment of vertigo :- gelsenium, calcarea and cocculus.
    • Herbal remedies: these include Ginko Biloba for increased blood flow to the brain and ginger capsules or ginger tea if vertigo is accompanied by nausea, also Feverfew.

    Personal Experiences of Vertigo and Dizziness

    “I’ve used Stemetil® from the GP but have two homeopathic remedies that I carry should the vertigo creep in. The first time vertigo arrived I felt like an astronaut trying to get from a shop back to the car. I’ve had to give up using escalators, because I get completely disorientated on them and especially getting off them. I never realised how unpleasant vertigo is. I tried using a wobble board with a physio only to find it rapidly triggered off the vertigo so I got driven home very nauseated.”

    “There were no drugs which worked for me so I was referred for vestibular therapy. It completely took away mine after 18yrs of increasing debility due to vertigo. I used to sleep sitting up or if I'd slide down during the night, it would take me an hour to get out of bed lifting my head inch at a time, I was that dizzy.”

    “I’d taken Stemetil® in increasingly high doses for 12 years. I found it of little help. By then it was discovered that Stemetil ®(Prochloperazine) taken in large doses over such a long period of time can cause Parkinson's disease type symptoms. I was told to stop immediately and tested for Parkinson’s - thankfully I'd got away with it.

    However because I'd had this drug in my bloodstream for 12 years, even though it's not addictive, I had to wean myself off gradually. My GP was ever so helpful in prescribing a liquid version and a syringe to measure the dosage and actually wrote down for me just when to lower the dosage etc. and it took me 6 months to get weaned off. Despite all this I’ve been told I can take the drug occasionally in future should I have another acute attack”

    “I have suffered with vertigo for about 15 yrs and in the early days I would have bouts where I thought I was on board a ship and walking across a room was awful. I went to see a neuro and his advice to me was, ‘Don’t lie in bed and don’t keep your head still.’ Up until I saw him I would always try to keep my head still; so that is how I have coped with it by moving around a lot and trying to ignore the symptoms.”

    “Vestibular therapy was the only option I had and I haven't looked back......well actually I have, because I can now turn my head in all directions without feeling too dizzy. I can even look out of side windows of a moving car instead of straight ahead.”

    “I tried a Homeopathic remedy for vertigo - cocculus. I was advised to only take this for a week as any longer can exacerbate symptoms. I began to feel slightly better taking cocculus, then stopped taking it after a week as advised, but I still was getting whirly pits and nausea, just not as bad. The wooziness has almost completely gone as has the nausea now, but then I've had a course of oral steroids recently so it’s hard to attribute the improvement to any one thing because everyone is different.”

    “My neuro explained it like this: your head operates like a ship and water goes from side to side to make you feel dizzy. If you keep your head still, when you do move it there is a big wave and you feel awful but keep your head moving, and then smaller waves until your brain has compensated. I found it difficult at first and I guess that not everyone could cope with moving around but I wouldn’t be beaten and in the end it got easier. First thing in the morning was worst but then as I moved more and more during the day the symptoms would subside.”

    “I found that the nausea and anxiety associated with a spinning world can make getting to sleep very difficult. Placing dim lights around the house at night helped a little. Avoiding sudden head movements and using walls, lamp posts or a cane for guidance can eased navigation. Going around the house in bare feet can assisted in the same way though I often stubbed my toes.”

    © Multiple Sclerosis Resource Centre (MSRC)

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