Balance disorders are a common complaint in medicine, especially by older people.

They must be the subject of a medical examination because they may indicate the presence of a neurological problem, among others.

Balance disorders are most often felt when walking or when the person stands up. They can be more or less severe (cause falls or not), interfere with daily tasks, be associated with other symptoms such as pain, muscle weakness, dizziness, etc. Balance disorders are frequently associated with walking disorders.

Balance disorders can have many causes. Among the most frequent, we can distinguish:

• taking certain medications
• disorders of the inner ear, which is in some ways the organ of balance
• neurological disorders
• muscle disorders
• orthostatic hypotension (drop in blood pressure when standing up), very common in the elderly

In the event of loss of balance, always make sure that it is not a side effect of treatment. It is indeed one of the most frequent causes of loss of balance. Many drugs can cause such disorders, in particular psychotropic drugs (benzodiazepines, neuroleptics, antidepressants), antiepileptics, drugs used in cardiology, etc.

In other cases, to identify the possible causes of the disorder, the doctor will examine you in a standing position, with your eyes open or closed, observe your gait, reactions in the event of voluntary imbalance, and will prescribe additional examinations if necessary (brain imaging, for example).

In the event of intense dizziness, the possible causes are, among others (see the fact sheet on vertigo):

• Ménière’s disease
• vestibular neuritis
• benign paroxysmal positional vertigo

If the loss of balance is associated with walking disorders, we generally speak of ataxia (sensitive, cerebellar, etc.). Ataxias which are disturbances of balance and motor coordination, with many possible causes including cerebral damage to the cerebellum, damage to the nuclei or the vestibular nerve, damage to the proprioceptive pathways (which “inform” the brain about body position) and damage to other areas of the brain.

Finally, other causes can be identified:

• hypoglycemic episodes
• intracranial hypertension (tumor, for example)
• multiple sclerosis
• migraine attacks
• epilepsy
• Parkinson’s disease and parkinsonian syndromes, etc.
• decreased visual acuity

The main risk is the risk of falling, especially in the elderly. Balance disorders can also be extremely disabling in daily life, and considerably restrict a person’s independence. The signs that are sometimes associated with it (dizziness, nausea) are also very troublesome.

The solution obviously depends on the disease in question. The first step is therefore to undergo a complete medical evaluation.

When the loss of balance is linked to taking medication, withdrawal may be necessary. A change of molecule or a readjustment of doses may also be sufficient to resolve the problem.

In other cases, depending on the disease in question, it may or may not be possible to alleviate the symptoms pharmacologically or through rehabilitation.

In the elderly, prevention of falls is essential because the risk of fractures and serious complications is high. Several solutions make it possible to adapt the home to limit the risks or alert the entourage or emergencies in the event of a fall (electronic bracelet, in particular).