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.
Heat can be an aggravating factor and many patients report they are worse in hot weather, especially if they have to perform physical exertion or even after having a hot shower. The presentation of MS can vary widely with some patients suffering a majority of mental changes, whilst others suffer incoordination, one sided weakness, lower body weakness, depression or symptoms with vision. Symptoms can be worse if the patient has another illness at the same time such as bacterial infections, while trauma and emotional stresses are not thought to have a high level of effect.
Optic neuritis is a common onset symptom with disturbance of vision as well as eye pain in some cases. Numbness and tingling are common complaints in the limbs with varying degrees of weakness and there can be arm or leg pain syndromes associated with MS. Mental effects can also be profound with emotional lability or actions thought to be inappropriate by people around them, dementia and depression. Urinary incontinence is very common as is retention (being unable to pass water) and there is usually interference in sexual function.
Magnetic resonance imaging (MRI) scans of the head or the spinal column can be uses to identify the location of sclerotic lesions within the central nervous system. Typical nerve lesions in MS are located close to the ventricles of the brain, small reservoirs for the cerebro-spinal fluid. They are located in the white matter, the parts of the nervous system where the insulated nerve axons are packed together and where there are no, or very few, nerve cell bodies. Even what seem like older lesions can have a surrounding area of inflammation as they advance outwards. Some recent studies suggest that the grey matter (areas of nerve cell bodies) may be involved, with atrophy of the cortex and decline in mental ability.
Treatment of MS is difficult and complex and such patients usually have multifactorial needs and requirements. Medical treatment, psychological counselling, information, rehabilitation access, provision of orthotics and housing issues are all frequent requirements when dealing with patients with this disease. If patients have been on steroids for long periods or are immobile or past the menopause then bone density may need evaluation. Some patients are very dependent and have little or no family support and so present problems with long term housing and care.
Fatigue can be a very strong symptom in MS and can be treated with medication. Overall the aim is to prevent the progression of the disease especially if it diagnosed early on in its progress when drug treatment can be most effective. If patients become more disabled they are less responsive to current medical treatments and suffer a significant impact upon their quality of life. This leads to an increased incidence of suicide, around 7.5 times higher than the general population and not explained simply by reactive depression. The immune moderating drugs related to interferon are used to prevent relapses and slow disease progression.
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.
Author: Jonathan Blood-Smyth