The Nature of 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.

Sensitivity to heat is a common report from patients with multiple sclerosis and this may occur after something small such as having a hot shower or after undergoing physically difficult work in a hot environment. Multiple sclerosis can present in a variety of ways as it evolves, with typical symptoms including vision problems, mental difficulties with depression, weakness of the lower body, weakness of one side and poor balance and coordination. Exacerbation of MS symptoms can occur if the patient has a bacterial infection at the same time whilst it is thought there is little effect from physical trauma or mental stresses.

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.

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.

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.

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.

A large number of drugs are employed to limit the number of attacks but it is not clear if this has any effect on the longer term nervous system degeneration or disability levels. Once an attack of MS has begun no especially effective treatment is available although steroid use may lessen the time to recovery whilst having no effect of the amount of recovery. Surgery is not a common option and limited to a few choices such as releasing contractures of the hip adductors and for the treatment of severe pain of a neuropathic nature.

Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Physiotherapist Bristol visit his website.