DRUGS & CONDITIONS

WHAT IS MULTIPLE SCLEROSIS?


Nerves are the "electrical wiring" of the human body. Just as the wiring in our homes carries electrical current to run our appliances, nerve fibers called axons carry electrochemical impulses that allow us to move and function in other ways. When an electrical wire is stripped of its protective insulation, the electricity it carries "spills out." The current is weakened or lost, affecting the performance of the appliances we are trying to use. Multiple sclerosis (MS) affects the body in a similar way.

MS damages the myelin sheath that surrounds and insulates the nerves of the brain and spinal cord. Myelin is a protective fatty coating that allows smooth, high-speed transmission of electrical impulses along the nerve fibers. MS also damages the nerve fibers (axons).

MS causes myelin to become inflamed and swollen. Eventually the myelin may completely detach from the nerve fibers. This demyelination (destruction of the myelin) stimulates cells in the area to multiply, resulting in random patches of hardened scar tissue. The words "multiple sclerosis" mean "many scars." The "many scars" of MS hinder or prevent the transmission of electrical instructions to certain parts of the body, impairing vision, speech, mobility and/or coordination. Recent research suggests that the nerve fiber damage that occurs along with demyelination may be responsible for permanent neurological deficits. It is thought that axon loss may progress as MS lesions age, resulting in irreversible damage. It is now believed that damage to neurons begins before the patient even experiences the symptoms of MS. For this reason, it is important to seek treatment early.

MS is an autoimmune disease. This means that the body's immune system attacks its own tissues. In MS, the immune system identifies myelin as a foreign invader. It dispatches white blood cells that target the body's own myelin for destruction. The reasons for this are not entirely understood.

MS is a chronic (long-term) disease of the central nervous system (the brain and spinal cord). It is not a fatal disease, but the "many scars" it produces along the nerve pathways can cause temporary or permanent damage. The severity of a person's symptoms depends upon the locations of the scar tissue or "plaques," the number of plaques, and the extent of the demyelination in those areas. For example, if plaques are located in the cerebellum region of the brain, which controls movement of the arms and legs, the patient will probably have symptoms that affect the limbs. If plaques are located on the cranial nerves of the brain, the functions controlled by those nerves-- swallowing, vision, speech or hearing-- will probably be affected. Because of these variables, the type and severity of MS symptoms can vary widely from patient to patient.

Although the symptoms of MS had been observed since about 1835, it was not recognized as a disease until about 30 years later. In 1868 the French neurologist, Jean-Martin Charcot, was the first to provide a complete description of the disease he called sclerose en plaques ("hardening in patches"). Today, neurologists define four categories of MS.

MS is grouped into several categories and treatment is determined by the individual's MS type and specific set of symptoms.

Relapsing-Remitting (RR) is the most common type of MS, accounting for about 85% of initial cases. RR MS has clearly defined periods of disease worsening (relapses). These periods are followed by full or partial recovery although some patients may continue to have slight problems. There is no progression of the disease in the periods between the relapses.

Primary-Progressive (PP) accounts for about 10% of MS cases. Patients with this form of MS experience gradual, continuous progression from the onset of the disease. Patients may experience plateaus in symptoms and temporary minor improvements.

Secondary-Progressive (SP) begins as relapsing-remitting disease. Over time, the disease starts to progress with or without occasional relapses and minor remissions. Approximately 50% of patients diagnosed with relapsing-remitting MS develop SP within 10 years; 90% of those with relapsing-remitting MS develop SP within 25 years.

Progressive-Relapsing (PR) accounts for about five percent of MS cases. Patients with this type of MS experience a pattern of continual worsening from the beginning of the disease. Later, they also begin to experience relapses (episodes of intense worsening). Patients may or may not have a full recovery after the relapse ends.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

WHO GETS MS?


Worldwide, it is estimated that 1 million people have multiple sclerosis (MS). Generally speaking, it is least common in countries near the equator. MS is five times more likely to occur among people who live in temperate climates than among those who live in tropical regions. Currently in the U.S. about 350,000 people have MS.

Studies have shown that the risk of developing MS is related to where a person lives before the age of 15. If a person younger than 15 moves from a high-risk region to a low risk region, or vice versa, he or she assumes the risk of the new location. If the move occurs after the age of 15, he or she retains the risk of the original location. Researchers are not sure why this is true. It is believed that some environmental agent acting prior to puberty may affect susceptibility to MS.

