Many neurological disorders can cause balance problems, which can result in falls and injuries. If you or a loved one has developed new or worsening unsteadiness, it’s important to get it checked out. Once your doctor has identified whether a neurological condition is responsible for your loss of balance, you’ll be able to work together to come up with a treatment plan to manage your symptoms.
So, which neurological conditions are the most common culprits of balance issues? We asked our experts for their insights, plus details on what imbalance caused by a neurological disorder might feel like and how it’s different from balance issues caused by an injury or arthritis.
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How Neurological Disorders Cause Balance Problems
Your nervous system is responsible for keeping you balanced. It consists of your brain, spinal cord, and nerves, which work together to control communication between the brain and the rest of the body. “The primary functions of the neurological system include sensation or being able to feel and control of muscle contractions for movement,” says Michelle Cameron, M.D., a professor emerita in the department of neurology at Oregon Health and Science University in Portland, OR.
Neurological disorders can cause changes to how a person’s nervous system functions. “This can cause balance issues by altering the ability to feel and/or altering the ability to control muscle contractions for movement,” Dr. Cameron explains.
Parkinson’s Disease
Parkinson’s disease is a condition in which the brain gradually loses certain chemical signaling, especially the neurotransmitter dopamine, that helps the body move smoothly and automatically. “As the dopamine signaling circuits break down, the brain has a harder time initiating movement,” says Nina Mosier, M.D., the co-founder and executive director of Power for Parkinson’s, an organization that provides exercise instruction and education to people with Parkinson’s disease in Austin, TX.
That can lead to Parkinson’s symptoms such as postural instability, or difficulty maintaining balance when you feel unsteady. Postural instability doesn’t always respond to common Parkinson’s treatments, and it’s a major contributor to falls and hospitalizations among people with the condition, notes a review published in the journal Brain Sciences. In fact, studies estimate that up to 68% of people with Parkinson’s disease experience a fall each year, notes a paper published in Dementia & Neuropsychologia.
Parkinson’s can cause other symptoms that can often impact balance too, including shakiness, stiffness, slow movement known as bradykinesia, and walking problems such as freezing of gait, where a person suddenly freezes up and can’t move forward, according to the Parkinson’s Foundation.
Multiple Sclerosis
Multiple sclerosis (MS) happens when the immune system mistakenly attacks myelin, the protective coating around the body’s nerve fibers. These attacks affect the function of the brain and spinal cord and lead to problems with movement.
MS can cause muscle weakness, spasticity, or fatigue, as well as vision changes and trouble coordinating movements—all of which can impact stability while walking, according to a review published in the Handbook of Clinical Neurology. “It is common for people with multiple sclerosis to have balance issues. These problems can begin early or later in the disease,” Dr. Cameron says.
Like Parkinson’s disease, the movement symptoms caused by MS can put people with the condition at a high risk for falls, with around half of MS patients falling at least once a year, notes the Handbook of Clinical Neurology review.
Peripheral Neuropathy
Peripheral neuropathy is nerve damage that happens outside of the brain and spinal cord, frequently in the legs and feet. Often the result of uncontrolled high blood sugar or diabetes, it’s the most common neurological disorder among older adults and a common cause of falls, per a paper published in the Journal of the Peripheral Nervous System.
If you’re wondering how peripheral neuropathy can lead to falls, it’s because the condition can cause numbness, tingling, weakness, burning, or pain in the parts of the body that are affected—including the feet. That can make it harder for a person’s feet to sense their position in space, which can make it harder to balance and lead to falls, per the Mayo Clinic.
Additional Neurological Disorders That Impact Balance
Parkinson’s, MS, and peripheral neuropathy account for many neurologic-related balance issues in older adults. But other, less common conditions can also cause unsteadiness.
Ataxia and Cerebellar Disorders
Ataxia is a rare neurological disease caused by damage to the cerebellum, which is the part of the brain that coordinates movement. It can cause coordination problems and affects a person’s ability to walk and balance. It can also cause trouble with speaking and fine motor skills, according to the National Ataxia Foundation.
