PT: Weekly Complications of Multiple Sclerosis(MS)

Multiple sclerosis (MS) is a chronic (long-term), progressive, degenerative disorder that affects nerve fibers in the brain and spinal cord. There are many complications associated with this disorder. Because the effects of nerve injury are widespread, the many complications can be very severe and affect all parts of the body. Although not all individuals with multiple sclerosis (MS) experience all of the following complications, any of them can negatively affect the individual’s quality of life.

There is increasing urgency around this illness because it strikes people, predominantly women, in the prime of their lives and causes significant morbidity for many years. The chronic nature of most types of MS requires a multidisciplinary approach following series of complications that may accompany it. Listed below are some of the many complications MS:

1. Fatigue: Fatigue is one of the most common and debilitating MS symptoms and affects at least two thirds of patients with MS. Fatigue causes a general lack of energy that significantly limits daily functioning regardless of any neurologic symptoms or specific muscle weaknesses. Up to 40% of patients describe it as the most disabling MS symptom, which is higher than weakness, spasticity, motor control, or bowel or urinary problems.

Many conditions that are common in MS, including sleep disorders, depression, hypersensitivity to sensation, hypothyroidism, medications, and heat, may contribute to fatigue. None fully explain the consistent presence or severity of this problem in MS.

1. Loss of mobility and spasticity: Nearly every individual with MS loses some mobility, which may take the form of impaired motor control, muscle weakness, impaired balance, tremor, and, importantly, spasticity. Spasticity is one of the primary symptoms of MS. It is characterized by weakness, loss of dexterity, and the inability to control specific movements. Spasticity is usually more severe in the legs and torso. Mobility can also be affected by many non-physical factors, including mental well-being, fatigue, and even the weather condition.
   
2. Venous thromboembolism (VTE)
   VTE occurs when a blood clot travels through the bloodstream to a vessel, causing a blockage. This is partly because people living with MS typically have risk factors for VTE. These include:
   

• disability
  
• spasticity (muscle stiffness)
  
• lack of mobility
  
• steroid use

To reduce the risk for VTE, people with MS can focus on overall care, including eating a healthy diet and improving mobility as much as possible

1. Pain: About two-thirds of MS patients experience pain at some point during the course of the disease and 40% are never pain free. MS causes many pain syndromes – some are acute (short-term) while others are chronic (long-term). Some worsen with age and disease progression. Pain syndromes associated with MS are trigeminal (facial) pain, powerful spasms and cramps, optic neuritis (pain in the eye), stiffened joints, and a variety of sensations including feelings of itching, burning, and shooting pain.

2. Bowel dysfunction: Bowel dysfunction, which can include constipation or fecal incontinence, is a serious problem for many MS patients. Constipation may be caused by the disorder itself or by medications used to treat spasms or other symptoms. Diarrhea may also occur.

3. Urinary urgency: Individuals with urinary urgency feel the need to urinate frequently and urgently. When urinary urgency takes place, the signals that coordinate urination are disrupted and the individual experiences an uncontrollable urge to urinate that can cause incontinence.

4. Nocturia: Individuals with nocturia must awake frequently during the night to go to the bathroom. There are a number of causes for this type of incontinence, but those with MS may experience nocturia due to the interruption of brain impulses that travel up and down the spine to coordinate urination.

5. Speech and hearing problems: Problems in speech may occur because of difficulty in controlling the quality of the voice and articulating words. Problems with language itself, however, are very rare in MS. Hearing problems also occur in MS and may affect speech.

6. Lung problems: As the muscles that control breathing weaken, the ability to cough is impaired and the individual with MS is at higher risk for pneumonia and other complications in the lungs. Breathing may become difficult, and may eventually require the use of a respirator to aid in breathing.

7. Osteoporosis: Osteoporosis, or the loss of bone density, and subsequent fractures are a common problem among individuals with MS. It is caused and worsened by immobility and by some MS medications. Fractures caused by falls can be far more serious in MS patients than in the normal population, leading to problems including deconditioning (loss of physical fitness) or even inability to walk, constipation (from pain-relieving medications such as opiates), and respiratory complications.

8. Cognitive problems: Cognitive problems, such as having trouble concentrating and solving problems, affect about half of MS patients. It has been found that more people with MS leave work because of such difficulties than because of physical problems. In about 10% of cases, mental dysfunction may be severe and resemble dementia. The severity of such mental changes appears to be associated with the degree of loss of brain tissue.

9. Depression: Between 40-60% of MS patients suffer from depression at some point over the course of the illness, and studies have reported risks for suicide ranging from 3-15%. There is some evidence that depression in multiple sclerosis is not only due to the social and psychological impact of MS but to the disease process itself.

Doctors should assess patients for depression, even though there may be no obvious signs of it. It should be noted that the risk for suicide may be present even in patients who are not obviously depressed. Individuals at highest risk for suicide are those who live alone, those with a history of an emotional disorder (such as those with depression, anxiety, or alcohol abuse), a family history of mental illness, and people with high social stress.

1. Sexual dysfunction: Sexual dysfunction is a common problem in those with MS, occurring in over 70% of patients. Men are likely to have impotence and women have problems with vaginal lubrication, both leading to sexual dysfunction. It appears to be highly associated with urinary dysfunction.

2. Visual problems: Vision problems that can occur with MS include: blurred or dimmed vision; pain with eye movement; blind spots, particularly involving central vision; color blindness; double vision; and nystagmus, or vision that jumps uncontrollably.

About 40% to 50% of the complications of MS discussed above can be effectively manage by a physiotherapist alongside other teammate (Occupational Therapist, Speech Therapist,…). The broad management of MS involves a multidisciplinary team approach for a better result. Has earlier pointed out on our previous post on MS, Physiotherapy play an essential role in keeping a patient with MS active and functional within the community. While there is no cure for multiple sclerosis, exercise appears to be beneficial at multiple level.

Exercises should be chosen according to one’s strengths and weaknesses. Prescribing the best ’dose’ (intensity, frequency and duration) of exercise therapy to achieve optimal beneficial effects in terms of activities and participation for patients suffering from MS. There was no evidence describing harmful effects of exercise therapy for MS patients, rather considered as a safe effective means of rehabilitation.

PT assessment will focuses on the following;

• Posture
  
• Movement and function
  
• Carefully considering how a patient’s performance may be limited by fatigue, pain or other factors.

Analyzing these results together with the proper opinion and interest of the person with MS will enable the physiotherapist to set up an individualized program. Education is also important to assist patients in managing their programs as independently as possible. A multidisciplinary treatment for MS patients may lead to positive effects.

For more information or to arrange an appointment (In-patient, Out-patient or Domiciliary), you can reach out to Physio Centers of Africa (PCA) on 0813 028 0496.