Multiple Sclerosis (MS) steals balance, like a thief working in the night. Quietly fraying the neural wires that keep you upright until walking across a room takes the concentration of a tightrope walker. Over time, inflammation and neurodegeneration disrupt how the brain, spinal cord, eyes, and inner ear communicate, so even simple skills, like walking, can feel like trying to keep a steady step on a moving bus.
Staying upright is a team effort between your eyes, inner ear (vestibular system), proprioception (body position sense), and motor control in the brain and spinal cord. MS can hit any of these systems, which is why balance problems are so common and so frustrating.
MS is an autoimmune disease where the immune system attacks myelin, the fatty coating that lets nerve signals travel quickly and smoothly. When myelin is stripped away, signals slow down, get distorted, or stop entirely, and with chronic inflammation, the underlying nerve fibers themselves start to degenerate. Brain scans and tissue studies reveal a mix of active inflammation alongside quieter, widespread damage that accumulates over time. As this damage accumulates along motor pathways, spinal cord tracts, and balance networks, the brain has to work harder to do basic movements, and compensation eventually fails.
Recent vestibular research found that more than 80% of people with MS had abnormal vestibulo–ocular reflex (VOR) function in at least one semicircular canal, and worse VOR function tracked with worse scores on standard balance tests. Reviews and rehab studies report that dizziness and balance problems affect roughly half of people with MS, often tied to demyelinating plaques in brainstem vestibular pathways and the vestibular nuclei.
For many people, balance and gait changes show up long before a cane or walker enters the picture. It starts subtly with slower speed, shorter steps, or feeling “wobbly” when multitasking. And objective gait analysis backs this up. Clinical gait studies in central nervous system demyelinating diseases, including MS, show decreased walking speed, step length, cadence, and joint motion, along with higher energy cost. Cognitive-motor “dual task” research shows that when people with early MS walk while performing a mental task, their gait becomes more irregular, revealing hidden motor problems linked to cognitive load and attention.
MS is no longer viewed as a purely relapsing disease with separate “inflammatory” and “degenerative” phases. Instead, inflammation and neurodegeneration run concurrently and feed into each other over time. This matters because the same biology that slowly erodes memory and thinking can also chip away at balance and movement. Modern reviews describe a shift from focal, acute inflammation (discrete lesions) to widespread chronic inflammation, failed remyelination, and progressive neurodegeneration as MS advances. Chronic activation of microglia and other immune cells can directly damage neurons and synapses, creating a vicious cycle that gradually reduces the brain’s reserve to compensate for motor and balance deficits.
It’s not hopeless, though!
Several lines of research suggest that targeted rehab and neuromodulation can strengthen remaining pathways and help the nervous system adapt. The goal is not just to walk farther, but to help the brain rewire how it manages balance. Vestibular rehabilitation, including immersive virtual reality–based programs, has shown improvements in dizziness, balance, gait, and fatigue impact in people with MS. Early work with non‑invasive brain stimulation (like transcranial direct current stimulation) combined with balance training suggests potential gains in control of posture and reduced fall risk.
As ever, these are small, early trials and more research is needed... but we'll take any glimmer of hope we can get in the fight against this debilitating disease!
Sources:
https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
https://pmc.ncbi.nlm.nih.gov/articles/PMC11417908/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10148385/
https://www.americanbrainfoundation.org/process-of-demyelination/
https://pmc.ncbi.nlm.nih.gov/articles/PMC8893310/
https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2025.1620300/full
https://www.ataxia.org/scasourceposts/snapshot-transcranial-direct-current-stimulation/