MS is not an inherited disease. Most people with MS do not have a close family member with the disease. Genetic factors, however, do play a role in predisposing certain people to MS. While people in the general population have about a 1 in 1,000 chance of getting MS, children and siblings of patients with MS are at greater risk-- between 1 in 100 and 1 in 50. Being related to someone with MS is not considered a major risk factor, however. Studies with identical twins show that the twin of an MS patient has a 1 in 3 chance of getting the disease. Fraternal twins have the same risk as any other siblings. These findings show that genetics is involved, but that it is obviously not the only factor. MS researchers think that people with MS have probably inherited a particular combination of genes. They suspect that people with this genetic predisposition get MS in response to some environmental trigger, such as a virus.

Racial ancestry is significant. Most patients are Caucasians descended from northern European ancestors, particularly the Scandinavians. Whites are twice as likely to have MS as blacks, but American blacks are more likely to have it than African or Caribbean blacks. Asians have a very low occurrence of MS, and Eskimos are apparently immune to the disease.

Other significant factors include gender and age. Among those who are younger at onset, women outnumber men two to one. Among those who develop the disease later, however, the ratio of men to women is closer. Patients with primary progressive MS show an equal sex ratio. Most cases of MS develop between the ages of 15 and 50 (90%). The average age of onset is around 28 to 30. Multiple sclerosis rarely strikes children under the age of 10 or adults over the age of 60.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

UNDERSTANDING THE CAUSES


The definite cause of multiple sclerosis (MS) is not known. The general theory is that MS results from an abnormal autoimmune reaction in genetically susceptible people. The immune system evidently attacks its own myelin in response to an infection or some other environmental trigger. (Myelin is the fatty substance that insulates nerve fibers in the brain, spinal cord and optic nerves.) MS destroys or damages myelin, interrupting the electrical impulses carried by the nerves. It also damages the nerves themselves.

Much of the research done so far implicates a virus, or viruses, in some way. A recent study found that patients with MS are more likely than other people to have active infections of Human Herpesvirus Six (HHV-6). Other viral suspects include: herpes viruses 1 and 2, the varicella-zoster virus (which causes chicken pox), the Epstein-Barr virus (which causes mononucleosis), the measles virus, any of the retroviruses, including HIV, and several others. Bacteria have also been implicated, particularly Chlamydia pneumoniae. None of these infectious agents has been proven to cause MS.

Viruses are considered the most likely suspects for several reasons. One reason is that abnormal levels of viral antibodies are consistently found in the cerebrospinal fluid of patients with MS. Fifty years of studies have shown that more than 10 types of viral antibodies are present in patients. Today's researchers now know that children living in northern latitudes accumulate more viruses over the years than those living closer to the equator. MS is more prevalent among those living in northern latitudes. This may be because sunlight, which becomes more plentiful moving toward the equator, can destroy or inactivate viruses (a virucide).

Many people have wondered if vaccinations cause MS. Two separate studies suggest that they do not. Evidence strongly suggests that vaccinations for hepatitis B, tetanus and influenza do not increase the risk of getting MS. The studies also suggest that vaccinations don't cause relapses in people who already have MS, although some "live vaccines," like the nasal spray flu vaccine, are not recommended for those with MS.

Although it is not known which infectious agent is involved, researchers believe that an environmental pathogen acts as a "trigger" in a series of events that results in MS. It is thought that the infectious "trigger" activates white blood cells in a way that enables them to penetrate the brain's defenses (the blood/brain barrier). Once inside the brain, these cells stimulate the other parts of the immune system, which respond by attacking the myelin and also damaging the axon fibers.

It is not clear exactly how an infectious agent becomes a trigger for this sequence, but extensive research continues. Experts think that perhaps one of the following could be responsible for MS:

It is likely that genetic factors work in combination with infectious agents to cause MS. Researchers think that people with MS have probably inherited a particular combination of genes. They suspect that people with this genetic predisposition get MS in response to some environmental trigger, such as a virus.

New research suggests that the various forms of MS may actually be different diseases with different causes. A study of brain tissue from patients with MS revealed four distinct patterns of lesions. Researchers found that while lesions differed between patients, each patient's own lesions fit only one pattern. MS experts think that each lesion pattern may result from a different cause. More studies are needed to determine if the different lesion patterns call for different treatments.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

WHAT ARE THE SYMPTOMS?


Topics:

The symptoms of multiple sclerosis (MS) vary greatly from person to person. Symptoms can be mild or severe. They may appear briefly and then subside, or they may last for a long time. People also experience different combinations of symptoms. Most MS symptoms are caused by inflammation leading to demyelination and the damage done to nerve fibers (axons).

