About Multiple Sclerosis – Part Two
Due to the fact that almost everybody with MS has a steady progression of their condition even if they don’t have obvious attacks, the term benign MS appears to be a misnomer. A very few patients may turn out to have had a clinical attack and then did not move to progression, but most get worse steadily with time. A realistic assessment should be made so that the patient, relatives and doctors all understand what is likely to happen and what treatments are appropriate. Tiredness is a common finding amongst MS sufferers, either physical or mental, and is separate from tiredness secondary to poor sleep or excessive exertion in the attempt to be independent.
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.
The onset of MS can include the presence of optic neuritis with disturbance of sight and pain in the eye or around it. The arms and legs may suffer from tingling and numbness, weakness of the muscle groups or degrees of pain syndromes. There can also be significant mental effects including inappropriate speech and actions, depression and dementia and difficulty in controlling the emotions. Urinary symptoms are common with incontinence and retention (problems passing water) and sexual function is often interfered with.
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.
Even older looking lesions can have an area of inflammation around them indicating they may still be growing. The grey matter, the brain areas which house the nerve cell bodies, have also recently been suspected of involvement, which can result in decline of mental faculties.
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 Physiotherapists, physiotherapy, Bristol Physiotherapy, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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