MS Management
M.S. symptoms are chronic signs of plaque damage to any area of the brain and/or spinal cord. M.S. relapses are different from M.S. symptoms in that they are a sudden flare up of old symptoms or new symptom that typically worsen over several days and last several weeks. Common M.S. symptoms include fatigue, bladder and bowel dysfunction, spasticity, memory problems, depression, vision changes, pain, weakness, numbness, tingling and balance abnormalities. M.S. symptoms are often interrelated. One untreated symptom may aggravate a host of additional symptoms and significantly impact a patients life. An example of this would be increased bladder problems may lead to disturbed sleep, which may lead to decreased cognitive abilities, which may lead to worsening depression and fatigue. Effective symptom management includes a combination of medications, physical therapy, patient education, and physician interaction.
Fatigue
Fatigue is the most common symptom of M.S. patients it is seen in more than 75% of M.S. patients. An appropriate exercise regimen, with the help of a physical therapist, can help manage fatigue. Keeping cool by avoiding heat and using cooling techniques such as a cooling vest, and drinking cold water can help minimize fatigue. Treating depression with antidepressants and the help of a psychologist will also improve fatigue. Discussing fatigue with your physician is important to help eliminate other health problems or medication side effects. Getting a good nights sleep will also help treat fatigue. There are several prescription medications which have been proven to reduce fatigue. Provigil and Amantidine are used frequently in M.S. to reduce fatigue. There are many energy conserving tips that can be incorporated into an M.S. patients daily routine. Using adaptive equipment and mobility aids can conserve needed energy.
Depression
Depression affects over 50% of people with M.S. Depression can be caused by the challenges of living with M.S., neurological changes and even the medications taken to control M.S. Effective depression management includes four key factors. These are pharmacological intervention with antidepressants, counseling, exercise, and treatment of sleep disturbances and other symptoms.
Spasticity
Spasticity is involuntary muscle stiffness, or sudden muscle contractions. Treatment for spasticity includes avoiding pain, tight clothing or shoes, poor posture, infections, and temperature extremes. Exercise is a main stay in the treatment of spasticity. Daily stretching can greatly improve symptoms and increase flexibility. Yoga and water therapy are other valuable exercises. A personal physical therapist can often aid individual M.S. patients in the most appropriate exercise for them. Orthopedic devices such as braces or splints can become necessary. Prescription medications inclusive of tizanidine, baclofen, gabapentin, benzodiazepines, and dantrolene can be useful. Botulinum toxin injections can help relieve spasticity to localized areas. Intrathecal baclofen pumps can improve tone in those patients who fail to respond to medications. Surgical management can be used for severe spasticity for M.S. patients who do not respond to medications or other therapies.
Bowel & Bladder Issues
Increased frequency, urgency, dribbling, incontinence, and hesitancy, are common bladder symptoms. Urinary tract infections are more common inpatients with M.S. and should be diagnosed and treated quickly. Kegel exercises can improve control of urination. Medications and/or patches can also help with various bladder issues. Incontinence pads can be useful. A consult with a urologist, and urodynamic testing is often helpful to fully diagnose bladder problems. Bowel difficulties include constipation, diarrhea, and incontinence. A high fiber diet will help manage bowel difficulties. A high fiber diet includes foods such as whole grain cereals and breads, granola, vegetables, and fruits with skins. Bulk agents such as psyllium can be additionally helpful. M.S. patients should drink 8-12 cups of water daily. Regular exercise will help maintain bowel motility.
Cognitive Impairment
Occurs in approximately 50% of people with M.S. Symptoms can be difficulty with multi tasking, problem solving, slowed thinking, forgetfulness, visual spatial disturbances, language problems, and or personality changes. Can be seen even early in the disease process It does not correlate with physical disabilities It does correlate with lesion volume on M.R.I. Treatment for cognitive impairment is multidimensional. It includes the use of many modalities. The first treatment step is the use of disease modifying therapies to delay disease progression. (INF-B,glatiramer acetete, mitoxanthone, various other chemotherapy agents) Adaptive strategies are important such as a formal cognitive rehab. Treatment of underlying comorbidities as depression, fatigue, and evaluation for other metabolic problems as thyroid disease are necessary. Avoidance of aggravating factors as sleep deprivation, metabolic abnormalities (thyroid disease), and medication side effects must be explored. Symptomatic therapy with cholinesterase inhibitors is effective in some patients.