PT Weekly: Multiple Sclerosis(MS) in Women

MS is generally considered an autoimmune condition that affects the brain and spinal cord of the central nervous system. The immune system attacks myelin, which is the protective layer around nerve fibers. This causes inflammation and scar tissue, or a lesion which makes it almost impossible for the brain to send signals to the rest of the body.

The disease affects women more often than men. According to the National Multiple Sclerosis Society, women are more susceptible than men. The disease can also cause symptoms specific to women. But women and men share almost the same symptoms of MS.

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 that includes health care providers, social workers, and community support to deal with the myriad issues that arise from this potentially debilitating illness in a young and middle age population.

What causes MS?

MS affects individual differently, which makes the severity of the disease and the types of symptoms vary from person to person. The exact cause of MS is unknown. However, scientists believe that four factors may play a role in the development of the disease.

1. Immune system: MS is considered an immune-mediated disease: the immune system malfunctions and attacks the CNS. Researchers know that the myelin sheath is directly affected, but they don’t know what triggers the immune system to attack the myelin.
2. Genetics: Several genes are believed to play a role in MS. Your chance of developing MS is slightly higher if a close relative, such as a parent or sibling, has the disease.
3. Environment: Epidemiologists have seen an increased pattern of MS cases in countries located farthest from the equator. This correlation causes some to believe that vitamin D may play a role. Vitamin D benefits the function of the immune system. People who live near the equator are exposed to more sunlight. As a result, their bodies produce more vitamin D
4. Infection: A variety of viruses have been linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis.

What can trigger MS symptoms?

There are several triggers that people with MS should avoid.
Stress
Smoking
Medication
Lack of sleep
Infections

Types of MS include:

1. Relapsing-remitting MS (RRMS)
RRMS involves clear relapses of disease activity followed by remissions. During remission periods, symptoms are mild or absent and there’s no disease progression. RRMS is the most common form of MS at onset.

2. Clinically isolated syndrome (CIS)
CIS involves one episode of symptoms lasting at least 24 hours. These symptoms are due to demyelination in your central nervous system.
There are two types of episodes, monofocal and multifocal. A monofocal episode means one lesion causes one symptom. A multifocal episode means you have more than one lesion and more than one symptom.

3. Primary-progressive MS (PPMS)
In PPMS, the neurological function becomes progressively worse from the onset of symptoms. However, short periods of stability can occur.4. Progressive-relapsing MS was a term previously used for progressive MS with clear relapses. This is now called PPMS. The terms “active” and “not active” are used to describe disease activity.

5. Secondary-progressive MS (SPMS)

SPMS occurs when RRMS transitions into the progressive form. There may still be a noticeable relapses, in addition to gradual worsening of function or disability.

MS complications

MS is a lifelong condition that can affect overall health. With proper management of symptoms, people living with MS can often remain active for many years. And not everyone will have complications. However, some complications are common to many people living with MS.

1. Corticosteroid-related complications

Corticosteroids are typically used only to make an attack go away quickly. Complications that may arise from corticosteroid use include:
high blood pressure
fluid retention
weight gain
mood and memory problems
infections
high blood sugar
reduced adrenal gland function

2. Bladder and bowel problems

MS causes interruptions in signals between the brain and the urinary tract and bowel systems. These bladder and bowel problems usually include:
constipation
diarrhea
incontinence
The bladder may be overactive or fail to empty completely. To help with bowel and bladder issues, some people follow a high-fiber diet or take medications like fiber agents or stool softeners. Others receive nerve stimulation and physical therapy to help them regain some bowel and bladder function.

3. Mental health complications

People living with MS experience higher rates of depression and bipolar affective disorder. Depression may be connected to changes in brain tissue caused by MS. It may also be the result of the emotional challenges of living with the condition. Some people with MS may feel a sense of isolation, and face career, economic, and social challenges.
Bipolar affective disorder may also be a side effect of MS progression or certain medications such as corticosteroids.

4. Vision changes

Vision changes occur as MS progresses. One may experience some of these symptoms for a short time, or they may become permanent. Possible vision complications include:
blurry vision
diplopia (double vision)
nystagmus (uncontrolled eye movements)
vision loss

5. Cognitive impairment

Many people believe MS only affects mobility, but about half of people living with the condition develop cognitive issues, like memory loss and slower intellectual processing. These issues could also result in reduced problem-solving, verbal, abstract reasoning, and visual-spatial abilities. These changes in cognition are likely from brain atrophy or lesions caused by MS.

6. Sensory impairment

People with MS may have a feeling of numbness or other physical sensations. Dysesthesia is a painful form of these sensations. This condition can cause:
aching
burning
a feeling of tightness

7. 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

Multiple Sclerosis and Heart

Many people with MS appears to be at higher risk of heart disease, congenital heart failure, stroke, and peripheral vascular disease, according to a review of studies on Multiple sclerosis. While the review couldn’t establish the reasons for the increase risk, it was pointed out that, majority of people with MS have higher rate of smoking and being overweight or obese, with lower level of inactivity than the general population. All of which can contribute to CVD.
To reduce the risk, its important to saty active and exercise, even while on a wheelchair. Eating a heart-healthy diet and deligent about knowing ones numbers, especially cholesterol counts and blood pressure. Any abnormal pain, fatigue or shortness of breath should prompt an individual to see a medical professional.

Living with Multiple Sclerosis

Living well with MS means much more than getting treatment for symptoms, adopting new techniques, and adjusting to physical changes. It means accepting MS as part of your life. Accepting without giving in is not an easy task, and there is no one right way to do it.

Multiple Sclerosis Rehabilitation provides some of the tools you need to take control of your MS rather than having MS take control of you. Counseling by a psychologist, social worker, or psychiatrist who has worked with people who have chronic diseases may be extremely helpful.
It may also be helpful to meet other people who live with MS. Support groups, self-help meetings, and trained peers with MS all provide a chance to share information and concerns.

Physical Therapy Management (current best practice)

Physical therapy 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 levels and it may have an important role to play in delaying negative symptoms of the disease.
Exercises should be chosen according to one’s strengths and weaknesses. It is to state the best ’dose’ (intensity, frequency and duration) of treatment to achieve optimal beneficial effects of exercise therapy 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.

The PT assessment will focus on 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. This program needs to be set up so that it can easily be performed at home.

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 on 0813 028 0496!