You are walking on a perfectly flat sidewalk, and suddenly the ground seems to give way. This type of episode, even if brief, can signal a neurological dysfunction. Understanding balance loss of neurological origin helps to distinguish a simple transient dizziness from a signal that warrants a quick consultation with a doctor.
Proprioception and peripheral neuropathy: the cause that is detected too late
Before talking about the brain, we must talk about the feet. Proprioception is the body’s ability to sense its own position in space. Sensors located under the soles of the feet, in the tendons and joints, continuously send information to the brain.
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When these sensors are damaged, the brain receives false or incomplete data. The result: a feeling of instability, even on flat ground, without any dizziness or sensation of rotation.
Diabetic peripheral neuropathy is a common cause of balance loss, even in patients who have never experienced dizziness. Recent studies (Pop-Busui et al., Diabetes Care, 2024) confirm that this neuropathy alters the proprioception of the feet and increases postural oscillations. The risk of falling becomes significantly higher than in diabetics without nerve damage. A detailed overview of neurological disorders on Valbreon helps to better understand these often underestimated mechanisms.
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What makes this cause treacherous: the patient does not necessarily feel pain. They just notice that they trip more often, hesitate to walk in the dark, or need to lean against walls at night.
Parkinson’s disease and early balance disorders
Have you ever noticed that an elderly person walks with quick, small steps, as if they are chasing their own center of gravity? This walking pattern often characterizes a parkinsonian syndrome. However, balance disorders related to Parkinson’s appear well before this visible stage.
Research in movement neurology (Postuma et al., Lancet Neurology, 2023) shows that subtle alterations in postural control precede the classic motor symptoms of Parkinson’s disease. Tremors or slowness of movement are not yet present, but balance is already deteriorating, measurable on a force platform.
What signals should raise concern
Some reference centers now incorporate instrumented balance tests in the screening for early parkinsonian syndromes. Targeted individuals present:
- Rapid eye movement sleep disorders (sudden movements during dreams, falls from bed)
- A progressive and unexplained loss of smell (anosmia)
- Family history of Parkinson’s disease
A simple dual-task test (walking while counting backwards) can reveal an instability that normal walking masks. When attention is required, automatic postural control deteriorates in these patients, while it remains stable in a person without neurological impairment.
Multiple sclerosis and cerebellar ataxia: two distinct mechanisms
Multiple sclerosis (MS) causes lesions to the myelin, the sheath that surrounds nerve fibers. When these lesions affect the cerebellar pathways or the posterior columns of the spinal cord, information about the body’s position circulates poorly. The patient feels instability while walking, sometimes described as a sensation of drunkenness.
Cerebellar ataxia is characterized by a wide gait and poorly coordinated movements. The person spreads their feet to compensate, and their steps are irregular. This presentation differs from classic dizziness related to the inner ear, where the sensation of rotation dominates.
In MS, these disorders can appear in relapses, with periods of remission. It is this alternation that complicates diagnosis: the patient consults between relapses, at a time when the clinical examination may seem normal.
Neurological medications and fall risk: an underestimated factor
Some treatments prescribed for neurological or psychiatric disorders can worsen balance loss. Recent data point to a specific effect of certain molecules, beyond the simple “dizziness” mentioned in the leaflet.
- New-generation antiepileptics can impair fine motor coordination, even at correct therapeutic doses
- Some antidepressants and anxiolytics alter postural reaction time, increasing the risk of falling during a change in position
- Atypical antipsychotics, prescribed for certain dementias, cause rigidity that limits catch reflexes
The cumulative effect of multiple medications on balance often exceeds the sum of their individual effects. A patient who tolerates a single treatment well may become unstable as soon as a second medication is added. This phenomenon of polypharmacy particularly affects people over 65.
What to check with your doctor
If balance loss appears or worsens after a change in treatment, the first step is to report the exact timeline to the doctor. A dose adjustment or spacing of doses may sometimes restore stability. Stopping a treatment without medical advice remains dangerous.
Neurological balance loss is not always spectacular. It often manifests through discreet signs: hesitation when getting up, an increased need to hold onto the railing, abnormal fatigue after a short walk. These signals deserve a neurological assessment, especially when they develop gradually without an obvious vestibular cause.