~~~SYMPTOM'S OF MULTIPLE SCLEROSIS~~~
Multiple Sclerosis (MS)
Symptoms
People who have multiple sclerosis (MS) do not all have the same symptoms. Symptoms vary according to which parts of the brain or spinal cord (central nervous system) are damaged by the disease. The loss of myelin and scarring caused by MS can affect any part of the central nervous system.
Symptoms may come and go or become more or less severe from day to day and, rarely, from hour to hour. Symptoms may become more severe with increased (or, less commonly, decreased) body temperature or after a viral infection.
Early symptoms
The most common early symptoms of MS include:
* Muscle (motor) symptoms, such as weakness, leg dragging, stiffness, a tendency to drop things, a feeling of heaviness, clumsiness, or a lack of coordination (ataxia).
* Visual symptoms, such as blurred, foggy, or hazy vision, eyeball pain (especially with movement), blindness, or double vision. At some point in the course of the disease, about 40% of people have an attack of optic neuritis, which causes sudden vision loss and eye pain, usually in only one eye.
Less common early symptoms include:
* Sensory symptoms, such as tingling, a pins-and-needles sensation, numbness, a bandlike tightness around the trunk or limbs, or electrical sensations moving down the back and limbs.
* Balance symptoms, such as lightheadedness or dizziness, a spinning feeling (vertigo), nausea, or vomiting.
* Bladder symptoms, such as an inability to hold urine (urinary incontinence), an inability to completely empty the bladder, a loss of bladder sensation (the person is unable to sense the bladder becoming full until there is a sudden, urgent need to urinate), or a loss of male sexual function. These problems are not common in the early stages of the disease.
Advanced symptoms
As MS progresses, symptoms may become more severe and may include:
* Stiff, mechanical movements (spasticity) or uncontrollable shaking (tremor).
* Pain and other sensory symptoms.
* Inability to control urination (incontinence) or, less often, an inability to urinate (urinary retention).
* Constipation and other bowel disorders.
Thinking (cognitive) and emotional problems are common in people who have had MS for some time. They rarely occur as a result of the first attack of MS. Since thinking and emotional problems may be treatable or may be caused by conditions other than MS, the person should always mention any new symptoms to his or her doctor.
* Thinking problems may include memory loss, difficulty in concentration, reduced attention span, or speech problems.
* Emotional symptoms may include depression or mood disorders. A rare symptom is excessive cheerfulness that seems inappropriate.
Progressive relapsing multiple sclerosis ( WHICH I LIVE WITH)
Progressive relapsing multiple sclerosis (MS) is a form of MS in which the steady deterioration of nerve function begins when symptoms first appear. Relapses occur, during which symptoms are worse than usual, but damage to the nerves continues and symptoms become increasingly disabling even when the person is not having an attack. This is not a very common course for the disease to follow.
Multiple Sclerosis (MS)
What Happens
In general, multiple sclerosis (MS) follows one of four possible courses:
* Relapsing-remitting
* Secondary progressive
* Primary progressive
* Progressive relapsing
Many people with MS may not follow one of these patterns exactly. The course is often hard to predict. Not only does it vary from person to person, but the course of the disease in a single individual may change over time.
The disease most commonly advances in a series of attacks or relapses for a period of many years (relapsing-remitting MS). In many people, the first MS attack involves a single symptom. It may be months or years before the person has a relapse. As time goes by, symptoms may tend to linger after each relapse so that the person's ability to fully recover from a relapse decreases. New symptoms often develop as the disease damages other areas of the brain or spinal cord.
Several factors seem to be associated with more severe disease progression and disability. These include:
* Frequent relapses during the first few years of the disease.
* Incomplete recovery between attacks.
* Early, lasting motor problems (problems that affect movement).
* Many "silent" lesions on MRI (lesions that do not correspond to symptoms the person has had so far)
How long does the disease last?