Demyelination is the loss of myelin, the fatty covering that insulates the nerves in the brain and spinal cord. Wherever myelin is damaged, the message carried by the affected nerve becomes garbled or lost, altering the performance of some part of the body. Inflammation may also be associated with damage to the underlying nerve fibers (axons). It is thought that axon loss progresses as MS lesions age, resulting in irreversible damage. It is now believed that damage to nerve fibers begins before the patient even experiences the symptoms of MS.

The type of symptoms one experiences depends on where the demyelination occurs. Most people experience more than one symptom, but no one exhibits all of the possible symptoms. An individual's own symptoms can also vary from time to time. Many patients experience complete or partial remission of symptoms, especially in the early stages of MS. Remissions occur when myelin is able to repair itself.

Here are some of the most common symptoms of multiple sclerosis.

Vision Problems

Many people with MS report that their first symptom was a vision problem. In MS, the optic nerve, which connects the eye with the brain, can become inflamed and demyelinated. This condition, known as optic neuritis, results in dimmed, grayed or blurred vision, or even loss of vision in one eye. Sensitivity to light, "holes" in the visual field and distortion of color vision can occur. Other vision problems may be caused by nystagmus, or uncontrolled horizontal or vertical eye movements. All of these problems are usually temporary and normal vision returns within a few weeks. Visual problems are less common in later stages of MS.

Altered Sensations

MS typically causes people to experience paresthesias. Paresthesias are abnormal sensations that result from the loss of myelin. Altered sensations may include numbness in an arm or leg, tingling, itching, burning, "pins and needles" or an increase in sensitivity (hyperesthesia). Paresthesias occur spontaneously, and often involve only a patch of skin in a specific area, such as a hand, arm or leg. One kind of altered sensation is known as Lhermitte's sign. Lhermitte's sign is an electrical shock-like sensation that occurs when the neck is flexed forward. The sensation travels down the spine and into the arms or legs. Lhermitte's sign is suggestive of MS, but a majority of patients don't experience this symptom. While it signifies that spinal cord damage has taken place in the neck region, it is not a conclusive indication of MS. Lhermitte's sign is a disturbing sensation, but it is not serious. While paresthesias are bothersome, they are considered more benign symptoms than major problems. Little can be done to alleviate numbness, but if a patient is especially annoyed by other paresthesias, medications can sometimes be prescribed to lessen the symptoms.

Fatigue

Fatigue is the most common symptom of MS. For many, it is the major disabling symptom. The fatigue experienced by patients with MS is unique and more severe than fatigue experienced by other people. The fatigue of MS is both physical and mental, and can be overwhelming in both regards. Fatigue can make it difficult to concentrate. It slows the thinking process and makes one forgetful. It can even affect motivation. Other chronic symptoms of MS are made worse by fatigue. It can contribute to muscle pain and spasms. Because fatigue is "invisible" to everyone but the patient, it can be difficult for others to understand. MS fatigue generally increases with both physical exertion and exposure to heat and humidity. For many patients, fatigue is worse later in the day.

Weakness

Weakness is different from fatigue. While the exhaustion of fatigue affects the whole person, weakness is more of a true loss of strength and control in the legs and sometimes in the arms. The legs may feel "heavy" and hard to move, especially at the end of a day or when stepping up onto a curb or a stair step. Weakness is often just temporary, but can last for an extended period.

Weakness can contribute to problems with walking. Weak foot and ankle muscles can cause "foot drop," a condition where the toes drop before the heel when walking. Weak hip muscles can cause "hyperextension," requiring the leg to swing out so the foot can clear the ground when walking. Vision problems and several other symptoms, whether alone or in combination, can also make walking more difficult. Because many things can contribute to difficulty in walking, it is important to accurately identify the source of the difficulty. Once the underlying problem or problems are clear, medication, physical therapy, or other measures can be appropriately prescribed.

As with the other MS symptoms, weakness is caused by an interruption in the electrical impulses carried over the nerve pathways. Most patients will, at some point in the course of their disease, experience weakness in their extremities and have some difficulty with balance, walking or coordination as a result.

Bladder Problems

Most patients with MS experience some type of bladder difficulty during the course of their disease. Bladder problems are caused by demyelination in the parts of the central nervous system that control bladder function. The type of problem a person has depends on the exact location of the demyelination. MS-related bladder dysfunction is sometimes called "neurogenic bladder."

Bowel Problems

MS causes demyelination of the areas of the brain and spinal cord that control bowel function. This can result in several types of problems, such as diarrhea, constipation, incontinence, and hemorrhoids.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

WHAT CAN I EXPECT?


