Multiple sclerosis can cause various symptoms: changes in sensation (hypoesthesia), muscle weakness, abnormal muscle spasms, or difficulty moving; difficulties with coordination and balance; problems of speech (dysarthria) or swallowing (dysarthria), vision problems (nystagmus, optic neuritis, phosphena or diplopia), fatigue and acute or chronic pain syndrome, bladder and intestinal difficulties, cognitive impairment, or emotional symptoms (especially major depression). The main clinical measures in the development of disability and symptom severity are the Extended Disparity Status Scale or EDSS.
Initial attacks are often temporary, mild (or asymptomatic), and limited to oneself. They often do not request health care visits and are sometimes only identified in retrospect after the diagnosis is done after further attacks. The most commonly reported early symptoms are: sensation changes in arms, legs or face (33%), complete or partial vision loss (optic neuritis) (20%), weakness (13%), double vision (7%), faltering walking (5%), and balance issues (3%); but many early symptoms are rarely reported such as aphasia or psychosis. Fifteen percent of individuals have some symptoms when they first seek medical attention.
Video Multiple sclerosis signs and symptoms
Bladder and bowel
Bladder problems (See also urine and urination system) appear in 70-80% of people with multiple sclerosis (MS) and they have important effects on both hygiene and social activity habits. Bladder problems are usually associated with high levels of defects and pyramidal marks in the lower limbs.
The most common problems are increased frequency and urgency (incontinence) but difficulty in starting urination, hesitation, leakage, incomplete urge sensation, and retention also occur. When retention occurs secondary urinary tract infections are common.
There are many cortical and subcortical structures involved in urination and MS lesions in various central nervous system structures can cause such symptoms.
The goal of treatment is to alleviate the symptoms of urinary dysfunction, treatment of urinary tract infections, reduction of complicating factors and preservation of kidney function. Treatment can be classified into two main subtypes: pharmacological and non-pharmacological. Pharmacological treatments vary greatly depending on the origin or type of dysfunction and some examples of drugs used are: alfuzosin for retention, trospium and flavoxate for urgency and incontinence, and desmopresin for nocturia. Non-pharmacological treatments involve the use of pelvic floor muscle training, stimulation, biofeedback, pessarium, bladder retraining, and occasionally intermittent catheterization.
Intestinal problems affect about 70% of patients, with about 50% of patients suffering from constipation and up to 30% of fecal incontinence. The cause of intestinal disorders in MS patients is usually a decrease in bowel motility or disturbance in the control of the neurological defecation. The former is generally associated with immobility or secondary effects of drugs used in the treatment of disease. Pain or bowel problems may be aided by dietary changes that include changes in increased fluid intake, oral laxatives or suppositories and enemas when the habit changes and oral action is insufficient to control the problem.
Maps Multiple sclerosis signs and symptoms
Cognitive
Some of the most common deficits affect memory, attention, processing speed, visual-spatial abilities, and recent executive functions. Symptoms associated with cognition include emotional instability and fatigue including neurological fatigue. Generally a form of cognitive disorder is experienced, in which certain cognitive processes may remain unaffected, but the cognitive process as a whole is impaired. Cognitive deficits are not dependent on physical defects and may occur in the absence of neurological dysfunction. Severe damage is a major predictor of low quality of life, unemployment, caregiver, and difficulty in driving; limitations in social activities and work of the patient are also correlated with the extent of the damage.
Cognitive impairment occurs in about 40 to 60 percent of patients with multiple sclerosis, with the lowest percentage usually from community-based studies and the highest of hospitals. Disorders may present at the onset of the disease. The likelihood of multiple sclerosis sufferers, meaning after the first attack but before secondary confirmation, has up to 50 percent of patients with an onset disorder. Dementia is rare and occurs in only 5 percent of patients.
The size of tissue atrophy correlates well with, and predicts, cognitive dysfunction. Neuropsychological results are highly correlated with linear size of subcortical atrophy. Cognitive impairment is the result of not only tissue damage, but tissue repair and adaptive functional reorganization. Neuropsychological tests are important to determine the level of cognitive deficits. Neuropsychological rehabilitation may help reverse or decrease cognitive deficits even though research on this issue is of low quality. Acetylcholinesterase inhibitors are commonly used to treat dementia-related Alzheimer's disease and are thought to have potential in treating cognitive deficits in multiple sclerosis. They have been found to be effective in early clinical trials.
Emotional
Emotional symptoms are also common and are considered normal responses to debilitating diseases and damage to certain areas of the central nervous system that produce and control emotions.
Clinical depression is the most common neuropsychiatric condition: a prevalence of 40-50% lifetime depression and a 12-month prevalence rate of about 20% has been reported specifically for a sample of people with MS; these figures are much higher than for the general population or for people with other chronic diseases. Brain imaging studies attempting to associate depression with lesions in certain areas of the brain have met with variable success. On balance the evidence appears to favor association with neuropathology in the left anterior temporal/parietal region.
Other feelings such as anger, anxiety, frustration, and despair also often arise and suicide is a very real threat because it results in 15% of deaths in MS sufferers.
