COBOB - balance question

Hi Bob,

Further to the discussion on cerebellar lesions and balance (cr*p, this sounds like a business letter!) I was wondering if you know if balance issues that are migraine-related would be similar to MS lesion realted ones?  Unclear question sorry, let me try again:

If one had migraine-associated vertigo, does the vertigo subside/dissipate during sleep the same as it does for MSers with cerebellar lesions?

I have a cerebellar lesion and appalling balance issues when I get out of bed, and have always wondered why I feel fine when I wake up, lying in bed, (and dreading getting up). So do you know if the same mechansism which protects one while asleep takes hold if you have migraine vertigo?

I hoep that makes sense - it's very early morning here, and guess what? I'm dizzy ! LOL

Cheers

Jemm

[rendean]

Hi Jemm,

Sorry , not Cobob but I can answer your question with a degree of certainty. The dizziness of migraine associated vertigo  occurs in the pons not the cerebellum;

"Cutrer and Baloh suggest that when dizziness is unrelated to headache, the dizziness occurs from the release of neuropeptides (ie, neuropeptide substance P, neurokinin A, calcitonin gene–related peptide [CGRP]).2 Neuropeptide release has an excitatory effect on the baseline firing rate of the sensory epithelium of the inner ear, as well as on the vestibular nuclei in the pons."

http://emedicine.medscape.com/article/884136-overview

I have both migraine vertigo and MS induced vertigo. My migraine vertigo is fine if I don't move my head meaning I am not stimulating the vestibular apparatus. I think the  non-movement due to sleep is due to not moving while sleeping.

You can Google the article above about vertigo associated with migraines. It talks about neuro peptides affecting the brain and spreading to the pons and vestibular apparatus.

I hope this helps. I can totally empathize with you regarding the vertigo it is awful!! My longest stint of vertigo was 3 months long. It was attributed to a cerebellar lesion. I  also know the dread of getting up during one of these episodes, migraine or cerebellar related.

Take care,
Ren

[JemmAus]

Wow, we could start a club! I can never tell which is migraine and which is my MS. I know at the moment I am having an "attack", been going for a week now, had a mild headache for the first few days but no headache now, but the vertigo continues...


Can you tell the difference when you are having a turn?


Life, aint it grand?? LOL

[supermum_ms]

I dont get migraines, never really had a headache were i've needed to take a pain killer. The only head pain i've ever had are the ice pick throught the eyeball (kill me now) type, sunlight brings on the achie squashing eyeball type pain but i'm light sensetive so wear sunnies for that. I've got a thick skull lol i use to always have an egg on my noggin, when i was little, I even tried to break my neck once. Ahhh literally, head dived into the bottom of a concrete pool, hole neck board, no feeling on one side, ambulance scary ride etc. still didn't get a headache let alone a migraine, so if i was ever going to get them i've done enough to help it along. lol..

I'm not dizzy, or anything like that, though i do feel strange and spacey after i've fallen hard. My none migraine related type of imbance, literaly feels like the ground just tilted off its axes or i'm walking down/along/up a steep slope but the ground is really flat. Uneven surfaces tip you over with each step, you know it shouldn't but it does anyway.lol

Have you ever played that game, were your blindfolded and someone leads you around, your legs are unsure of whats ahead, each step is tracking for the feeling of solid ground under your feet, no sure confident steps. Your arms are doing there own form of tracking, and like a hywire act they are splayed and constantly moving trying to direct through touch whilst also trying to maintain stability. Thats me, toss in the right leg over lift, left leg under lift and elastic kneecaps and you'll get the picture ROFL.

Cheers...............JJ

[JemmAus]

"Dizzy" is the wrong word for what I feel too actually. It's more like trying to walk on a rowing boat that's rocking around on a choppy lake. With a bit of durr feeling in the brain.... so yeah i get you there. Sometime the descriptive words just aren't available!

[COBOB]

I'll side with Ren. Migraines are neuro-chemically mediaed vascular events .   I was not talking about vertigo, I was discussing "Postural Balance."   Vertigo is dizziness and fails to provide the correct vestibular data to the cerebellum.  Loss of balance (like MS) caused by a sensory error is a bit different.