Multiple sclerosis (MS) is an unpredictable disease. Symptoms can vary in duration and intensity and appear in different combinations in different people. These variables make it difficult to predict how MS will progress over time for a given person. However, these facts are known:

While it is impossible to determine the exact path an individual's disease will take, it may be possible to predict something general about its long-term direction. There are several variables that affect the long-term progression of MS:

New research links the rapid progression of MS to a gene known as apolipoprotein E-4 (APOE-4). Variations of this gene have previously been linked to Alzheimer's disease and heart disease. Patients who have the APOE-4 gene develop MS earlier and progress faster toward disability. In the future, detecting the presence of this gene may help doctors treat and counsel patients more accurately.

Lifestyle Concerns

Most people with MS are concerned about the way the disease will affect their family life, career and social life. Symptoms play the biggest role--how we are feeling determines what we can do. However, patients with MS must also make lifestyle decisions that will accommodate their disease.

Family

A diagnosis of MS often opens important family discussions. Couples may have to redefine their roles to accommodate MS. Household duties and childcare routines may require a shift in workload or an adjustment in expectations. Couples may also discuss living on one income instead of two, to ease stress for the partner with MS.

Couples who plan to have children will want to seriously consider how they will handle the demands of a family while coping with MS. While MS has no adverse effect on pregnancy and childbearing, it is important to think in terms of the 18-plus years that parenting requires. As long as couples understand and can make the necessary adjustments, MS need not deter them from having children.

Career

It is a good idea to examine one's occupation in light of having MS. If physical limitations or cognitive changes were to occur, could the present occupation accommodate those changes? If the answer is no, it may be necessary to consider different career options. Career counselors can help if job retraining or further education is needed.

Social Life

Maintaining a network of friends is important. Having fun is important too. Both help keep life in perspective. Patients with MS are limited socially only by their energy level and their symptoms. Planning ahead for fun times and staying rested will help preserve a good social life.

Healthy Living

A healthy lifestyle is especially important for people with MS. Fatigue and other symptoms are affected by several factors over which we have some control. Here are seven healthy strategies for anyone with MS:


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

BLADDER DIFFICULTIES


Most patients with MS experience some type of bladder difficulty during the course of their disease. Bladder problems are caused by demyelination in the parts of the central nervous system that control bladder function. The type of bladder problem a person has depends on the exact location of the demyelination. MS-related bladder dysfunction is sometimes called "neurogenic bladder."

A lack of normal bladder function can affect socialization, employment, sexual function and self-esteem. Therefore, it is important to discuss bladder problems with a doctor as soon as they occur.

Normal Bladder Function

The bladder is a muscular bag that expands as it collects urine. At the junction of the bladder and the urethra (the tube that takes urine outside the body), there is an internal sphincter muscle. There is also an external urethral sphincter that stays contracted between times of urination, keeping urine in the bladder. When 200 - 500 milliliters of urine (about 1-2 cups) collects in the bladder, a signal is sent to the brain. The brain returns a signal that permits the bladder to contract and the external sphincter muscle to open and release urine. This process of normal urination is under the voluntary control of an individual.

In MS, plaques on the nerves of the brain and spinal cord interrupt the messages between the bladder and the brain. The bladder and sphincter are no longer able to coordinate their functions properly, creating problems for the patient.

Common Bladder Problems

There are three bladder problems commonly experienced by people with MS.

Failure to Store

Symptoms:

Failure to store syndrome, also known as a "spastic" or "small" bladder, is the most common bladder problem. The bladder involuntarily contracts as if it were full when only a small amount of urine is present, and the person feels a strong need to urinate. The bladder tends to empty automatically, resulting in frequent urination, incontinence or dribbling. Nocturnal incontinence can be a problem as well. People with a reduced capacity for bladder sensation do not experience as strong an urge to urinate.

Treatment focuses on relaxing the bladder so that it will hold a normal amount of urine before contracting to urinate. Anticholinergic drugs are most effective for this. Tolterodine tartrate is frequently prescribed. Oxybutynin or propantheline bromide may also be prescribed. Patients with a spastic bladder should avoid diuretics (substances that create an increase in urine), such as alcohol, caffeine and aspartame. Behavior modification techniques such as timed urination or scheduled urination may be recommended and taught to patients.

Failure to Empty

Symptoms:

Failure to empty syndrome, or a "flaccid" or "big" bladder, occurs when bladder fullness is not correctly perceived. The bladder also may not completely empty because the sphincter muscle is tight and spastic and does not open properly. It contracts when it should relax to release urine. Usually some, but not all, urine is released from the bladder. Retained urine can encourage bacteria growth, which can lead to a urinary tract infection. Urine can also back up in the ureters, causing kidney damage or stones in the bladder or kidneys.