Sparse psychosis can also be displayed.
Fatigue
Fatigue is very common and disabling in MS with a close relationship with the symptomatology of depression. When depression diminishes fatigue also tends to decrease and it is recommended that patients should be evaluated for depression before other therapeutic approaches are used. In the same way, other factors such as disturbed sleep, chronic pain, poor nutrition, or even some medications can cause fatigue and medical professionals are encouraged to identify and modify it. There are also different medications used to treat fatigue; such as amantadine, or pemoline; as well as psychological interventions of energy conservation; but the effect is small and for this reason, fatigue is a difficult phenomenon to manage. Fatigue is also associated with certain brain areas in MS using magnetic resonance imaging.
Internuclear ophthalmoplegia
Internuclear ophthalmoplegia is a disorder of the lateral gaze of conjugation. The affected eye shows a decrease in adduction. The couple's eyes deviate from the affected eye during the abduction, resulting in diplopia; during extreme abduction, nystagmus compensator can be seen in the couple's eyes. Diplopia means double vision while nystagmus is an unconscious eye movement characterized by subtle pursuits alternating in one direction and saccadic movements in the other direction.
Internuclear ophthalmoplegia occurs when the MS affects the part of the brainstem called the medial longitudinal fasciculus, which is responsible for communication between two eyes by connecting a single-sided induced nucleus to an oculomotor nucleus of the opposite side. This causes the failure of the medial rectus muscles to contract appropriately, so the eye does not move equally (called disconjugate stare).
Different drugs and optical compensation systems and prisms can be used to improve these symptoms. Surgery can also be used in some cases for this problem.
Mobility restrictions
Limitations in mobility (walking, transfer, bed mobility, etc.) are common in individuals with multiple sclerosis. In the 10 years after onset of MS a third of patients achieved a score of 6 on the Extended Disability Status Scale (EDSS), requiring the use of unilateral help, and with a 30-year proportion increasing to 83%. In five years of onset, EDSS is six in 50% of those with progressive forms of MS.
Various disorders may be present in MS patients who can act alone or in combination to have a direct impact on the balance, function and mobility of a person. Such damage includes fatigue, weakness, hypertonia, low exercise tolerance, impaired balance, ataxia and tremors.
Interventions can be directed at an individual disorder that reduces mobility or at the disability level. These second-level interventions include the provision, education and instruction in the use of equipment such as walkers, wheelchairs, motorized scooters and car adaptations as well as instructions on compensating strategies for completing an activity - for example by transferring securely by rotating in a bent posture rather than standing and stepping around.
Optical neuritis
Up to 50% of patients with MS will develop episodes of optic neuritis and 20% of the time of optic neuritis is a sign of MS presentation. The presence of demyelinating white matter lesions in brain MRI at presentation for optic neuritis is the strongest predictor in developing a clinical diagnosis of MS. Almost half of patients with optical neuritis have white matter lesions consistent with multiple sclerosis.
In the five years of follow-up, the overall risk of developing MS was 30%, with or without MRI lesions. Patients with a normal MRI still developed MS (16%), but to a lesser extent than patients with three or more MRI lesions (51%). From another perspective, however, 44% of patients with demyelinating lesions on MRI at presentation will not develop MS ten years later.
Individuals experience rapid onset of pain in one eye followed by blurred vision in some or all of their visual fields. Flashes of light (phosphen) may also exist. Inflammation of the optic nerve causes the most visible loss of vision by swelling and destruction of the myelin sheath that covers the optic nerve.
Blurred vision usually disappears within 10 weeks but the individual is often left with a less obvious color vision, especially red, on the affected eye.
Systemic intravenous treatment with corticosteroids can speed up the cure of the optic nerve, prevent vision loss and delay the onset of other symptoms.
Pain
Pain is a common symptom in MS. A recent study has systematically collected results from 28 studies (7101 patients) estimating that pain affects 63% of people with MS. These 28 studies illustrate the pain in a variety of different people with MS. The authors found no evidence that pain is more common in people with progressive MS types, in women than in men, in people with different disability levels, or in people who have had MS for different time periods.
Pain can be severe and debilitating, and can have a profound effect on the quality of life and mental health of the sufferer. Some types of pain are thought to occur occasionally after lesions into the ascending or descending channels that control painful stimulus transmission, such as the anterolateral system, but many other causes are also possible. The most common types of pain are headache (43%), lacerated limb pain (26%), back pain (20%), painful seizures (15%), Lhermitte pain phenomenon (16%) and Trigeminal Neuralgia (3%). These authors did not find enough data to measure the prevalence of painful optic neuritis.
Acute pain is mainly due to optic neuritis, trigeminal neuralgia, signs of Lhermitte or dysesthesias. Subacute pain is usually secondary to disease and can be a consequence of spending too much time in the same position, urinary retention, or infected skin ulcers. Chronic pain is common and more difficult to treat.
