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Due to the fact that almost everybody with MS has a steady progression of their condition even if they don’t have obvious attacks, the term benign MS appears to be a misnomer. A very few patients may turn out to have had a clinical attack and then did not move to progression, but most get worse steadily with time. A realistic assessment should be made so that the patient, relatives and doctors all understand what is likely to happen and what treatments are appropriate. Tiredness is a common finding amongst MS sufferers, either physical or mental, and is separate from tiredness secondary to poor sleep or excessive exertion in the attempt to be independent.

Heat can be an aggravating factor and many patients report they are worse in hot weather, especially if they have to perform physical exertion or even after having a hot shower. The presentation of MS can vary widely with some patients suffering a majority of mental changes, whilst others suffer incoordination, one sided weakness, lower body weakness, depression or symptoms with vision. Symptoms can be worse if the patient has another illness at the same time such as bacterial infections, while trauma and emotional stresses are not thought to have a high level of effect.

Optic neuritis is a common onset symptom with disturbance of vision as well as eye pain in some cases. Numbness and tingling are common complaints in the limbs with varying degrees of weakness and there can be arm or leg pain syndromes associated with MS. Mental effects can also be profound with emotional lability or actions thought to be inappropriate by people around them, dementia and depression. Urinary incontinence is very common as is retention (being unable to pass water) and there is usually interference in sexual function.

The lesions which are responsible for the neurological changes in this condition can now be imaged in MRI or magnetic resonance imaging scanning of the nervous system. The ventricles within the brain, reservoirs of the cerebrospinal fluid, are the areas where the lesions are closest to, with the lesions occurring inside the white matter of the brain. The white matter consists of the insulated nerve sheaths of thousands or millions of nerve tubes on their way to parts of the nervous system they are serving.

The complexity and difficulty of treating multiple sclerosis is related to the widely varied and many sided requirements of the patients. They may need providing with orthotics, drug treatment, information giving, mental counselling, access to rehabilitation facilities and assistance with placement. Longer term steroid use plus being past the menopause means that bone density could be relevant and should be investigated. High degrees of dependency develop in some patients and with a lack of support from a family this can challenge the ability to look after them in the long term.

Fatigue can be a very strong symptom in MS and can be treated with medication. Overall the aim is to prevent the progression of the disease especially if it diagnosed early on in its progress when drug treatment can be most effective. If patients become more disabled they are less responsive to current medical treatments and suffer a significant impact upon their quality of life. This leads to an increased incidence of suicide, around 7.5 times higher than the general population and not explained simply by reactive depression. The immune moderating drugs related to interferon are used to prevent relapses and slow disease progression.

A large number of drugs are employed to limit the number of attacks but it is not clear if this has any effect on the longer term nervous system degeneration or disability levels. Once an attack of MS has begun no especially effective treatment is available although steroid use may lessen the time to recovery whilst having no effect of the amount of recovery. Surgery is not a common option and limited to a few choices such as releasing contractures of the hip adductors and for the treatment of severe pain of a neuropathic nature.

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About the Author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about <a rel=”nofollow” target=”_blank” href=”http://www.thephysiotherapysite.co.uk”>Physiotherapist</a>, back pain, orthopaedic conditions, neck pain, injury management and <a rel=”nofollow” target=”_blank” href=”http://www.thephysiotherapysite.co.uk/physiotherapy/physiotherapists/uk/avon/bristol”>Bristol Physiotherapists</a>. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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