If failure to empty is due to a spastic sphincter, symptoms may respond to treatment with the drug baclofen. The most successful way to manage failure to empty syndrome is with intermittent self-catheterization. At intervals throughout the day the patient inserts a thin catheter through the urinary opening and into the bladder. Urine drains out through the tube, completely emptying the bladder. Self-catheterization is a relatively simple procedure that most people can learn. It is easier for men than for women. Indwelling catheters can be used when self-catheterization is not practical. Catheterization may only be needed for a short period of time, since normal bladder function may return after a period of weeks or months.

The Conflicting Bladder

Symptoms:

The conflicting bladder, or "combined dysfunction," has both storing and emptying problems. The condition is "conflicting" because the bladder muscle works in conflict with the sphincter muscle. This lack of coordination can mean either that the bladder is contracting to empty but the sphincter will not allow urine to pass, or that the sphincter relaxes to release urine when the bladder is not contracted. This condition is also known as "dyssynergic bladder" or "mixed failure to store and failure to empty."

A conflicting bladder is treated in the same way as the two conditions it combines. (See above).

Diagnosing Bladder Problems

An accurate diagnosis of bladder problems must be based upon test results.

The first step is usually to rule out a urinary tract infection. A urine sample will be examined to see if bacteria or white blood cells are present. If bacteria are found, antibiotics are given. If symptoms persist after completion of the antibiotics, other tests will be done.

A post-void residual test is usually done. This test measures whether there is urine left in the bladder after voiding. The patient is asked to drink a quantity of water. After voiding, a bladder scanner (ultrasound machine) is used to measure the amount of urine left in the bladder. The ultrasound can also determine the shape and size of the bladder, kidneys and prostate. Alternatively, a catheter can be inserted into the bladder to drain any remaining urine. If the amount of urine in the bladder measures greater than 100 cc, the patient is retaining urine and may have a flaccid bladder, or more likely, dyssynergic bladder. If the amount is smaller than 100 cc, the patient may have a spastic bladder.

Cystoscopy is a procedure that uses a thin, telescope-like instrument called a cystoscope to perform a visual check inside the bladder.

Urodynamic tests allow the physician to determine whether bladder sensations are normal and whether it fills and empties normally. These tests look for obstructions to urinary flow, examine the bladder wall to determine its stability, and study sphincter muscle activity.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

BOWEL DIFFICULTIES


Many patients with MS experience some type of bowel problem in the course of their disease. Bowel problems can be treated, but the goal should be to prevent them.

Why Do People with MS have Bowel Problems?

MS causes demyelination of the areas of the brain and spinal cord that control bowel function. The information that travels along the nerve fibers is slowed, directly resulting in several possible problems:

Bowel problems can also result from the symptoms of or treatments for MS. Medications used to treat spasticity or bladder spasms can cause constipation. Immobility reduces the speed at which food travels through the system. Depression or antidepressant drugs can contribute to constipation. Patients may restrict their fluid intake in an effort to minimize urinary symptoms. Restricting fluid intake can contribute to bowel problems.

Types of Bowel Problems

How are Bowel Problems Treated?

A neurologist, gastroenterologist or other physician should evaluate each patient to determine the best course of action. Treatments for constipation may include one or more of these: additional daily fluids, stool softeners, oral stimulants, bulk forming agents, mild laxatives or suppositories. Patients should avoid continuous or long-term use of laxatives, suppositories or enemas. Diarrhea is usually treated with additional fluids, bulk forming agents and medication to slow the intestinal tract. Occasionally, if a person has been taking antibiotics for a bladder infection, other organisms in the body can cause diarrhea. When this is the case, a special antibiotic is needed to cure the diarrhea.

What Can be Done to Prevent Bowel Problems?

There are many things patients can do to prevent bowel problems. Following these healthy guidelines can help keep a person regular and accident-free.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

FATIGUE IN MULTIPLE SCLEROSIS


Fatigue is the most common symptom of multiple sclerosis (MS). For many patients fatigue is the most disabling symptom of their disease.

The fatigue experienced by patients with MS is more severe than fatigue experienced by other people. This is because it is a neurological fatigue, associated with the MS disease process. MS produces inefficient transmission of nerve impulses that creates both physical and mental fatigue. Both kinds of fatigue can seriously disrupt daily activities.

Physical fatigue may be present even after a good night's sleep. If other problems, such as muscle spasms, are interfering with sleep at night, fatigue may be an even greater problem during the day. Some people experience fatigue primarily in the legs. For others, physical fatigue is a persistent and overwhelming tiredness.

