Multiple Sclerosis – Part Two
The very large majority of patients with MS suffers a gradual deterioration in their functional abilities with time even without specific attacks so it is mostly unhelpful to use the term benign MS. A patient can have a clinical attack which looks very much like MS and then never progress any further and so may be truly in this benign category. It is important that patients, relatives and medical carers have a realistic view of the disease and thereby agree on the best management strategy. A common complaint among patients is that of tiredness, both mental and physical, and distinct from the more normal tiredness after poor sleep or functional exertion.
Multiple sclerosis sufferers report they are sensitive to heat, even after a hot shower and often if they have to physically exert themselves in hot weather. How MS presents as a condition can be widely variable with patients complaining of poor coordination and balance, weakness on one side, weakness from the waist down, visual disturbance, depression and some with a preponderance of mental changes. If there is an ongoing illness at the same times such as an infection then this can worsen MS symptoms, with further negative effects also caused to a much lesser extent by stress and physical trauma.
Visual disturbance secondary to optic neuritis is a frequent symptom of onset as well as varying degrees of eye pain. The limbs can be the site of frequently reported tingling and numbness with varying levels of muscle weakness and sometimes leg or arm pain problems. Profound mental effects can also be present which can include depression and dementia and inappropriate actions or utterances with lability of emotions. Common urinary symptoms are retention (difficulty in passing water) and incontinence, with frequent disturbance of sexual function.
The lesions which are responsible for the neurological changes in this condition can now be imaged in MRI or magnetic resonance imaging scanning of the nervous system. The ventricles within the brain, reservoirs of the cerebrospinal fluid, are the areas where the lesions are closest to, with the lesions occurring inside the white matter of the brain. The white matter consists of the insulated nerve sheaths of thousands or millions of nerve tubes on their way to parts of the nervous system they are serving.
The complexity and difficulty of treating multiple sclerosis is related to the widely varied and many sided requirements of the patients. They may need providing with orthotics, drug treatment, information giving, mental counselling, access to rehabilitation facilities and assistance with placement. Longer term steroid use plus being past the menopause means that bone density could be relevant and should be investigated. High degrees of dependency develop in some patients and with a lack of support from a family this can challenge the ability to look after them in the long term.
Severe tiredness can be an important symptom in MS and can be treated to a degree with medications. Halting the disease’s progress is the overarching aim of medical treatment and this works best in the early disease stages where the condition is most responsive. With increasing disability levels patients suffer highly reduced quality of life and respond less well to drug therapy. Suicide risk is also raised, to a level 7.5 times that of the wider population and this effect is not wholly taken account of by the levels of depression. Drugs which moderate activity of the immune system are employed to retard disease progress and to cut the number of relapses.
Many other drugs are used to suppress attacks but there is no agreement that this has a long term effect on the extent of neural degeneration or levels of disability. Once an MS attack has started there is no particularly effective therapy, although a steroid may improve the time to recovery yet not affect the end result. Surgery is not commonly used in multiple sclerosis but it can be employed to release contractures such as of the hip adductors or to treat severe neuropathic pain by cutting the nerve tracts responsible.
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapist, back pain, orthopaedic conditions, neck pain, injury management and Physiotherapists in Bristol. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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