From the Guidelines
Dizziness in multiple sclerosis (MS) patients who are diagnosed with benign paroxysmal positional vertigo (BPPV) should be treated with a Canalith Repositioning Procedure (CRP), as it has been shown to be effective in this population. The treatment of dizziness in MS is complex and multifaceted, requiring consideration of various etiologies, including BPPV 1. According to the clinical practice guideline on BPPV 1, a substantial number of MS patients with dizziness may have BPPV, which can be successfully diagnosed and treated with CRP.
Key considerations in managing dizziness in MS patients include:
- Identifying and treating BPPV with CRP, as it is a common and treatable cause of dizziness in this population 1
- Addressing underlying inflammation with disease-modifying therapies, as dizziness may result from demyelinating lesions in vestibular pathways or the cerebellum
- Prescribing vestibular rehabilitation exercises to help the brain compensate for balance disturbances
- Providing guidance on preventing falls, such as adequate hydration, avoiding sudden position changes, and using assistive devices
- Regular follow-up to adjust treatment as needed, as dizziness patterns may change with MS progression
In terms of specific treatment options, CRP is a recommended treatment for BPPV in MS patients 1. Additionally, vestibular suppressants such as meclizine or diazepam may be used to manage symptoms, although their use should be carefully considered in the context of MS. It is essential to prioritize treatments that address the underlying causes of dizziness and improve quality of life, rather than simply managing symptoms 1.
From the Research
Treatment Options for Dizziness in Multiple Sclerosis (MS)
- Vestibular rehabilitation is a treatment option for dizziness in MS, as it can improve symptoms and quality of life 2, 3.
- Immersive virtual reality (VRi) is an emerging tool in vestibular rehabilitation, and studies have shown its potential in improving dizziness, balance, and quality of life in patients with MS 2, 4.
- Vestibular rehabilitation therapy (VRT) has been shown to be effective in improving dizziness and balance in patients with MS, compared to other interventions such as noisy galvanic vestibular stimulation (nGVS) 3.
- A gaze and postural stability (GPS) retraining intervention has also been studied as a potential treatment option for dizziness in MS, but its efficacy compared to other interventions such as strength and endurance (SAE) training is still being researched 5.
- Management of chronic dizziness in MS patients involves a multidisciplinary approach, including rehabilitation, counseling, and addressing any underlying clinical problems that may be contributing to the dizziness 6.
Key Findings
- Studies have shown that vestibular rehabilitation can improve dizziness, balance, and quality of life in patients with MS 2, 3.
- VRi has been shown to be a feasible and safe intervention for vestibular rehabilitation in MS patients 4.
- VRT has been shown to be more effective than nGVS in improving dizziness and balance in MS patients 3.
- GPS retraining intervention has been shown to improve dizziness and balance in MS patients, but its efficacy compared to other interventions is still being researched 5.
Intervention Details
- Vestibular rehabilitation protocols, such as the Cawthorne-Cooksey protocol, can be used to improve dizziness and balance in MS patients 2, 4.
- VRi interventions can be designed to target specific vestibular rehabilitation exercises, such as gaze and postural stability training 2, 4.
- Interventions can be delivered in a variety of settings, including clinical and home-based settings, and can be tailored to individual patient needs 2, 3, 4, 5.