The duration of the disease varies:
* Most people who get MS live with it for decades; the average duration is more than 30 years. While people with MS often become disabled over time, the disease itself is rarely life-threatening and may not directly reduce the person's natural lifespan.
* Some people (about 10%) have a single attack or a few attacks from which they recover entirely. This is called benign MS.
* Very rarely, people die within several months of the onset of MS. This is called malignant or fulminant MS
Complications of MS
Complications that often result from MS include:
* Urinary tract infections (UTIs). People with MS often have bladder problems, such as the inability to control or release urine. These problems increase the risk of UTIs.
* Constipation. Weakness and spasms in the bowel and a low level of physical activity are common in people with MS and can lead to constipation.
* Pressure sores. Pressure sores can develop when a person has to lie in bed for long periods of time, especially if the person is unable to change positions.
* Confinement to a wheelchair some or all of the time.
MS should not interfere with most routine health care procedures, such as dental anesthesia, general anesthesia (except if you have respiratory problems), and vaccinations, including flu shots.
Because MS may affect a person's ability to move and walk, it often limits what a person can do, particularly as he or she gets older. Many people with MS have some disability, but the disability is not always severe and not always constant. In a study that examined the medical records of people with MS over a 60-year period, one-third were still working and two-thirds were still walking 25 years after developing MS.1
If you or someone in your family has MS, talk to your doctor about how MS may affect daily living. Knowing what to expect will help you plan for the future.
Controlling Muscle Spasms
Many people with MS experience spasticity, or muscle stiffness and spasms. It usually affects the muscles of the legs and arms, and may interfere with the ability to move those muscles freely.
Spasticity can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, especially at night. It can feel like a muscle tightening or it can cause severe pain. Spasticity can also produce feelings of pain or tightness in and around joints and can cause low back pain. It may vary depending on your position, posture, and state of relaxation.
What Causes Spasticity?
Spasticity is the result of an imbalance in the electrical signals coming from the brain and spinal cord, often caused by damage to these areas from MS. This imbalance causes hyperactive muscle stretch reflexes, which result in involuntary contractions of the muscle, and increased muscle tension.
What Triggers Spasticity?
Spasticity may be aggravated by extremes of temperature, humidity, or infections. Tight clothing can even trigger it.
How Is Spasticity Diagnosed?
To diagnose spasticity your doctor will first evaluate your medical history, including what medications you have taken and whether there is a history of neurological or muscular disorders in your family. To confirm the diagnosis, several tests can be performed to evaluate your arm and leg movements, muscular activity, passive and active range of motion, and ability to perform self-care activities.
How Is Spasticity Treated?
Spasticity can be treated using physical therapy, medications, surgery or any combination of these treatments. Your doctors will consider the severity of your condition, your overall health, and the following factors when prescribing an appropriate treatment plan:
* Is the spasticity impacting function or independence?
* Is the spasticity painful?
* What treatment options have already been tried, and how did they work?
* What are the costs of the possible treatments?
* What are the limitations and side effects of the treatment?
* Will the benefits outweigh the risks?
How Does Physical and Occupational Therapy Help Spasticity?
A basic physical therapy stretching program is the first step in treating spasticity. A daily regimen of stretching can lengthen muscles to help decrease spasticity.
An occupational therapist may prescribe splinting, casting, and bracing techniques to maintain range of motion and flexibility.
If physical and occupational therapy do not adequately control the spasticity, medications may be added to the treatment plan.
What Medications Are Used to Treat Spasticity?
Common medications used to treat spasticity include muscle relaxant Baclofen and Zanaflex. Baclofen prevents the nerves in the spinal cord from sending a message to the muscles to contract.
Another drug that might be used to treat spasticity is Valium, which is often helpful when taken at night to relieve spasms that interfere with sleep.
If medications taken orally are not effective, a pump can be surgically implanted to deliver the medication (such as the Baclofen pump). Botulinum toxin can also be injected locally into the affected area to relax the muscles.
