Benign MS is a term used to describe some patients’ presentations but appears mostly incorrect as almost all patients suffer a continual progression of their disability, in some cases without particular attacks. Truly benign episodes are those attacks which occur and then remit without repetition in the future, which is rare. It is vital to have a realistic viewpoint from the perspective of the doctors, relatives and patients so that the correct information can be given and the correct treatments followed. Patients report mental and physical tiredness which is different from the more typical tiredness of functional over effort or poor sleep.
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.
Visual disturbance secondary to optic neuritis is a frequent symptom of onset as well as varying degrees of eye pain. The limbs can be the site of frequently reported tingling and numbness with varying levels of muscle weakness and sometimes leg or arm pain problems. Profound mental effects can also be present which can include depression and dementia and inappropriate actions or utterances with lability of emotions. Common urinary symptoms are retention (difficulty in passing water) and incontinence, with frequent disturbance of 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.
In multiple sclerosis there can be high levels of fatigue which present a problem and are treatable to a degree with drugs. The main aim of treatment is to prevent the disease progressing, particularly in its early stages where treatment with medication works best. As patients become increasingly disabled they respond less well to drugs and their quality of life reduces significantly. There is then an increased suicide risk which is calculated at seven and a half times the risk in the population and is not wholly explained by the patients being depressed. Immune moderating medication is used to slow the progression of the disease and to attempt to reduce the number of relapses.
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, editor of the Physiotherapy Site, writes articles about Physiotherapist, back pain, orthopaedic conditions, neck pain, injury management and Physiotherapists Bristol. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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