Balance issues: When vertigo and multiple sclerosis (MS) join hands  

A 44-year-old female suffered sudden vertigo, nausea, and was unable to walk. An MRI revealed multiple sclerosis, a neurological condition, and now she is one of 150,000 to 200,000 people living with MS in India, most of them women between 20 and 40 years old.

Multiple Sclerosis unmasked: when your brain fights itself  

• MS is a chronic neurologic and immune-mediated disease.   
• It targets healthy tissues of the brain, the myelin sheath that covers nerve fibers, nerve cell bodies, and neuronal axons, and causes scar-like tissue known as plaques.  
• As the disease progresses, the cerebral cortex (outermost layer of the brain) shrinks and causes cortical atrophy.   
• The severity of the attacks, location, and size of the lesions determine the symptomatic journey of MS patients.2 

Spotting MS: From numbness to fatigue  

• Vision: Double vision, optic neuritis, eye pain, vision loss  
• Muscle weakness in arms and legs, stiffness, muscle spasms  
• Loss of balance  
• Cognitive difficulties  
• Intermittent or constant dizziness  
• Bladder control problems  
• Partial or complete paralysis    

MS risk factors: Are you in the zone?  

• Genetics: HLA-DRB1 gene alleles  
• Vitamin D deficiency  
• Lifestyle: Alcohol, smoking, inactivity, and mental health  
• Epstein-Barr virus (EBV)

MS and vestibular dysfunction: a dizzying connection  

• Prevalence rate of vestibular dysfunction in MS ranges from 5 to 78%, based on clinical definitions.  
• MS primarily impacts the central pathway, i.e., the brain, but it also affects the peripheral pathway involving the vestibular nerve, leading to vestibulopathies.  
• 49–59% of patients suffering from MS experience dizziness, and 20% experience true vertigo.  
• Benign Paroxysmal Positional Vertigo (BPPV) is the most common etiology behind vestibular dysfunction in MS and affects 50% of MS patients.  
• Weakness, spasticity, imbalance, double vision, and gait abnormalities are symptoms seen in an MS relapse case.  
• In a few patients, dizziness is caused by rotation of the head or body, which could be due to an eye disorder.   
• These symptoms can affect a patient’s social life and lead to falls, injuries, and disabilities.  

MS or BPPV? Don’t miss the difference  

Dizziness in MS can imitate BPPV, especially when it presents as the first symptom. Precise diagnosis is crucial; positional tests like Dix-Hallpike and Supine head roll, HINTS (head impulse, nystagmus, and skew deviation), along with MRI scans, help differentiate central (MS-related) from peripheral causes. Lumbar puncture and optic coherence tomography (OCT) can test diseases that may look like MS. Without proper evaluation, MS-related vertigo can be easily misdiagnosed.3,4,5 

Decode Vertigo: The tech behind the tests  

Diagnosing vertigo starts with a thorough review of medical history, neurological and physical exams, especially focusing on eye movements (like nystagmus) and balance control. To dig deeper, doctors use advanced tools that offer objective insights:  

• EquiCOG: Next-gen videonystagmography  

This is a crucial test. You wear goggles with infrared cameras, look at the lights, move your head, or feel cold/warm air in your ears, and even the tiniest eye movements (nystagmus) will be recorded. The sequence or the patterns of these eye movements will help identify the peripheral pathway lesions, which cause specific types of nystagmus that differ from the central pathway.  

• EquifHIT: Precision testing for vestibulo-ocular reflex (VOR)    

Using high-speed video goggles, this test checks how well your eyes stay focused on a target during quick, unpredictable head movements. A disrupted reflex here often points to a peripheral issue like vestibular neuritis.  

• EquiCCG: Smart craniocorpography for balance assessment  

This balance test uses motion tracking while you stand still or on unstable surfaces, with head trackers on your head. It measures body sway to determine whether the imbalance stems from the brain or the inner ear.  

• Equipoise: Precision posturography for balance assessment  

The system provides clinicians with accurate diagnostics and motivating rehabilitation tools that are perfect for individualized balance care. You can stand on the pressure plate and view real-time balance statistics. The system also identifies subtle deficits that traditional assessments frequently overlook. It gives patients instant visual feedback, which keeps them motivated during their recuperation and helps them understand their progress. 6 

Shaky signals: rewiring balance in MS  

1. Disease-modifying treatments  

• Infusions: Alemtuzumab, Ocrelizumab, Natalizumab  
• Oral medications: Fingolimod, Dimethyl fumarate, Teriflunomide, Cladribine   
• Injectable medications: Beta interferon drugs, Glatiramer acetate  

2. Bedside physical maneuvers  

• Epley or Semont  

3. Physical therapies  

• Stretching, water therapy, Yoga  

4. Occupational therapies  

• Assistive device  

5. Stress management   

6. Vestibular rehabilitation

Start your journey towards stability, but how?  

• Track your signs and symptoms thoughtfully  
• Schedule a comprehensive vestibular assessment  
• Request a personalized treatment strategy  
• Stay focused on your recovery path  

Dizziness isn’t your destiny; it’s a treatable signal, not a life sentence, and whether it’s MS, vertigo, or any vestibular issue shaking your world like static in your signal, you can tune into the smart diagnostics like EquiCOG, EquifHIT, EquiCCG, and Equipoise and step into the world of clarity.   

For more information, visit www.taevasglobal.com/products.  

Book your consultation today.  

References   

1. Mathur, B. (2025) Multiple Sclerosis in India: Symptoms, diagnosis, treatment, cost explained, @bsindia. Business Standard. Available at: https://www.business-standard.com/health/multiple-sclerosis-india-symptoms-diagnosis-treatment-cost-care-125053000640_1.html (Accessed: 31 July 2025).  

2. National Institute of Neurological Disorders and Stroke (2025) Multiple Sclerosis, www.ninds.nih.gov. Available at: https://www.ninds.nih.gov/health-information/disorders/multiple-sclerosis. 

3. Meshref M, Shaheen A, Elmatboly AM, Hamdallah A, Abdella WS, Amro Y, Khairat SM, Swed S. Central positional vertigo as first initial multiple sclerosis symptom: A case report with systematic review. Clin Case Rep. 2022 Aug 8;10(8):e6154. doi: 10.1002/ccr3.6154. PMID: 35957787; PMCID: PMC9359970.  

4. Marsden, J., Pavlou, M., Dennett, R., Gibbon, A., Knight-Lozano, R., Jeu, L., Flavell, C., Freeman, J., Bamiou, D.E., Harris, C. and Hawton, A., 2020. Vestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with booklet based vestibular rehabilitation for vestibulopathy and a 12 month observational cohort study of the symptom reduction and recurrence rate following treatment for benign paroxysmal positional vertigo. BMC neurology, 20(1), p.430.  

5. Woo D, Frohman TC, Frohman EM. Vestibular testing and multiple sclerosis. Handbook of Clinical Neurophysiology. 2010 Jan 1;9:478-86. 

6. Taevas Global. (n.d.). *Taevas Global*. Retrieved June 16, 2025, from https://www.taevasglobal.com/