What Types of Surgery Are Available?
When other treatments fail, rhizotomy and tendon release are two surgical procedures used to treat spasticity.
Rhizotomy involves surgically cutting away part of the spinal nerve. It is performed to relieve pain or decrease muscle tension.
Tendon release, also called a tenotomy, may be performed to help reduce the frequency or magnitude of the spasticity, depending on the age of the patient. The surgery involves cutting severely contracted tendons away from the muscles to which they're attached.
Tendon release may need to be repeated. It is usually only done in cases of extreme pain that do not respond to other treatments.
Managing MS-Related Tremors ''
Many people with MS experience some form of tremor, or uncontrollable shaking, which can occur in various parts of the body.
There are several types of tremor, including:
* Postural tremors. A person who has a postural tremor will shake while sitting or standing, but not while lying down.
* Intention tremor. Means there is no shaking when a person is at rest. The tremor develops as the person attempts to reach or grasp something or move a hand or foot to a precise spot. This is the most common and generally the most disabling form of tremor that occurs in people with MS.
* Nystagmus. A tremor that produces jumpy eye movements.
Tremors occur because of the damage along the complex nerve pathways that are responsible for movement coordination.
How Are Tremors Treated?
Tremors are one of the most difficult symptoms of MS to treat. To date, there have been no reports of consistently effective drugs to treat tremors. Varying degrees of success have been reported with agents such as the anti-tuberculosis agent, isoniazid (INH); the antihistamines Atarax and Vistaril; the beta-blocker Inderal; the anticonvulsive Mysoline; a diuretic Diamox; and anti-anxiety drugs Buspar and Klonopin.
What Causes Tremors?
Psychological Impact of Tremors''
Tremors can have a tremendous emotional and social impact on a person. Unfortunately, people with severe tremors tend to isolate themselves to avoid embarrassment. Isolation can lead to depression and further psychological problems. A psychologist or counselor may be able to help a person with MS deal with these issues and become more comfortable in public. Talk to your doctor if you are having trouble coping with tremors.
Multiple Sclerosis (MS)
Symptoms
People who have multiple sclerosis (MS) do not all have the same symptoms. Symptoms vary according to which parts of the brain or spinal cord (central nervous system) are damaged by the disease. The loss of myelin and scarring caused by MS can affect any part of the central nervous system.
Symptoms may come and go or become more or less severe from day to day and, rarely, from hour to hour. Symptoms may become more severe with increased (or, less commonly, decreased) body temperature or after a viral infection.
Early symptoms
The most common early symptoms of MS include:
* Muscle (motor) symptoms, such as weakness, leg dragging, stiffness, a tendency to drop things, a feeling of heaviness, clumsiness, or a lack of coordination (ataxia).
* Visual symptoms, such as blurred, foggy, or hazy vision, eyeball pain (especially with movement), blindness, or double vision. At some point in the course of the disease, about 40% of people have an attack of optic neuritis, which causes sudden vision loss and eye pain, usually in only one eye.
Less common early symptoms include:
* Sensory symptoms, such as tingling, a pins-and-needles sensation, numbness, a bandlike tightness around the trunk or limbs, or electrical sensations moving down the back and limbs.
* Balance symptoms, such as lightheadedness or dizziness, a spinning feeling (vertigo), nausea, or vomiting.
* Bladder symptoms, such as an inability to hold urine (urinary incontinence), an inability to completely empty the bladder, a loss of bladder sensation (the person is unable to sense the bladder becoming full until there is a sudden, urgent need to urinate), or a loss of male sexual function. These problems are not common in the early stages of the disease.
Advanced symptoms
As MS progresses, symptoms may become more severe and may include:
* Stiff, mechanical movements (spasticity) or uncontrollable shaking (tremor).
* Pain and other sensory symptoms.
* Inability to control urination (incontinence) or, less often, an inability to urinate (urinary retention).
* Constipation and other bowel disorders.