Trigeminal neuralgia
Trigeminal neuralgia (or "tic douloureux") is a trigeminal nerve disorder that causes severe episodes of pain in the eyes, lips, nose, scalp, forehead, and jaw, affecting 2-4% of MS patients. Episodes of pain occur paroxysmally (suddenly) and the patient describes it as a trigger area on the face, so sensitive that touching or even air currents can carry episodes of pain. Usually successfully treated with anticonvulsants such as carbamazepine, or phenytoin although others such as gabapentin may be used. When drugs are ineffective, surgery may be recommended. Glycerol rhizotomy (glycerol to nerve injection) has been studied despite the beneficial effects and risks in MS patients from procedures that reduce the pressure on the nerves is still under discussion.
Lhermitte Sign
The Lhermitte sign is an electrical sensation that flows back and to the leg and is produced by bending the neck forward. This sign shows lesions in the dorsal columns of the cervical medulla or caudal medulla, which are significantly associated with cervical MRI abnormalities. Between 25 and 40% of MS patients report having Lhermitte sign during the course of their illness. It is not always experienced as painful, but about 16% of people with MS will experience a painful Lhermitte sign.
Dysesthesias
Dysesthesias is an unpleasant sensation produced by ordinary stimuli. Abnormal sensations are caused by lesions in peripheral or central sensory pathways, and are described as painful feelings such as burning, wetness, itching, electric shock or needles and needles. Both Lhermitte signs and diseased dis- sessions usually respond well to treatment with carbamazepine, clonazepam or amitriptyline. Related symptoms are pleasant, yet uneasy sensations that have no normal explanation (such as the thrill of warmth arising from the touch of a garment)
Sexual
Sexual dysfunction (SD) is one of many symptoms that affect people with MS diagnosis. SD in men includes both erectile and ejaculatory disorders. Prevalence of SD in men with MS ranged from 75 to 91%. Erectile dysfunction appears to be the most common form of SD documented in MS. SD may be due to ejaculatory reflex changes that may be affected by neurological conditions such as MS. Sexual dysfunction is also prevalent in MS women, usually less orgasmic, possibly associated with irregular genital disorders.
Spasticity
Spasticity is characterized by increased stiffness and slowness in limb movements, development of certain postures, association with weakness of voluntary muscle strength, and with accidental and sometimes painful leg cramps. Painful seizures affect about 15% of people with MS as a whole. A physiotherapist can help reduce flexibility and avoid development of contractures by techniques such as passive stretching. There is evidence, though limited, clinical effectiveness of THC and CBD extracts, baclofen, dantrolene, diazepam, and tizanidine. In the most complex cases an intrathecal injection of baclofen can be used. There are also palliative measures such as castings, splints or adjustable seating.
Speech
Speech issues include slurred speech, low tone of voice (dysphonia), decreased speech speed, and problems with voice articulation (dysarthria). A related problem, because it involves the same anatomical structure, is difficulty swallowing (dysphagia).
Transverse Myelitis
Some MS patients develop rapid onset of numbness, weakness, bowel or bladder dysfunction, and/or loss of muscle function, usually in the lower body. This is the result of MS attacking the spinal cord. Symptoms and signs depend on the nerves involved and level of involvement.
The prognosis for complete recovery is generally poor. Recovery from the transverse mielitis usually begins between week 2 and 12 after onset and may continue for up to 2 years in some patients and as many as 80% of individuals with transverse myelitis are left with long-lasting defects.
Tremor and ataxia
Tremor is an unintentional, rather rhythmic, muscle movement involving oscillations of one or more parts of the body. This is the most common of all unconscious movements and can affect the hands, arms, head, face, vocal cords, body, and legs. Ataxia is an unstable and awkward movement of limbs or torso due to a severe failure of the coordination of muscle movement. People with ataxia develop muscle failure in their arms and legs, resulting in a lack of balance and coordination or gait disturbances.
Tremor and ataxia often occur in MS and present in 25 to 60% of patients. They can be very crippling and embarrassing, and difficult to manage. The origins of tremors in MS are difficult to identify but can be caused by a mixture of factors such as damage to the cerebellum connections, weakness, flexibility, etc.
Many drugs have been proposed to treat tremors; But their efficacy is very limited. Drugs that have been reported to provide some relief are isoniazid, carbamazepine, propranolol and gluthetimide but evidence of published effectiveness is limited. Physical therapy is not indicated as a treatment for tremor or ataxia although the use of orthese devices may be helpful. An example is the use of wrist bandages with weights, which can be useful for increasing movement inaction and therefore reducing tremors. Daily use items are also customized for easier use and use.
If all of these actions fail, the patient is a candidate for thalamus surgery. Such surgery may be thalamotomy or thalamic stimulant implantation. Complications are common (30% in thalamotomy and 10% in deep brain stimulation) and include worsening ataxia, dysarthria and hemiparesis. Thalamotomy is a more effective surgical treatment for untreated MS tremors although a higher incidence of persistent neurologic deficits in patients receiving lesional surgery supports the use of deep brain stimulation as a preferred surgical strategy.
References
Source of the article : Wikipedia
0 Comments