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Some people with multiple sclerosis (MS) experience syncope (fainting spells) or blackouts (temporary loss of vision and consciousness). If you’ve dealt with these symptoms, it’s important to understand what could be going on so you can find the right treatment.
Here is what you need to know about fainting or blacking out with MS, including what these symptoms may feel like, what causes them, and how you can manage them.
Fainting and blacking out aren’t among the more common symptoms of MS, but they do affect some people with MS. Like itching, spasticity, and the MS hug, passing out may be connected to multiple sclerosis. Sometimes fainting is secondary to another MS symptom like extreme dizziness and vertigo (feeling off-balance).
Several MyMSTeam members have described episodes of fainting or blacking out. As one shared, “I experienced what my doctors called syncope after standing — total blackout!”
“I suffer from random blackouts,” wrote another member.
Some people deal with episodes repeatedly over an extended period. “I have blacked out at least five or six times,” one member shared. “The last time, I was out cold on the bathroom floor for about five hours.”
Fainting can prompt the need for emergency medical help. “I had a drop-down blackout,” a member explained. “I slammed my head and hit my skull. I didn’t wake up until I was in the hospital.”
For some MyMSTeam members, episodes of fainting or blacking out come on quickly, seemingly out of nowhere. For others, these episodes occurred alongside dizziness or vertigo that they’d been experiencing for a while. As one member wrote, “The dizziness I’ve been dealing with for a year or so has become really bad the last couple of months. Tonight is the first time that I blacked out and fell on the floor.”
Fainting and blacking out can be serious, indicating that something significant is going on in your body. Although fainting can have many causes, it may be traced back to MS.
An MS relapse, also known as an exacerbation, attack, or flare-up, happens when you experience new MS symptoms or an increase in current MS symptoms that lasts at least 24 to 48 hours. Inflammation in your central nervous system (CNS), which includes your brain and spinal cord, can cause MS flare-ups to feel different each time. They can vary from mild to severe.
During a relapse, balance problems and fatigue can get worse. These can make you more likely to fall. These symptoms do not by themselves cause true fainting (passing out). Fainting usually happens when blood flow to the brain drops or when the heart and autonomic nerves are not working together. The relapse symptoms you experience, such as vision problems, depend on the area of the CNS affected by inflammation. An MS relapse can last for days, weeks, or months.
MS is an autoimmune disease in which the immune system mistakenly attacks healthy tissues in the CNS. Lesions, or areas of damaged tissue, form on the nerves’ protective myelin coating. This process is called demyelination.
Fainting and blacking out with MS may be caused by new or growing MS-related lesions. If these lesions are located in specific areas, they may lead to autonomic dysfunction or dysautonomia, which happens when the autonomic nervous system (ANS) doesn’t work properly. The ANS regulates your unconscious body functions and helps you keep your balance. Autonomic dysfunction can cause people with MS to fall. Some people may experience autonomic failure, where ANS dysfunction leads to severe symptoms.
In some cases, however, blacking out and fainting may be caused by factors unrelated to MS.
Orthostatic intolerance (also known as orthostatic dysregulation or dysfunction) refers to a change in blood pressure when you stand up. This can cause you to pass out and experience hot flashes, heart palpitations, weakness, sweating, or nausea.
There are several types of orthostatic intolerance. Some people experience orthostatic hypotension, where their blood pressure drops significantly when they stand up. Others may experience postural orthostatic tachycardia syndrome, or POTS, where the heart rate accelerates even though the blood pressure doesn’t go up.
In one study, up to 63 percent of people diagnosed with MS also showed signs of orthostatic dysregulation, which could cause fainting. In a study of nine people with POTS and a history of MS, all had either passed out or nearly passed out before. However, results from studies like these have varied quite a bit based on the way the studies are done. Right now, it’s impossible to know exactly how many people with MS deal with orthostatic dysregulation, though the number is likely significant.
People with MS are more likely to experience orthostatic dysregulation because of demyelination. The lesions caused by demyelination get in the way of the electrical messages that the nerves are trying to pass to various parts of the brain. Lesions in the CNS areas that control heart function, lung function, and blood pressure could cause orthostatic dysregulation.
Vasovagal syncope, the most common cause of fainting in the general population, happens when the nerves connected to your cardiovascular system misfire or send inappropriate signals. This can cause your blood vessels to widen and your blood pressure to drop. Sometimes, you may pass out.
People with MS might experience vasovagal syncope as a concomitant symptom, even unrelated to MS. A tilt table test, used to evaluate autonomic dysregulation, may trigger vasovagal syncope in people with MS. Vasovagal syncope may be more common in people in MS remission, with POTS being more common during relapse, though the evidence to support this isn’t very strong.
Epilepsy is only slightly more common in people with MS than it is in the general population. Researchers aren’t sure why MS is linked with epilepsy and seizures. However, it’s likely related to the different ways demyelination caused by MS affects the brain.
Multiple types of seizures are possible in people living with MS and epilepsy. Though not all seizures lead to blacking out, some can cause total loss of consciousness.
At least one MyMSTeam member said they’d had seizures that led to blackouts: “I’ve had a few and saw a specialist in epilepsy, and he said it was my MS,” they wrote.
Some people diagnosed with multiple sclerosis experience dizziness and vertigo as a side effect of the medications they take for MS or another condition. Anytime dizziness gets too bad, it can cause fainting. For this reason, it’s important to work with your neurologist and other healthcare professionals to get medical advice and find treatments that don’t cause adverse side effects.
Fainting and blacking out can result from other conditions unrelated to MS or its symptoms. These causes include:
People may also faint because they:
It’s a good idea to talk with a doctor anytime you faint, especially when you’re also living with MS. Your neurologist may be able to help you determine what caused your fainting and make sure the help you get is compatible with your MS treatments.
Get immediate medical care if your fainting occurs with any of the following symptoms, which can be signs of a more serious underlying issue:
If your neurology team finds an underlying condition, such as POTS or epilepsy, it’s important to treat it effectively. Several therapeutic options are available, and your doctor will help you find one that’s right for you. These treatments should control or eliminate the fainting and blacking out.
Several MyMSTeam members note that standing up slowly helps them deal with orthostatic dysregulation problems. One member explained, “My doctor diagnosed it as ‘orthostatic hypotension.’ Not much to do for it except always remember to get up very slowly.” Another added, “I haven’t had another blackout but keep coming close — just stand up slower.”
This won’t eliminate the problem, but it can help you manage it until a suitable treatment is found.
If you faint or black out regularly — whether or not an underlying condition is involved — taking time for self-care can help you avoid the worst of these episodes. Make sure you eat and drink enough and that you don’t get overheated when it’s warm outside. Since these are all common causes of fainting, caring for yourself may help you avoid these episodes.
If you feel faint, take a few steps to avoid blacking out. Lie down flat and elevate your legs on a wall or a piece of furniture. Tensing your body can help get blood and oxygen flowing to the brain. Try crossing your legs or squeezing them together. You can also tense your torso and arms and even squeeze your hands into fists.
If you’re standing, take a seat to avoid falling and hurting yourself. This can also help balance your blood pressure.
On MyMSTeam, people share their experiences with multiple sclerosis, get advice, and find support from others who understand.
How has fainting or blacking out affected your daily life with MS? Let others know in the comments below.
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I had my first (and so far) my only fainting spell while I was driving. I remember the part before it so clearly! Then...NOTHING!! I ended up in a 3-way car crash that should've killed me. I hit a car… read more
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