Thinking (cognitive) and emotional problems are common in people who have had MS for some time. They rarely occur as a result of the first attack of MS. Since thinking and emotional problems may be treatable or may be caused by conditions other than MS, the person should always mention any new symptoms to his or her doctor.
* Thinking problems may include memory loss, difficulty in concentration, reduced attention span, or speech problems.
* Emotional symptoms may include depression or mood disorders. A rare symptom is excessive cheerfulness that seems inappropriate.
Progressive relapsing multiple sclerosis ( WHICH I LIVE WITH)
Progressive relapsing multiple sclerosis (MS) is a form of MS in which the steady deterioration of nerve function begins when symptoms first appear. Relapses occur, during which symptoms are worse than usual, but damage to the nerves continues and symptoms become increasingly disabling even when the person is not having an attack. This is not a very common course for the disease to follow.
Multiple Sclerosis (MS)
What Happens
In general, multiple sclerosis (MS) follows one of four possible courses:
* Relapsing-remitting
* Secondary progressive
* Primary progressive
* Progressive relapsing
Many people with MS may not follow one of these patterns exactly. The course is often hard to predict. Not only does it vary from person to person, but the course of the disease in a single individual may change over time.
The disease most commonly advances in a series of attacks or relapses for a period of many years (relapsing-remitting MS). In many people, the first MS attack involves a single symptom. It may be months or years before the person has a relapse. As time goes by, symptoms may tend to linger after each relapse so that the person's ability to fully recover from a relapse decreases. New symptoms often develop as the disease damages other areas of the brain or spinal cord.
Several factors seem to be associated with more severe disease progression and disability. These include:
* Frequent relapses during the first few years of the disease.
* Incomplete recovery between attacks.
* Early, lasting motor problems (problems that affect movement).
* Many "silent" lesions on MRI (lesions that do not correspond to symptoms the person has had so far)
How long does the disease last?
The duration of the disease varies:
* Most people who get MS live with it for decades; the average duration is more than 30 years. While people with MS often become disabled over time, the disease itself is rarely life-threatening and may not directly reduce the person's natural lifespan.
* Some people (about 10%) have a single attack or a few attacks from which they recover entirely. This is called benign MS.
* Very rarely, people die within several months of the onset of MS. This is called malignant or fulminant MS
Complications of MS
Complications that often result from MS include:
* Urinary tract infections (UTIs). People with MS often have bladder problems, such as the inability to control or release urine. These problems increase the risk of UTIs.
* Constipation. Weakness and spasms in the bowel and a low level of physical activity are common in people with MS and can lead to constipation.
* Pressure sores. Pressure sores can develop when a person has to lie in bed for long periods of time, especially if the person is unable to change positions.
* Confinement to a wheelchair some or all of the time.
MS should not interfere with most routine health care procedures, such as dental anesthesia, general anesthesia (except if you have respiratory problems), and vaccinations, including flu shots.
Because MS may affect a person's ability to move and walk, it often limits what a person can do, particularly as he or she gets older. Many people with MS have some disability, but the disability is not always severe and not always constant. In a study that examined the medical records of people with MS over a 60-year period, one-third were still working and two-thirds were still walking 25 years after developing MS.1
If you or someone in your family has MS, talk to your doctor about how MS may affect daily living. Knowing what to expect will help you plan for the future.
Controlling Muscle Spasms
Many people with MS experience spasticity, or muscle stiffness and spasms. It usually affects the muscles of the legs and arms, and may interfere with the ability to move those muscles freely.
Spasticity can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, especially at night. It can feel like a muscle tightening or it can cause severe pain. Spasticity can also produce feelings of pain or tightness in and around joints and can cause low back pain. It may vary depending on your position, posture, and state of relaxation.
What Causes Spasticity?
Spasticity is the result of an imbalance in the electrical signals coming from the brain and spinal cord, often caused by damage to these areas from MS. This imbalance causes hyperactive muscle stretch reflexes, which result in involuntary contractions of the muscle, and increased muscle tension.