Vertigo is normally the feeling that the "room is spinning."   Postural loss of balance is more "when you take a step, you begin to fall or fall."  It can also be something like "When you stand up from a sitting position, you continue to pitch forward without dizziness and you end up doing a push-up or a face plant."  

Dizziness (vertigo) can lead to a loss of balance by providing "bad" sensory data to the cerebellum.  My MS loss of balance doesn't really have dizziness.  I step and sometimes under-step or over-step.  I have stepped of a 4 inch curb and slammed my foot down so hard my ankle hurt.   I also "recover" a lot, where I am about to fall and do the not-so-graceful "surfer stance."  My vision prevents some real disasters, but I have hurt myself walking through the house or barnin the dark.  

I still bowl.  Not well, but a can get a 200 scratch game about once a month.  5 or 6 times out of 30 frames, I'll end up standing on my left foot and using my right and left hands and arms to prevent my face from hitting the approach.  It  looks funny, but it is that loss of balance and core muscle control.. It makes it pretty hard to hold my 275 lbs standing on my left leg with my left arm back, right arm forward and right leg curled behind my left.  Sometimes my team mates see it coming and yell "Timber!".  Just another day with MS.

Bob

[jujuminx]

LOL, great visual Bob! Glad to see that you don't let your MS slow you down.

Julie

[Lulu54]

The MS Foundation teleconference Monday/tuesday nights deals with issues of balance. I've posted the information here -

http://www.medhelp.org/posts/Multiple-Sclerosis/Teleconference---3-21-and-3-22---Strategies-for-MS/show/1484184

It may be of use to many of you to dial in and listen and ask your questions about balance.

best, Lu

[supermum_ms]

Yeah sometimes descriptive words aren't available lol what happens to me definitely has nothing to do with or altering of my level of thought or concousness, to use your term 'durr' there is nothing remotely like that in my brain, at all. Just like walking around in a jumping castle, the floors move under foot, physically your bracing your stance and balance and mentally your perfectly normal. Though to be expected, its somewhat discombobulating, feels strange when its happening and your not in that jumping castle, your sensory signals are being openly challenged with each step you take, and it shouldn't be.

I have to be aware of where my body is in space at all times, distractions in consentration, anything at all, will take away my focus of remaining balanced. So even something as simple as a cuddle can distract, if I let my self relax into the feeling of it. DH feels the difference, I loose my 'where I am in space' and I start to topple/slump or fall, it doesn't matter if i'm sitting or standing. Funny but i'm not aware that I am, my focus is on the cuddle, I do become concouse of something being off but i'm not aware of what. I seem to tune into the feeling of his tightening embrace as he tries to keep me from falling or his verbal que of "i've got you."

Interesting topic!!

Cheers.............JJ  

[Lulu54]

Here is an excellent resource on the whole topic of dizziness from a neuro group in Pennsylvania.  They go through all the different types of dizziness .......

http://www.pneuro.com/publications/dizzy

thank heavens for google and the web - there is so much great information out there, for free!
Lulu

[msisbs]

What descriptive word should I use for when I am going up a flight of bleachers and lift the legs too high and then force them down too hard while my eyes cannot seem to focus right? And during this I feel pretty wobbly.
Is this dizziness? vertigo? something else? Should I just lay off the daytime drinking? j/k!

[JemmAus]

I call it the "wobbly boot". But that implies I've been hitting the vodka again!

I think it's "proprioceptive dysfunction", but it's easier to say "dizzy", though I know and you know that it's NOTHING like the dizzy you get from spinning in a circle......

[drsdonthelp]

I have to add from what I have experienced a couple of years ago. I was constantly lightheaded, even laughing (forced air) made me feel light headed. I had this for 8 months along with not being able to find the ground. It felt as thought the ground was sinking and I couldn't get my footing. I also have horrible depth perception and always lift my leg up high to cross over what seems to be a step, but turns out the floor is even, or vice versa.

Vision problems along with uneven ground, is my worst nightmare!!
Pam

[COBOB]

I think there are a few different thing being discussed.  

