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MS Symptoms

Symptoms of MS can include but are not limited to:

  • Bladder and bowel problems
  • Depression
  • Fatigue
  • Memory changes
  • Numbness and tingling
  • Pain
  • Sexual difficulties
  • Shaking and loss of coordination
  • Spasticity
  • Visual disturbances
  • Weakness

Each person will experience different symptoms depending on where in the central nervous system (the brain & spinal cord) the myelin has been damaged. Not every person will experience all symptoms. Some symptoms will appear and disappear, while others may be more persistent. People respond differently to the medications used to treat each side effect, so you will likely have to work collaboratively with your doctor to find the treatment that works best for you.


Pain

Most people with MS experience pain during the course of the disease. The pain may have different causes. Pain can be a direct consequence of MS or a consequence of the disability that MS produces. Just because you are experiencing pain, it does not necessarily mean that the disease is progressing or getting worse.

Backache is the most common complaint and may be due to the strain put on the back when walking with weakened muscles. Someone experiencing back pain may want to consider physiotherapy (PT) to help strengthen muscles, improve posture, decrease pain, and postpone the use of gait aids such as canes and wheelchairs. Ibuprofen or another anti-inflammatory medication can also be helpful.

Pain due to spasticity or stiffness may be improved by stretching exercises, or by using a proper assistive device. If the pain cannot be managed in these ways, medications such as baclofen, tizanidine, diazepam, and Botulinum Toxin A might be beneficial.

A less commonly felt pain, but which sometimes occurs with MS is trigeminal neuralgia. It is usually felt as severe pain lasting several seconds at a time, located on one side of the face. Trigeminal neuralgia is managed by anti-convulsant medications, nerve block, radiation, or surgical intervention.

Other pain associated with MS is Lhermitte's sign. Lhermitte's sign is experienced as sudden electric-like shocks extending down the spine and into the arms and/or legs when flexing the head. This type of pain typically responds well to medications like carbamazepine and gabapentin.

Dysesthesia can also accompany a diagnosis of MS. Dysesthesia is an impairment in sensation (felt as a burning, aching, or tingling in the limbs) that can occur when the sensory pathways - either central or peripheral - are damaged. In the case of a person with MS, the damage is caused by demyelination (damage to myelin). Tricyclic antidepressants, carbamazepine, diphenylhydantoin, gabapentin, and capsaicin have all been shown to decrease dysesthesia.

Headache has also been associated with MS in a greater proportion than in the general population. The treatment is based on the symptoms and kind of headache being experienced. The most common headache types are migraine and tension.

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Sexual Difficulties

Seventy percent of people with MS experience sexual disturbances (Benbow, 2002). People with MS may experience decreased sexual desire, diminished orgasm, fatigue that interferes with sexual activity, difficulties with vaginal lubrication, problems with obtaining and maintaining erection, or decreased interest on your partners end. These difficulties may be a direct cause of the MS or from the side effects of medication used to treat other symptoms of the MS.

There are different alternatives depending on the difficulties you may be experiencing. Increasing the amount of sexual stimuli via fantasy, books or videos may aid in increasing desire. Looking into different positions or activities, and scheduling sexual activities during the day when your energy levels are higher may help if you are fatigued. Using a lubricant can help with vaginal dryness.

Discussing your difficulties with your doctor or sex therapist can help you find other solutions to problems you may be experiencing. Life changing circumstances, including MS, are not reasons to abandon a sex life. Instead, it is an opportunity to adjust and redefine your own personal definition of healthy sexuality.

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Spasticity

Spasticity is defined as an increase in muscle tone often caused by damage to central motor pathways that control voluntary movements. In MS this damage is due to demyelination. Spasticity may manifest as poor coordination, muscle weakness, fatigue, loss of agility, muscle spasms, a feeling of stiffness, hypertonicity, exaggerated deep tendon reflexes, evidence of primitive reflexes and clonus.

Ways to treat spasticity include: stretching; relaxation; mechanical aids; drugs such as baclofen, tizanidine, benzodiazepines, dantrolene; gabapentin, carbamazepine, phenytoin; surgery; and/or Botulinum Toxin A.

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Fatigue

The underlying cause of fatigue in MS is not entirely understood, although it has something to do with the nervous system being damaged. Everyone knows what it is like to be tired. But the weariness that accompanies MS seems to be an exaggerated response to otherwise normal circumstances. Physical, psychological, and social problems are other consequences brought about by fatigue. For example, the fatigue can be so severe that people are unable to continue working, suffer from anxiety and depression, and/or feel incapable of socializing or having a sex life.

Fatigue may be brought on by such things as exercise, smoking, warm temperatures, or eating a large meal. Many people experience the exertion as a heaviness or impairments in the sensory system such as numbness or visual disturbances. Sometimes fatigue can bring on symptoms experienced during past relapses. These symptoms do tend to disappear again once the person has gotten some rest.

