Multiple Sclerosis
Multiple Sclerosis (MS) is a disease that attacks the central nervous system. An autoimmune reaction causes stripping of protective nerve covering. This event leads to the expression of symptoms, which is different in every patient.
These symptoms include but are not limited to:
- Fatigue
- Weakness
- Spasticity
The expression of these symptoms may fluctuate as the disease flares, calms down and then repeats the cycle. With the advent of new disease modulating treatments, the advanced stages of disability that result from recurrent bouts of this nerve stripping may become less common.
Fatigue: Fatigue is one of the most common complaints heard from patients, affecting 90% of the MS population. Fatigue can be related to spasticity. If the patient is moving against stiff muscles, less energy will be left for activities of daily living. Sleep disorders, depression and other medical disorders such as anemia or low thyroid function can also contribute to fatigue. A therapy evaluation can assist a fatigued patient in determining the factors at play and combating them through a therapeutic exercise program such as one aimed at reducing spastic muscles. Energy conservation techniques and pacing can also help contain the effects of fatigue.
Weakness: Weakness may result from the central nervous system impairment or from dis-use. Spastic muscles can stretch out opposing muscles, causing them to weaken. A personalized therapeutic exercise program can enable a patient to maximize their chances of maintaining functional strength for mobility and self-care skills. The type of exercise recommended is based upon the degrees of weakness. Resistive exercises are appropriate for patients who are mildly to moderately weak. Extremely weak patients benefit from initial range of motion exercises and bracing with a gradual increase in exercise challenge as tolerated.
Spasticity: Spasticity results from an imbalance of brain and spinal cord influences on the muscles. Efforts to restore balance and normalize the muscle tone include the use of exercises, medications and modalities. Exercise programs specific for spasticity include a daily stretching program and strengthening of weak muscles so they can effectively pull against the stiff, spastic muscles. Modalities such as heat or cold can augment the effects of exercise. Medications for spasticity come in many forms, pills, injections and pumps.
Oral medications for spasticity include baclofen, dentrolene, diazepam and tizanidine. The oral medications circulate throughout the body and relieve spasticity. If localized spasticity occurs in certain muscles, injections directly into a given muscle can reduce spasticity without a systemic effect. When a patient cannot tolerate the side effects of the oral medication and is riddled with spasticity throughout the body, an intrathecal baclofen pump evaluation is appropriate. The pump evaluation involves a lumbar puncture and installation of liquid baclofen into the space around the spinal cord. A positive response with a reduction in spasticity helps identify appropriate candidates for baclofen pump implantation. Once the pump is surgically implanted, a member of the clinical team will manage the pump, including adjustments of dose to achieve the best possible spasticity control and pump refills.
Facts About MS
(National Multiple Sclerosis Society)
What is multiple sclerosis?
Multiple sclerosis is a chronic, unpredictable disease of the central nervous system (the brain, optic nerves, and spinal cord). It is thought to be an autoimmune disorder. This means the immune system incorrectly attacks the person's healthy tissue.
MS can cause blurred vision, loss of balance, poor coordination, slurred speech, tremors, numbness, extreme fatigue, problems with memory and concentration, paralysis, and blindness and more. These problems may be permanent or may come and go.
Most people are diagnosed between the ages of 20 and 50, although individuals as young as 2 and as old as 75 have developed it. MS is not considered a fatal disease as the vast majority of people with it live a normal life-span. But they may struggle to live as productively as they desire, often facing increasing limitations.
Typical symptoms of MS?
Symptoms of MS are unpredictable, vary from person to person, and from time to time in the same person. For example: One person may experience abnormal fatigue and episodes of numbness and tingling. Another could have loss of balance and muscle coordination making walking difficult. Still another could have slurred speech, tremors, stiffness, and bladder problems.
Sometimes major symptoms disappear completely, and the person regains lost functions. In severe MS, people have symptoms on a permanent basis including partial or complete paralysis, and difficulties with vision, cognition, speech, and elimination.
Who gets MS?
Anyone may develop MS but there are some patterns. More than twice as many women as men have MS. Studies suggest that genetic factors make certain individuals more susceptible than others, but there is no evidence that MS is directly inherited. MS occurs in most ethnic groups, including African-Americans, Asians and Hispanics/Latinos, but is more common in Caucasians of northern European ancestry.
What causes the symptoms?
MS symptoms result when an immune-system attack affects myelin, the protective insulation surrounding nerve fibers of the central nervous system (the brain and spinal cord). Myelin is destroyed and replaced by scars of hardened "sclerotic" tissue. Some underlying nerve fibers are permanently severed. The damage appears in multiple places within the central nervous system.
Myelin is often compared to insulating material around an electrical wire; loss of myelin interferes with the transmission of nerve signals.
Does MS always cause paralysis?
No. Moreover, the majority of people with MS do not become severely disabled. Two-thirds of people who have MS remain able to walk, though many will need an aid, such as a cane or crutches, and some will use a scooter or wheelchair because of fatigue, weakness, balance problems, or to assist with conserving energy.
Other Facts about MS
- Approximately 400,000 Americans have MS, and every week about 200 people are diagnosed.
- MS is NOT contagious and IS NOT directly inherited.
- MS is NOT considered a fatal disease
- The majority of people with MS DO NOT become severely disabled.
- There is no cure for MS yet, but drugs can help slow the course and/or symptoms in some patients
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