Dizziness -  Dizziness refers to an impairment in spatial perception and stability.  It is a very imprecise term. Dizziness is broken down into 4 main subtypes: vertigo (~50%), disequilibrium (less than ~15%), presyncope (less than ~15%) and lightheadedness (~10%).

Vertigo - Room Spins and the person tries to compensate.  Usually worse with head movement. Vertigo is a type of dizziness, where there is a feeling of motion when one is stationary.it is caused by a dysfunction of the vestibular system in the inner ear and is often accompanied by nystagmus.

Loss of balance (Failure of Equilibrioception) A sense of balance is one of the physiological senses. It helps prevent humans and animals from falling over when walking or standing still.  Can me worse with eye closed or trying to change body position.   This may be brought on by other sensory problems.  It may also be effected by spasticity.  I have more problems when I'm not taking Baclofen.

Proprioceptive Dysfunction -  Can lead to "Failure of Equilibrioception"

Pre-Syncope:  That feeling just before you become unconscious.

[COBOB]

Oh, I took most the stuff above from Wikipedia.  Their explanation seems to make a lot of sense.
Seems like everything else is a "specific kind of dizzy."

Bob

[twist330]

I went see a neuro physio last week and I explained to her my balance problems.

It as you desribed " loss of balance " for example - If I try to pick something off the floor I topple over. I bump into walls, I over turn. But I am not dizzy.

I also discussed with her constant cramp I get at the top of my foot.

After she had taken my history examined me she was convinced it was central nervous system. But there was nothing she could do to help, as I am very flexable (ex Dancer, now teacher).

She is reporting back to the consultants.

Is that correct there is no physio to help with balance constant cramp? I was very disappointed.

[COBOB]

I'm betting what you are describing as a cramp is a muscle that remains in some state of contraction. That is really spasticity.  It really isn't related to the typical "excessive lactic acid" cramp that you typically get from overworking a muscle.  Have you taken Baclofen?  If it is spasticity, it is most likely from a CNS cause.  

Bob

[rendean]

Dizziness that occurs with a migraine may precede, coincide and/or start after the head pain is gone. You can even have vertigo/dizziness without any head pain at all. That's what I was told for 5 years.

Yes, I do have migraines AND a cerebellar lesion. My aura with the migraine is a quick, fierce feeling of nausea that can be preempted by taking Zofran and then Fiorcet. I usually take a nap and if I'm lucky the symptoms are gone when I wake up.

The vertigo is different in it's onset in my case. If I turn my head too fast and experience the "I just got off the roller coaster" feeling it is the vertigo flaring again.

These are just my personal experiences. As for laying in the bed and feeling great until you get up, I usually get that with my vertigo and not my migraines. Either way it's a bad way to start the day.

Ren

[Nancy T]

I'm just curious--have any of you with dizziness (regardless of how you define it) had brainstem auditory evoked potentials, and if so were they normal or abnormal?

I am a migraineur (although I don't get bad or well-defined attacks, and in fact only know I'm a migraineur because of having had 3 visual auras in the past) and have always wondered whether the off-the-charts abnormal BAEPs I had many years ago could be caused by migraine. I was never given any explanation for the results.

Nancy T. (no MS but still a lot of strange unexplained symptoms incl. Lhermitte's)

[COBOB]

Middle-aged women who suffered migraine headaches accompanied by sensory disturbances or difficulty speaking (aura) had higher incidence of brain lesions later in life, according to a study of Icelandic patients.

Women who reported migraines with aura in midlife were 1.9 times more likely to have infarct-like cerebellar lesions late in life than women without similar headaches (95% CI 1.4 to 2.6), researchers reported in the June 24 Journal of the American Medical Association.

Cerebellar and other infratentorial lesions can cause abnormal BAERs.

Bob

[Guitar_grrrl]

"Loss of balance (Failure of Equilibrioception) A sense of balance is one of the physiological senses. It helps prevent humans and animals from falling over when walking or standing still.  Can me worse with eye closed or trying to change body position.   This may be brought on by other sensory problems.  It may also be effected by spasticity. " (Quoting Bob)

Yeah, Like Bob said, that's me a good deal of the time.  I'm spastic as hell, and there are times when I feel like I have absolutely NO sense of balance.  Definitely not vertigo.  My neuro exam points to spasticity (hyperreflexia, bilateral Babinskis, cerebellar ataxia), and it feels like it, too.