Treating fatigue involves accepting that it is part of having MS. Scheduling activities during times of the day you have the most energy, and allowing yourself time to rest when you feel tired are a couple of ways to manage the fatigue. An occupational therapist can assist in this planning. It is also thought to be of benefit to exercise and eat well. Amantadine is an anti-viral drug that seems to ease fatigue in many people with MS.

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Visual disturbances

It is not uncommon for someone with MS to experience problems with his/her vision. Loss of sight, double vision, or a disruption in part of the visual field can occur. Loss of vision due to MS is often caused by an inflammation of the optic nerve and is known as optic neuritis. Usually, vision is impaired in the centre of the field of vision in one eye or the other, may last a number of days or even weeks, and may be accompanied by an aching pain.

Treatment may include the use of anti inflammatory drugs to decrease the swelling in the optic nerve.

Some people with MS experience double vision. Images may be side by side or one on top of the other. Like loss of sight, the double images often last a number of days or weeks. The use of corticosteroids have shown to be effective in treating this symptom.

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Bladder and bowel disturbances

Bladder problems can include frequent urination (as often as every 15 minutes), leaking small amounts of fluid, a feeling of urgency, a difficulty starting to urinate, incontinence, or urinary infection. If there are problems with bladder function, the goals of therapy are to preserve normal kidney function, prevent urinary tract complications, and relieve symptoms. The most common treatments include using catheterization and the drug baclofen.

The two most common bowel problems associated with MS are constipation and diarrhea. In general, diarrhea is less of a problem than constipation. To help counteract constipation follow these useful guidelines:

  • Drink an adequate amount of fluid. A person should drink eight to twelve cups of liquid every day whether s/he feels thirsty or not. If there is an underlying bladder problem, have that cared for first.
  • Add fibre (found in raw fruit and vegetables and whole-grain cereals) to your diet to help keep the stool moving.
  • Schedule a time of day to move your bowels. The best time is approximately a half an hour after eating, when the emptying reflex is strongest. This routine is especially important since people with MS may have decreased sensation in the rectal area that can diminish the urge to eliminate.
  • Work out on a regular basis. Regular physical exercise can help promote good bowel health. Do not over exert yourself, but do try to stay active.

If the constipation continues to be problematic, you may need to use a stool softener, bulk supplement, laxative, suppository, enema, or manual stimulation.

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Depression

Mild to moderate depression affects almost half of all people with MS at one time or another during the course of the illness. It is difficult to tell what percentage of depression is caused by the MS itself, and how much is a reaction to the physical changes brought about by MS. No matter the cause, feeling sad is a normal reaction to being newly diagnosed, dealing with physical changes, and other losses.

More severe depression, which also occurs in people without MS, requires attention and treatment. Treatment for any stage of depression may be in the form of support groups, family help, psychotherapy, and/or medication.

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Memory changes

Because the CNS (Central Nervous System) is affected, some people find that memory, word finding difficulties, attention, short-term memory, judgment, reasoning, and/or concentration are compromised. The degree of cognitive impairment reflects the extent of the disease in the brain. Fatigue, depression, and stress may make these symptoms worse (whether you have MS or not). Allowing yourself more time for tasks, writing lists, using a calendar, jotting things down immediately after hearing them, and modifying expectations can help. At present, there is no medication that can improve these symptoms.

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Weakness

Most commonly, the muscles of the legs can feel weak, which in turn affects walking. However, weakness is not restricted to the legs. There are a number of possible causes for weakness: disuse of the muscles, fatigue, or neurological damage. If the weakness is due to lack of use, exercise will help. If the weakness is due to fatigue, rest will help. If the weakness is due to CNS damage, exercise and rest will not help. There is currently no treatment available for this kind of weakness.

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Numbness and Tingling

Numbness and tingling occur when the nerves that transmit feeling do not conduct the information adequately. Although the numbness and tingling can be annoying, the best way to deal with the symptoms is to ignore them, if possible. Medication is generally not used to treat numbness and tingling directly. However, when medications such as steroids are used to treat a relapse these symptoms may improve.

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Shaking and Loss of Coordination

Symptoms of decreased coordination may include loss of balance, tremor, shaking, unstable walking, dizziness, vertigo, clumsiness of a limb, and lack of coordination of arms, legs, and speech. Sometimes walking balance is affected. People with MS may find it impossible to ride a bicycle or go up and down stairs safely. Fine motor activities such as handwriting, manipulating buttons, or putting a key in a lock may be difficult.

A number of medications help to control these symptoms. Beta blockers, tranquilizers, and corticosteroids are some of the more common drug therapies. Physical therapists can teach exercises that may decrease the impact of the coordination loss. Bracing a joint has also been proven useful.

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