Featuring Barry A. Hendin, MD 

MSAA’s Chief Medical Officer 

Question: How do tremors with MS differ and what types of treatments help?

Answer: Dizziness and vertigo are common in the general population and even more common in people with MS. More than half of people with MS will experience dizziness or vertigo at some point.

Vertigo, which usually involves spinning or movement of the environment, can occur when there is a lesion in the cerebellum and its connections (these are balance centers in the brainstem). Vertigo can also occur due to other medical or neurological problems of the inner ear, which could be unrelated to MS.

Dizziness without spinning has multiple possible causes that can be related to or unrelated to multiple sclerosis. People may feel lightheaded due to changes in blood pressure, anxiety, side effects from a medication, or a number of other medical issues.

Dizziness associated with imbalance is common in multiple sclerosis, particularly when there are lesions in the spinal cord or in the coordination areas of the cerebellum and brainstem. Lesions in these areas may also affect control of eye movements and add to the sense of dizziness. In addition, lesions in the spinal cord can alter a person’s perception of their position in space, especially in the dark or on uneven ground. In such circumstances, dizziness may increase the risk of falling.

Fortunately, the exact source of any individual’s dizziness is usually identifiable through a careful neurological examination and a confirmatory MRI scan. Sometimes a subspecialty assessment by a neurotologist is helpful in very complicated situations. (Otology is an area of medicine that specializes with issues of the inner ear, while neurotology specializes with issues of the inner ear as well, but also encompasses parts of the brain and nervous system that relate to hearing and balance.)

Once the cause of dizziness or vertigo has been identified, this can be treated. Treatment may involve physical therapy, specific vestibular therapy, and medications. Successful treatment may allow for the resolution of dizziness and vertigo, or at least the better management of these symptoms.

For more information about dizziness and vertigo, please visit MSAA’s webpage dedicated to these symptoms.

Barry A. Hendin, MD, is a neurologist and Director of the Arizona Integrated Neurology MS Center. He is also Director of the Multiple Sclerosis Clinic at Banner University Medical Center and Clinical Professor of Neurology at the University of Arizona Medical School.

MSAA’s Ask the Expert series received a Merit Award from the 26th Annual Digital Health Awards!