Illuminating the ‘Other’ Symptoms of Multiple Sclerosis

by Dr. Tarun Singhal, Board Certified Neurologist and Medical Director of the Multiple Sclerosis Center at Sturdy Memorial Hospital

Multiple Sclerosis (MS) is a disease of the central nervous system that damages areas of the brain and spinal cord. Caused by abnormal activation of the immune system that targets 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.

Relapsing remitting multiple sclerosis (RRMS) is the most common form of multiple sclerosis. In RRMS, there are discrete “attacks” of MS symptoms lasting from one to several days. These symptoms include decreased vision in one or both eyes, double vision, numbness, weakness of one more limbs, imbalance, bladder or bowel dysfunction, spasticity, and so on. Primary progressive multiple sclerosis (PPMS) and secondary progressive multiple sclerosis (SPMS) are subtypes of MS and share these symptoms, but without distinct flare-ups and periods of recovery.

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, however, which are 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 (insomnia) because of spasticity, especially in the legs, or an increased need to go to the bathroom at night because of bladder problems (nocturia). MS-related nerve spasms and trouble swallowing (dysphagia), which involves the muscles of the throat, could cause sleep apnea, characterized by frequent pauses in breathing and then gasping during sleep. When sleep disturbances affect daily activities and quality of life, patients should consult with their physician 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 (UTIs), 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 appropriately manage and treat the issue(s), whether via medications, surgery, or pelvic floor muscle rehabilitation (physical therapy).

Pain and decreased muscle tone and bone density: Impaired mobility—a primary MS symptom—can cause inactivity and compensatory gaits (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, and preventing them is achieved with close observation and mobility devices.

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; even isolation, withdrawal, and depression. Patients should speak with their physician about effective treatment options ranging from support groups and psychotherapy to antidepressant medications.

Managing primary MS symptoms while also paying attention to secondary and tertiary symptoms is important for quality of life.

 Dr. Tarun Singhal, a Board Certified Neurologist, is the Medical Director of the Multiple Sclerosis (MS) Center at Sturdy Memorial Hospital. Sturdy’s MS Center celebrates 20 years (1995-2015) of providing specialized and coordinated care and services to people with MS. For more information or to make an appointment, call the MS Center at 508-236-7170 or 508-236-7098.

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