Mike, I can imagine that it's both. It took me forever to realize that my muscles were weak in my sides. I don't feel any sensation there--it's just that when you move, your body starts leaning in one direction, and then your side muscles (and back, too, I'm sure) clench up to stop you from going too far. If those muscles are weak, they don't clench enough, and you lose your balance.

Journal, journal, journal! It has taken me almost a year and a half to figure out the connection between my tiltiness and sitting up straight. I'm not saying that's the only time I get tilty--but there's definitely a connection. If you can figure out what's triggering those episodes, you might be able to avoid them.

Abby

Hi Stellatum,
Bear with me as I don't get online as often as some and I have several irons in the fire
OK, I noticed about 5 years ago I would get pain in my face - mostly left side - it got worse ea winter - now I think it has two factors - one is dryness - second is heat. I would put a small electric heater under my desk and when it came on the pain would follow. I would notice this when driving also. I read that MS is heat affected so I could see that MG is related and likely sensitive to heat..
Then, as the pain got worse I started to have balance issues - walking - driving - several times I would have to pull over and wait a few minutes to feel safe enough to drive. Went to my PCP, he thought it was allergies/sinus's - sprays and meds did not improve it. Went to ENT - ran bunch of tests - nothing... Basically said go home and deal with it... It got worse ea year and many days I would have to have wife drive me home.
I also started having left hip pains, would give out when walking - had tests and everything looked normal I was told - by now my PCP was thinking I was either nuts or a wimp, I was getting embarrassed to complain - tried to keep it to myself yet I was getting worse.
Thankfully I changed PCP and the new guy was familiar with B12 deficiencies. I started shots last April and felt 100% better immediately! Now, weather also got warmer and thus heaters were turned off - so not sure how that all factors in just yet - still learning myself.
At least part of my balance issues revolve around vision problems. Sitting in front of a computer was almost too much at times - now I am doing much better from the B12 shots but still having some vision issues. I would not call it dbl vision, but like one eye is focused at a different distance than the other - hard to put into words... Sometimes just watching someone talk to me can make me very dizzy, like the eye muscles cannot keep up with the movements?
I was a very competitive shooter until 3 years ago - actually inducted into a Hall of Fame for it, so you can understand I really was aware of vision changes.
So, I am still learning, is balance from vision? Is it from weakness? Not sure - I think combo.
One thing I learned is find a health care provider that believes in you as too many want to fix people with "simple" challenges, not many Dr Houses out there....
Whew - tired from typing!
Smokey

I definitely have a serious balance problem but with all the other more serious concerns it has not been anywhere on my list of topics to cover with my MG neuro. I hit door frames constantly and always on my right side which is the side that my right knee gives out. But even when I am walking fine, I will misjudge the door frame width or something. I really don't know how or why it happens but it's very frustrating not to mention painful.

My migraine neuro (a dif neuro) had me do a test to see if I could walk a straight line and I could and I said, "Thank you for not making me close my eyes." He then had me try to stand on a 'line' with my eyes closed (not walking) with my arms outstretched. I fell right over immediately. You might want to try it. I really wonder what that all meant. He asked me if I was really sensitive to the movement of other cars out my periphery when I am stopped at red light and sense movement. I said, "Yes." But it didn't really help me understand it all any better.

I lose my balance a lot during IVIG infusions too for some reason and then I recover pretty quickly after they are over. I am a 'special case' I hear......debra