What Triggers Spasticity?
Spasticity may be aggravated by extremes of temperature, humidity, or infections. Tight clothing can even trigger it.
How Is Spasticity Diagnosed?
To diagnose spasticity your doctor will first evaluate your medical history, including what medications you have taken and whether there is a history of neurological or muscular disorders in your family. To confirm the diagnosis, several tests can be performed to evaluate your arm and leg movements, muscular activity, passive and active range of motion, and ability to perform self-care activities.
How Is Spasticity Treated?
Spasticity can be treated using physical therapy, medications, surgery or any combination of these treatments. Your doctors will consider the severity of your condition, your overall health, and the following factors when prescribing an appropriate treatment plan:
* Is the spasticity impacting function or independence?
* Is the spasticity painful?
* What treatment options have already been tried, and how did they work?
* What are the costs of the possible treatments?
* What are the limitations and side effects of the treatment?
* Will the benefits outweigh the risks?
How Does Physical and Occupational Therapy Help Spasticity?
A basic physical therapy stretching program is the first step in treating spasticity. A daily regimen of stretching can lengthen muscles to help decrease spasticity.
An occupational therapist may prescribe splinting, casting, and bracing techniques to maintain range of motion and flexibility.
If physical and occupational therapy do not adequately control the spasticity, medications may be added to the treatment plan.
What Medications Are Used to Treat Spasticity?
Common medications used to treat spasticity include muscle relaxant Baclofen and Zanaflex. Baclofen prevents the nerves in the spinal cord from sending a message to the muscles to contract.
Another drug that might be used to treat spasticity is Valium, which is often helpful when taken at night to relieve spasms that interfere with sleep.
If medications taken orally are not effective, a pump can be surgically implanted to deliver the medication (such as the Baclofen pump). Botulinum toxin can also be injected locally into the affected area to relax the muscles.
What Types of Surgery Are Available?
When other treatments fail, rhizotomy and tendon release are two surgical procedures used to treat spasticity.
Rhizotomy involves surgically cutting away part of the spinal nerve. It is performed to relieve pain or decrease muscle tension.
Tendon release, also called a tenotomy, may be performed to help reduce the frequency or magnitude of the spasticity, depending on the age of the patient. The surgery involves cutting severely contracted tendons away from the muscles to which they're attached.
Tendon release may need to be repeated. It is usually only done in cases of extreme pain that do not respond to other treatments.
Managing MS-Related Tremors ''
Many people with MS experience some form of tremor, or uncontrollable shaking, which can occur in various parts of the body.
There are several types of tremor, including:
* Postural tremors. A person who has a postural tremor will shake while sitting or standing, but not while lying down.
* Intention tremor. Means there is no shaking when a person is at rest. The tremor develops as the person attempts to reach or grasp something or move a hand or foot to a precise spot. This is the most common and generally the most disabling form of tremor that occurs in people with MS.
* Nystagmus. A tremor that produces jumpy eye movements.
Tremors occur because of the damage along the complex nerve pathways that are responsible for movement coordination.
How Are Tremors Treated?
Tremors are one of the most difficult symptoms of MS to treat. To date, there have been no reports of consistently effective drugs to treat tremors. Varying degrees of success have been reported with agents such as the anti-tuberculosis agent, isoniazid (INH); the antihistamines Atarax and Vistaril; the beta-blocker Inderal; the anticonvulsive Mysoline; a diuretic Diamox; and anti-anxiety drugs Buspar and Klonopin.
What Causes Tremors?
Psychological Impact of Tremors''
Tremors can have a tremendous emotional and social impact on a person. Unfortunately, people with severe tremors tend to isolate themselves to avoid embarrassment. Isolation can lead to depression and further psychological problems. A psychologist or counselor may be able to help a person with MS deal with these issues and become more comfortable in public. Talk to your doctor if you are having trouble coping with tremors.