Fatigue takes a toll on mental abilities too. The depletion of myelin disrupts the speed and quality of thinking. Forgetfulness, difficulty in concentration, and slow thinking are evidences of mental fatigue. A recent study with both patients and healthy people demonstrated this. Study participants were given tests that measured memory, conceptual planning, attention span and verbal communication. They were given the same tests repeatedly. With repetition, healthy participants' performance improved while MS patients' performance declined. The patients felt more mentally fatigued and depressed than the others in the study. The researchers are not sure why cognitive fatigue occurs.

Fatigue can worsen other chronic symptoms a person typically experiences. The extreme fatigue that characterizes multiple sclerosis is different from normal fatigue in that it:

The fatigue of MS has no direct correlation with a person's degree of physical impairment, nor does it occur because of depression. However, if a person with MS is also depressed, the depression can intensify fatigue. Similarly, fatigue can be a result of conditions like anemia and thyroid disease. It can be a side effect of medications, or it can be related to poor sleep patterns. For these reasons, when fatigue becomes a problem patients should consult with their physicians to evaluate the cause of the fatigue and develop a treatment regimen.

Improving Fatigue

Medications: There is no way to completely relieve fatigue, but many people have been helped by antidepressant medications. One side effect of these drugs can be insomnia, so it is necessary to take these drugs early in the day to avoid interfering with sleep. Other drugs being used for fatigue include amantadine, methylphenidate and fluoxetine. Modafinil has been found to help many patients when other drugs are ineffective.

Stay Physically Cool: One of the best ways to combat fatigue is to avoid heat. Hot weather, hot baths or showers, strenuous physical activity or fever can all increase fatigue. The warmer temperatures make it harder for myelin-depleted nerves to carry impulses. (For years the "hot bath test" was used to help diagnose MS. If a person 's symptoms got worse after soaking in a hot tub, MS was considered the likely cause).

Staying cool helps improve fatigue and other MS symptoms. Climate control in the home is key. Air conditioning in the summer and a lower thermostat setting in the winter can be very helpful. Cooler climates, cooler showers, and less strenuous activities may each benefit the patient. Aquatic exercise in cool water is ideal for anyone with MS because the water dissipates the heat generated by exercise.

Stay Emotionally Cool: Emotional stress may increase fatigue. Learning to manage stress is very important for everyone with MS. Support groups, stress management and relaxation techniques, and psychotherapy can help patients successfully manage stress and develop a more "laid back" approach to life.

One of the most frustrating aspects of MS is that sometimes friends, family or coworkers mistake fatigue for depression or laziness. Patients should communicate openly about how they are feeling and look for ways to educate those in their lives about the fatigue that is so symptomatic of MS.

Conserve Energy: Scheduled rest periods, particularly around the early afternoon, can be helpful. Fatigue can also be addressed with occupational or physical therapy. An occupational therapist can suggest energy conservation techniques for home and work activities. A physical therapist can instruct patients in exercise regimens that will help restore instead of deplete energy, and teach ways to conserve energy while walking or doing other tasks.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

PAIN IN MULTIPLE SCLEROSIS


Pain is not a significant problem for all patients with MS, but more than half will, from time to time, experience some type of pain or discomfort. Many experience chronic pain, and women are more likely than men to have pain with MS. Pain that accompanies MS is different from pain that comes from infection or injury. MS-related pain is neurogenic. That is, it results from an abnormal flow of nerve impulses in the central nervous system. All of the various kinds of pain experienced with MS can be reduced or alleviated with medication or other treatments.

It is important to remember that types and levels of pain are not related to the severity or progression of MS.

Types of Pain

Muscle Spasms

Opposing muscles are designed to work in cooperation, with one muscle contracting while the other relaxes. Spasticity causes both opposing muscles to contract or relax at the same time. This can cause painful muscles spasms. Cramping can also occur if the patient's water intake is out of proportion with the body's sodium and potassium.

Ways to help relieve or prevent muscle spasms:

Muscle, Joint or Back Pain

Several things can cause muscle, joint or back pain. Spasticity, which results from MS itself, is one cause. Other causes, which are secondary to the disease, may be easier to remedy. Here are some of these secondary causes, along with suggestions for alleviating discomfort:

Balance or gait problems. When there are problems related to walking, people may overcompensate in ways that strain muscles and joints.

Incorrect use of mobility aids. Walkers, wheelchairs or other assistive devices, if improperly used, can put pressure on joints and cause overuse of certain muscles.

Immobility. Sitting or lying in the same position too long puts pressure on the tailbone and hipbone area, causing pain. Keeping limbs in the same position too long can cause muscle pain when the position is finally changed.

