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Timothy L. Vollmer, MD
Department of Neurology
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HEALTH NOTES: The other symptoms of Multiple Sclerosis

Knowing the whole picture can help treatment

Multiple Sclerosis (MS), a disease of the central nervous system that damages areas of the brain and spinal cord, is caused by abnormal activation of the immune system that target the insulating material around the nerve fibers, the myelin sheath. MS is essentially a disease that disrupts connections within the brain and between the brain and the rest of the body. This interruption directly causes one or more of MS symptoms in patients to varying levels of severity.

While there are other forms, relapsing remitting multiple sclerosis is the most common form of multiple sclerosis. In this form, there are discrete attacks of MS symptoms - including vision changes, weakness, imbalance and spasticity among others - lasting from one to several days.

Much of MS care is targeted to its primary symptoms. Medications, physical therapy, and other treatments can keep many of these problems under control and help preserve patients' physical, cognitive and vocational functioning. The secondary and tertiary symptoms - complications of the initial problems of MS - are sometimes underrecognized and undertreated. Maximizing overall health and well-being requires identifying and managing them.

Fatigue and sleep disruption
Fatigue affects nearly 80 percent of people with MS, according to the National Multiple Sclerosis Society (NMSS). It's been linked to the brain and body's need to expend more energy than people without MS to process and accomplish daily tasks. But fatigue can also come from sleep disruption, a secondary symptom of MS. People with MS often have trouble falling or staying asleep because of spasticity, especially in the legs, or an increased need to go to the bathroom at night because of bladder problems. MS-related nerve spasms and trouble swallowing could cause sleep apnea, characterized by frequent pauses in breathing and then gasping during sleep. When sleep disturbances affect daily activities, patients should talk to their doctor to determine causes and treatments. A referral to a sleep specialist may be necessary.

Bladder infections
Bladder dysfunction is a common, primary symptom among MS patients, as MS can block or delay transmissions of nerve signals that control the bladder and urinary sphincters. Bladder dysfunction, such as urinary urgency or retention, can lead to secondary complications like repeated urinary tract infections, bladder infections and kidney stones, which can have long-term consequences. Early medical evaluation is important to determine the cause of the bladder symptoms and manage and treat the issues, whether via medication, surgery or pelvic floor muscle rehabilitation.

Pain and decreased muscle tone and bone density
Impaired mobility - a primary MS symptom - can cause inactivity and walking with a limp to accommodate limb weakness and prevent tripping. When these issues happen, deconditioned muscles, disuse weakness, reduced stamina and changes in walking patterns can cause back and hip pain, poor postural alignment and core control and decreased bone density (and increased risk of fracture). The best way to increase strength, improve walking and avoid associated pain, discomfort and risk for injury is an early referral for physical therapy. Also, severe immobility and paralysis can cause pressure sores, which can become infected.

Stress and depression
Social, emotional and psychological complications of MS can be defined as tertiary symptoms, which are the trickle down effects of MS on patients' lives, according to the NMSS. Symptoms like loss of physical and cognitive abilities, such as memory, concentration and information processing, can interfere with work, social lives and daily activities. This contributes to stress and anxiety, and possibly isolation, withdrawal and depression. Patients should speak with their physician about effective treatment options ranging from support groups and psychotherapy to antidepressant medications.

Story Source: The above story is based on materials provided by THESUNCHRONICLE
Note: Materials may be edited for content and length

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