Multiple Sclerosis (MS)

Symptoms

Many MS symptoms are related and interdependent. One untreated symptom may aggravate a host of additional symptoms and strongly impact a patient's quality of life. For example, a fatigued patient may be more susceptible to depression. Or a fatigued patient may decrease his or her frequency of exercise, which in turn may lead to increased spasticity and constipation. Some of the more common MS symptoms include:

FATIGUE

• Fatigue is the most common symptom of MS, occurring in more than 75% of patients. In 30% of patients, fatigue occurs before other MS symptoms.
• Generally occurs daily and worsens as the day progresses
• Typically more severe than normal fatigue, occurs early in the morning and comes on more easily and suddenly
• Often described as a feeling of extreme tiredness, fogginess and lack of energy

BLADDER AND BOWEL DYSFUNCTION

• Approximately 80% to 96% of patients with MS experience bladder symptoms. These symptoms include: increased frequency, urgency hesitancy, dribbling, and incontinence.
• Treatments include consultation with a nero-urologist, diagnosis and treatment of urinary tract infections, kegel exercises, incontinence pads, bladder control medications or catheters.
• 35%-45% of MS patients experience constipation. Causes of constipation may vary from person to person including MS-related neurological damage, not drinking enough water (to avoid bladder difficulties) and limited physical activity due to weakness, fatigue, and spasticity.
• Treatments for constipation may include eating a high-fiber diet, add bulk formers, drinking 8-12 cups of water each day, regular exercise or various medical therapies (stool softeners, laxatives, enemas).

SEXUAL DYSFUNCTION

• 48% - 75% of people with MS report experiencing sexual difficulties which may be caused by both physical and emotional aspects of MS.
• Men may have difficulty achieving or maintaining an erection, decreased genital sensation, difficulty with ejaculation or fatigue and/or decreased interest in sexual intimacy.
• Women may have issues with fatigue, decreased sexual desire, loss or orgasm, reduced/altered/painful sensations, vaginal dryness, anxiety about incontinence, and/or urinary tract infections
• Treatment options include, resolving relationship issues, treating contributing factors such as fatigue, incontinence, spasticity pain and hormonal and psychophysiologic issues, as well as prescription medications, lubricants or eliminating medications with potential side-effects.

COGNITIVE DIFFICULTIES

• Occurs in 43% - 65% of people with MS
• Symptoms include:
  - Difficulties with problem-solving and multi-tasking
  - Slowed thinking
  - Short-term memory loss/forgetfulness
  - Difficulty with visual representation and spatial relationships
  - Personality changes
  - Language problems
• Treatment of cognitive dysfunction can involve several approaches, including the use of disease-modifying therapy, treatment of fatigue and depression through psychotherapy, avoiding aggravating factors (sleep deprivation, substance abuse), pursuing speech and occupational therapy for cognitive rehabilitation, and pharmacologic therapy with cholinesterase inhibitors.

DEPRESSION

• Depression is the most common mood symptom of MS, affecting between 47% and 54% of people with MS
• Can be caused by MS-related neurological changes, challenges of living with MS, or disease-modifying therapies
• Consult with your healthcare provider immediately if you suspect you are depressed.
• Treatments for depression can include prescription medications, psychotherapy or counseling, exercise and effective treatment of other MS symptoms

NUMBNESS, TINGLING

MUSCLE WEAKNESS AND BALANCE ISSUES

VISION CHANGES

SPASTICITY

• Between 40% and 80% of MS patients experience some degree of spasticity.
• Spasticity is defined as involuntary muscle stiffness or sudden muscle contractions and movements such as stiff or tight-feeling muscles or painful spasms or twisting limbs.
• Spasticity often results from the MS demyelination process that attacks the nerves controlling muscle tone.
• Treatments for spasticity include various muscle-relaxing drugs, physical therapy, occupational therapy, braces/splints and other prescription medications.

PAIN

How MS Affects Nerve Cells

The human brain contains millions of nerve cells, known as neurons. Each neuron is insulated by a myelin sheath, which helps nerve impulses reach their targets. With patients who have MS, the myelin sheath that protects the neuron is damaged by repeated attacks by antibodies from the immune system. If the damage is severe enough over time, the neuron may become cut and no longer transmit nerve impulses.

Types of MS

• Relapsing-remitting—Most common form of MS 55% of patients have this form In this form of MS there are unpredictable relapses during which new symptoms appear or existing symptoms become more severe. This can last for days or months and there is partial recovery between relapses. The disease may be inactive for months or years.
• Secondary progressive
  - 30% of patients have secondary progressive MS
  - Patients with relapsing-remitting MS convert to secondary progressive MS gradually over time.
  - With Secondary-progressive MS, symptoms become steadily worse.
• Primary progressive
  - 5-10% of patients have this form of MS
  - This form of MS is characterized by a lack of distinct attacks, but with slow onset and steadily worsening symptoms. There is an absence of distinct relapses.
• Benign MS
  - Less than 5% of patients
  - Complete recovery between relapses

Treatment Options for MS

Disease-modifying treatments
- Interferon Beta Agents
» There are currently three FDA-approved interferon agents
» Interferon beta drugs can help limit the excessive attacks from the body's immune system on the neurons thereby reducing the damage to the neurons.
- Glatiramer Acetate
-there is currently one FDA-approved glatiramer acetate therapy Immunosuppressive drugs
- Corticosteroids are a kind of immunosuppressive drug that is used for the treatment of relapses and is often used in combination with other drugs to treat aggressively for breakthrough disease

Care Team:
Charles Wang, M.D.
Steven Zak, M.D.