[Nancy T]

Thanks much, Bob. Do you know whether it's easy to see cerebellar lesions on MRI? My MRI reports have always mentioned small lesions (the latest says a "multitude"), but they are nonspecific. No location is ever given except "the deep white matter."

I SUSPECT I had cerebellar problems one summer when I was constantly missing things when reaching, undershooting on the first try unless I was looking directly at the object or consciously thinking about hitting the target (refrigerator door handle, kitchen drawer handles, dishwasher rack, toilet lever, my tongue when licking my finger to turn pages, etc.). That went away 98 percent, very gradually.

To all suffering from dizziness--my heartfelt sympathy! My balance is reasonably OK, but my head is constantly woozy and whooshy, worse after head movement. Not fun.

[COBOB]

Deep white matter lesions are Cerebral lesions (the main upper part of the brain.)  Cerebellar lesions are in the infratentorial brain (way in the back and down near the .  Cerebellar lesions of any significant size are pretty easy to visualize on MRI.  The issue is that it may not take a visible lesion to cause symptoms.  

Bob

[Lulu54]

You can read the original copy of information that Bob has given here   "Women who reported migraines with aura in midlife were 1.9 times more likely to have infarct-like cerebellar lesions late in life than women without similar headaches (95% CI 1.4 to 2.6), researchers reported in the June 24 Journal of the American Medical Association"  at these websites-

http://www.medpagetoday.com/Neurology/Migraines/14832

OR

http://www.paincare.org/hot_issues/message.php?id=16



The quote from Wikipedia -  is taken from http://en.wikipedia.org/wiki/Equilibrioception

"Loss of balance (Failure of Equilibrioception) A sense of balance is one of the physiological senses. It helps prevent humans and animals from falling over when walking or standing still."

You might want to read these original sources for more details.  

best, Lulu

[COBOB]

I think I stated above that the Dizziness information came from Wikipedia.

Thanks for adding sources fro the migraine lesions.  I missed a cut & paste on that one.

Bob

[Lulu54]

It is a good thing to include the complete source reference, to say nothing of an important  point in not lifting stuff from other sites And by giving the source of the quoted material we can all go read more on the topic than can be expanded here.  

Intellectual property is an interesting area these days.  You wouldn't believe the plagarism we see on campus all the time.  Lots of students just don't get it..... and they don't understand how easy it is to track, especially since we are all trained in the methods to find the problems.   :-)


Lulu

[Sumanadevii]

Then the moderators should be aware of what is and is not a copyrighted material.  Wikipedia is written by the ordinary person.  I could go in there today and edit anything.  There is no copyright on it.

This page http://www.paincare.org/hot_issues/message.php?id=16 is not shown as copyrighted.  

So I guess we need to decide what is "itellectual property" and what is not.

[Lulu54]

If someone puts the effort into writing material, even if it is not copyrighted with that cute little  (c), due credit should be given to where it has been taken from.  We shouldn't lift words from other people without acknowledging their work.

[Sumanadevii]

When you publish something on the internet without a formal copyright, you put it in the public domain.  If you wanted the material protected, it should have been registered for copyright.  It is a simple process.  My husband owns many.

[COBOB]

While I appreciate the defense and deserve the hand slap, this has nothing to do with dizziness or balance.  Now that the missing items have been correctly cited by Lulu, I suggest we get back to the topic of Dizziness and the specific subtypes and what we experience as part of our disease(s).