Traumatic Brain Injury
Between 30% and 65% of people who sustain a traumatic brain injury have trouble balancing. The problem can impact people while sitting or standing and also cause feelings of lightheadedness or dizziness, per the University of Washington.
Cervical Myelopathy and Spinal Cord Disorders
Cervical myelopathy is a disorder that happens when a person’s spinal cord becomes compressed. Often caused by age-related wear and tear or a herniated disc, it can cause a number of neurological symptoms including balance issues and clumsiness, neck pain or stiffness, numbness or tingling in the arms or hands, and trouble with fine motor skills, notes the Cleveland Clinic.
Vestibular Migraine
Vestibular migraine causes all of the same symptoms as regular migraine like intense headache, nausea, and sensitivity to light or sound. But it has the added complication of causing dizziness and balance problems. Sometimes the dizziness only lasts for a few minutes, but other times it can persist for hours, according to the Migraine Trust.
Dementia and Other Neurodegenerative Conditions
Dementia and related conditions like Alzheimer’s disease cause progressive cognitive decline that can impair a person’s ability to make decisions and solve problems while performing tasks. Often, that makes it harder for a person to walk steadily, which can increase their risk for falls, notes a paper published in the journal Geriatric Orthopaedic Surgery & Rehabilitation.
Stroke and Transient Ischemic Attack (TIA)
Both strokes and TIAs or ministrokes can cause a sudden loss of balance, as well as other sudden symptoms like vision changes, facial drooping, arm weakness, or trouble speaking. Stroke is a medical emergency, so call 911 immediately if someone is experiencing any of these symptoms, warns the American Stroke Association.
What Does Neurological Imbalance Feel Like?
Balance issues caused by a neurological issue can feel different depending on the specific cause. “Some people describe not being able to feel where they are putting their feet; others describe having their legs collapse, tripping easily, or feeling dizzy, but it’s generally not associated with pain,” Dr. Cameron says. She adds that, “with some conditions, the imbalance can feel the same on the right and the left.”
That’s different than balance trouble caused by an injury (like a sprain) or from a condition like arthritis. These sorts of balance problems are usually painful. You’ll often feel the discomfort or weakness coming directly from one specific area—usually a joint like the ankle, knee, or hip. You might also notice redness, stiffness, or swelling around the affected spot, per the American Academy of Orthopaedic Surgeons and the Cleveland Clinic.
How Are Neurological Balance Problems Diagnosed?
It’s not uncommon for balance to decline somewhat with age, notes the National Institute on Aging. But you should never ignore a big or sudden change. “I recommend people of any age talk to their primary care doctor if they notice a decline in their balance or are falling,” Dr. Cameron says. Together, you and your doctor can talk about your symptoms to determine if the issue is likely to be age-related or related to an underlying condition. In both cases, there may be ways to help you feel more steady on your feet.
If your doctor suspects that the problem could be caused by a neurological disorder, they may refer you to a neurologist, per the National Institute of Neurological Disorders and Stroke. The neurologist will use different tests to find out more about your neurological function, including:
- Blood and urine tests
- Brain imaging scans, like a CT scan, MRI, PET scan, or single photon emission computed tomography (SPECT)
- Cerebrospinal fluid analysis, which checks the fluid surrounding your brain and spinal cord
- Physical exam to assess your movement, sensation, hearing and speech, vision, coordination, and balance
- Tests to check your mental status, including your ability to solve problems and remember information
Takeaways
Balance problems can be caused by a number of different neurological conditions, many of which are serious. Parkinson’s disease, multiple sclerosis, and other chronic conditions may contribute to balance problems but are also treatable with the help of a medical professional. If you or a loved one has been having trouble balancing, let your doctor know. Figuring out the underlying cause is the first step to managing your balance issues and reducing your risk of falling.
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