Ways to help relieve or prevent muscle, back and joint pain:

Dysesthesias

Dysesthesias are sensations of burning or aching in the arms or legs, or pain that may girdle around the trunk. Dysesthesias can be acute or chronic. As with most symptoms of MS, dysesthesias occur because of improper conduction of nerve impulses in the central nervous system.

Ways to help relieve dysesthesias

Lhermitte's sign

Lhermitte's sign is an electrical shock-like sensation that occurs when the neck is flexed forward. The sensation travels down the spine and into the arms or legs. A majority of patients don't experience this symptom. While it signifies that spinal cord damage has taken place in the neck region, it is not a conclusive indication of MS. Lhermitte's sign is a disturbing sensation, but it is not serious. It is usually not treated with medication since it comes and goes so quickly, but anticonvulsants are sometimes used. A soft collar that restricts neck flexion may be the most helpful treatment.

"Regular" Pain

Like everyone else, people with MS can experience pain that is unrelated to MS. Tension or migraine headaches, backaches, and other conditions or illnesses are examples. It is important to describe and discuss painful symptoms with a physician who can determine whether the cause is MS or something else. An accurate diagnosis is necessary to successfully treat the problem.

Trigeminal Neuralgia (Tic Douloureux)

Some people with MS experience a very painful condition called trigeminal neuralgia. This disorder, also known as tic douloureux, also occurs in people who do not have multiple sclerosis. Trigeminal neuralgia is a disorder of the fifth cranial nerve, the trigeminal nerve. The trigeminal nerve communicates the sensory messages of touch, pain, pressure and temperature from the regions served by its branches: the lips, upper and lower jaws, nose, forehead, scalp and eyes.

Trigeminal neuralgia causes intense pain, which may be experienced as electric shock-like, stabbing sensations, typically on just one side of the face. The attacks may be stimulated by normal activities like brushing the teeth, putting on makeup, chewing, swallowing or talking. Even a slight breeze or a light touch to the face can trigger an attack. The pain can be agonizing, usually lasting only a few seconds, but coming and going many times a day. Trigeminal neuralgia can persist for days, weeks or even months before disappearing for many months or years.

Trigeminal neuralgia is more common in women than in men and does not often occur in people younger than 50, unless they have MS. However, cases have been reported even in very young children. Trigeminal neuralgia is often mistaken for dental pain. It can be one of the very first symptoms of MS.

Relieving Trigeminal Neuralgia
No tests are needed to diagnose trigeminal neuralgia. Following a physical examination, anticonvulsant medications may be prescribed. Baclofen, a muscle relaxant, or antidepressant drugs are sometimes also used. These medications will often be tapered in dosage and discontinued after a period of weeks or months, depending on the response.

If medications are not effective a surgical procedure called rhizotomy can be performed to sever the nerve roots that allow sensation. Alternative approaches, such as acupuncture, meditation, or chiropractic care may be effective for some patients.

Emotional Well-being and Pain

Emotions affect a person's perception of pain and influence one's ability to tolerate pain. Fear, worry, or an excessive focus on pain can magnify pain until it plays a disproportionate role in our lives. To keep pain in perspective, we must nurture our overall emotional well-being.

When emotional and social needs are well met, pain may not seem as predominant. A combined strategy, consisting of self-help, support from others and pain management therapies may be the best approach. Alternative therapies like biofeedback, acupuncture, yoga or hypnosis can be added to more mainstream approaches such as medication, support groups and psychotherapy. Staying socially active and getting involved in helping others through church or community groups can also help keep pain in perspective.

References:

Accordant Health Services. Core materials.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

SKIN PROBLEMS


There are three skin problems that may be experienced by patients with MS. Each of these problems can be effectively treated. Treatment is easiest when problems are detected early, making regular self-examination of the skin a good practice. Many skin problems can be avoided altogether by establishing a good care routine.

Pressure Sores

Pressure sores are also called bedsores, or decubiti. Pressure sores occur in places where skin has remained under pressure for a long time. They often result from a lack of mobility, causing a person to remain too long in one position in a chair, wheelchair or bed.

Constant unrelieved pressure stops or slows the blood flow to the area, causing a blister to form. The blister can become infected if it is not treated, and the infection can reach into the tissues below and even extend to the bone. Such an infection can worsen the patient's overall health.

Pressure sores are most common in areas where bone lies directly under the skin, such as the elbow, hip, tailbone, shoulder blades, ankles, heels or even the head. People who are underweight are at greater risk for pressure sores because their bones are more prominent. Other risk factors include smoking, poor nutrition, obesity, dry skin, cognitive confusion, incontinence, decreased sensation, moist skin, diabetes, anemia or cardiovascular problems.