Bob

[supermum_ms]

I read the site you listed Lulu but it wouldn't stick, i did notice it didn't really mention lesions or MS, and I suppose the listed types just made me confused because i didn't really feel i fit into any of them, almost all included dizzy and i'm not dizzy. The symptoms list though, i could tick a lot of boxes but after reading everything on the site, i'm now confused because i could have 2 different issues! lol

btw Jemm supplied me with this, which I totally understood.......  

http://www.unitedspinal.org/msscene/2009/03/03/cerebellar-ms-a-case-study/

Issue 1: eyes closed balance - whilst standing ( same thing happens if looking 'straight' up, head need not move and its from any position) - i fall backwards within a second or two, physically and mentally i can feel myself falling backwards, like falling in a dream is the best i can explain it. I dont feel dizzy but there is a mental change, an awareness, its quick and the feeling and fall stop as soon as I open my eyes. My knees dont buckle as you'd expect in a faint or near faint, its more a straight fall backwards. If i tilt my head forward and close my eyes i'm out of balance, not falling but I sway as i counter balance the backwards tilt, but i cant do that unless my heads bent forward.

Issue 2a: eyes open - walking balance, it isn't helped by my puppet walking but walking balance is still a seperate issue to the way i walk. I'm constantly scanning for ques of where i am in space, physically through my feet and hands as well as visually. I'm scanning because my sensory system is lying to me and totally unreliable. I dont wear shoes because I have to feel the ground, grass, sand or gravel are sensory nightmares because it squishes under my feet. In my head i know the ground is solid and stable but my reaction is that the floor has suddenly moved or is constantly moving, I step into invisible sink holes. I'm as unstable as a toddler learning to walk! I trip, i wobble, i fall!

Issue 2b: eyes open - standing balance, I should have all the sensory ques telling me i'm vertical, standing up right but they dont work. I can feel the ground through my feet, i can feel the object or person next to me and i can certainly see that visually everything is at the right angle it should be. All the ques are there and still i will start to lean at a weird angel or just topple over like i've been pushed. Most of the time i'm totally unaware i'm moving or falling until i'm caught or i hit the ground, lol which ever comes first. I sometimes, from a sitting position fall off chairs or gulp the toilet. When i conciously change my position in space i have to brace for impact lol i mean brace my stance to maintain balance to try to prevent a fall.

There is no dizzy, or light headedness or vertigo or spin etc. nothing and i do know that feeling but it is notibly absent with what i keep experiencing. If you have any clues on where this fits please let me know.

Cheers........JJ

[supermum_ms]

was it something I said? lol (bump)

[COBOB]

No JJ.  Dizziness is one of those terms people use when they can't differentiate.  I don't have vertigo and I'm not going to pass out. Not light heded, so I'll take Failure of Equilibrioception.  My brain can't seem to figure out where my body is relative to it's environment.

Bob

[essdipity]

Regardless of what you call it (and I've seen many descriptions), I've had several extended periods where I've felt exactly like I was on a rocking boat. By 'extended' I mean up to a year each. Not now, glad to say, because it's bad enough trying to walk on an actual broken ankle.

Add general MS balance issues into the mix and we have a mess. Yesterday I told my PT that I seem to be walking like Chester on Gunsmoke. (Anyone remember?) When my balance gets bad, I'm like a bombed Chester.

ess

[supermum_ms]

Bob: hmmmmm my dd closes doors with her feet stuffed under the gap, she closes draws with her left hand and her right hand is still getting the thing out of the draw. She told me last night she fell walking out the door, forgot the steps, fell getting in to her bosses car, butt not on seat but on garden bush. She almost ran over her boss with the bakers trolley, he would need to be 2inches thick for her spacial judgement to of been right. She opened the pantry door and smacked it into her own head, laughed and imediately did it again, then cracked her elbow on the table edge. lol her favorite T.shirt is of a gold fish with a joke about 3 second memory, over here we call it jackie syndrome! ?

Ess: Not too old but maybe wrong country, was he by chance a cowboy? A drunk one?

Cheers..............JJ

[COBOB]

Well, there are physiologic problems and then there are some folks that are just plain clumsy and have no excuse.  I choose to blame  mine on the physiologic effects of MS.  

Keep in mind it isn't always MS.  When I walk into a door, I'll say it is (even if I;m just not paying attention.)

Bob

[rendean]

I remember Chester from Gunsmoke. And, I too, have one the drunk Chester walk.

Ren

[rendean]

That should have read "done" and no, I'm not drunk,lol.

Ren

[Khiba]

I remember Chester, but I call it the Captain Jack Sparrow walk instead. ;)

[SarahL2491]

Guess my "drag" ever so slight is Chester on a good day!