Vestibular disorders in multiple sclerosis: clinical and management aspects (narrative review)

Abstract

Vestibular disorders are a frequent and disabling manifestation in multiple sclerosis (MS), with complex pathophysiological mechanisms involving both central structures and associations with peripheral vestibulopathies, such as benign paroxysmal positional vertigo (BPPV).Objective of the study. To perform a detailed evaluation of the specialized literature in order to analyze the relationships between the clinical forms of MS, lesion topography, types of vestibular syndromes, functional markers, and treatment options. Materials and Methods. Literature synthesis, conducted in accordance with PRISMA, of 39 articles published between 2015-2025 in English in PubMed, Elsevier, Frontiers, and ResearchGate. Results. Relapsing-remitting MS (RRMS) is more frequently associated with acute/episodic vestibular syndromes related to new lesions in the brainstem/vestibulo-cerebellar region, while progressive forms present with chronic vestibular syndrome. vHIT, VEMP, VNG, and posturography correlate with MS severity and progression. Effective interventions include personalized vestibular rehabilitation, repositioning maneuvers for peripheral forms, and early treatment of relapses. Recent studies support the benefits of VR-based therapy and integrated rehabilitation programs in improving balance and reducing dizziness. Conclusions. An integrated approach, guided by phenotype and objective markers, optimizes the differential diagnosis of vestibular disorders in multiple sclerosis and the personalization of therapy/rehabilitation, with potential to reduce dizziness, improve balance, and lower the risk of falls.