Living
The balancing act:
Managing balance problems
by Evelyn Leigh
Balance problems are among the most common symptoms
reported by people with multiple
sclerosis—second only to fatigue,
according to a 2003 study of
more than 650 people with MS.
But just like MS itself, the ways
in which balance problems show
up vary from person to person.
“Balance is a complex
phenomenon involving
practically the entire brain,”
explains Dr. Robert Baloh,
professor of neurology and head
and neck surgery at the David
Geffen School of Medicine at
UCLA, and a leading expert
on neurological causes of
imbalance and dizziness. “Just
about any lesion in the brain
or central nervous system can
affect balance. Some of the
most common causes are lesions
in the spinal cord that affect
sensorimotor function,” or the
way your body uses input from
its senses to propel movement.
“We see balance problems in
all stages of the disease due to
MS lesions and atrophy,” says
Dr. Angeli Mayadev, a physical
medicine and rehabilitation
physician at the Multiple
Sclerosis Center at Swedish
Neuroscience Institute in
Seattle. “We now know that
Maintaining balance is crucial to mobility.
Staying active, adjusting activities to ability
level—and adopting assistive devices when
needed—can improve both stability and
independence.
gray-matter atrophy can play a
role in imbalance.” Gray-matter
atrophy describes the shrinkage
of brain cells that occurs in
MS after the connections (in
the white matter) are lost.
Balance issues can also be a
result of demyelination and loss
of connection pathways, Dr.
Mayadev explains.
For Mary Wideman-Williams, imbalance while
walking was one of the first
symptoms she noticed before
being diagnosed in 2010. “I
don’t know what it is like to
have MS without balance issues.
It was a very dramatic opening
to my journey with MS,” says
Wideman-Williams, 48, the
chief operating officer of
Seattle Center, home of the
Space Needle.
Complicating factors
Vertigo, a specific type of
dizziness that causes a spinning
sensation, often accompanies
imbalance in MS. “About 5
percent of patients experience
vertigo as their initial symptom,
and about 50 percent will
have it at some time,” says Dr.
Baloh. For people who don’t
have MS, vertigo is often traced
to structures of the inner ear,
or vestibular system. However,
for those who do have MS,
“vertigo almost always results
from lesions in the central
nervous system,” Dr. Baloh
says. “This type of vertigo is
usually accompanied by other
symptoms, such as double vision
and imbalance,” so it’s unlikely
to respond to treatments
targeted to the vestibular system,
he says.