Pressure sores begin benignly as small areas of red or purplish skin. If pressure continues on this area, the skin begins to break down, evidenced by blistering, swelling, and continued redness. If untreated, the problem will continue to progress until live tissue begins to die. The fat and tissue underneath the pressure sore will be affected, creating a hole or crater with an offensive smell. The ulcer can continue deeper, eventually reaching deep muscle tissue and bone. Infection can occur and the size of the sore can increase.

Pressure sores can be treated at any point along this declining path, but more advanced sores are harder to treat. If a sore is noticed early, it can heal if the source of pressure is simply eliminated. More advanced sores require protective covering, medication and special medical care.

Pressure sores can be prevented by following these guidelines:

Patients should:

Itching

The itching that sometimes occurs with MS does not result from an external cause. That is, there is nothing actually irritating the skin, such as a rash, insect bite or an allergy to something in the environment. This type of itching is neurologically caused. It is one of several possible paresthesias - abnormal sensations that result from the loss of myelin along the nerve fibers. Other paresthesias can include a feeling of "pins and needles," burning, numbness or prickling.

This kind of itching can be intense and may begin suddenly on any part of the body. Because it is not externally caused, nothing applied to the skin can relieve it. It can be remedied by several medications that must be prescribed by a physician. Carbamazipine and phenytoin (anticonvulsants), amitriptyline (an antidepressant), and hydroxyzine (an antihistamine) have been used to successfully treat itching in patients with MS.

Incontinence and Skin Breakdown

Skin is more likely to break down when it is moist. Bladder or bowel incontinence increases the risk of developing pressure sores or rashes. Skin should be examined daily for signs of breakdown. After an episode of incontinence, the skin should be gently washed with a mild cleanser and gently dried. Washing and drying should be done without rubbing, which creates friction.

People with incontinence problems can use products that help protect the skin from moisture. Special topical lotions that create a moisture barrier for the skin, and absorbent padding materials that keep urine away from the skin, are available.

Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

SPASTICITY


The body's opposing muscles are designed to work in cooperation with each other. Normally, one muscle contracts while the other relaxes. When opposing muscles both contract or relax at the same time, spasticity occurs. Spasticity can be defined as an abnormal increase in muscle tone that results in an almost spring-like resistance to movement. Spasticity may come and go in the form of spasms, or it can be a sustained involuntary stiffness.

Many people with MS have problems with spasticity. In fact, spasticity is one of the most common symptoms of MS.

What are the effects of spasticity?

Spasticity primarily affects the muscles of the legs, but muscles in the arms or other regions of the body can also be affected. Some people experience mild spasticity, usually just a feeling of tightness in the muscles. Others may experience severe spasticity with uncontrollable and painful spasms. Spasticity can also cause lower back pain and a feeling of tightness or pain around the joints.

Spasticity can cause a number of problems, depending upon its severity and location. Walking may be more difficult, due to stiffness, clumsiness or painful leg spasms. Spasticity in the muscles of the mouth and throat can affect speech. The ability to control urination can be affected by spasticity in the urinary sphincter muscle and bladder.

In cases where the legs are weak, the increased muscle tone of spasticity can sometimes actually be a plus, providing some needed support. These patients find that spasticity helps make standing and walking easier.

Types of Spasticity

The legs are affected by two kinds of severe spasticity, which usually occur at night.

Flexor Spasms primarily affect the muscles on the back of the leg. Spasms lasting two or three seconds draw the legs upward with the hips and knees bending forward.

Extensor Spasms affect the muscles on the front of the upper legs. These spasms can last for several minutes, suddenly straightening the legs into a stiff extended position. The hips and knees are straight and the legs are close together or crossed at the ankles.

Contractures

Untreated spasticity can result in joints "frozen" in either a flexed or extended position. This condition, known as contracture, is created when spastic muscles, shortened due to weakness or lack of use, pull across joints. The joints are injured or deformed and range of motion decreases dramatically. Contractures can occur in arms or legs.

What causes spasticity? What aggravates it?

Like all symptoms of MS, spasticity results from demyelination of the nerves. Nerve impulses cannot flow properly along the spinal cord, resulting in garbled signals to the muscles.

Some people experience a worsening of spasticity when the weather is very cold. Others may be more affected by extreme heat. Humidity, infection and even tight clothing may aggravate spasticity in some people.

How is spasticity treated?

Reducing spasticity is usually desirable because it reduces fatigue and discomfort, and gives the patient more freedom and better coordination. However, in cases where the legs are weak, it may be inadvisable to treat spasticity, since it may actually worsen the patient's functioning by making the muscles too weak.

Spasticity varies greatly from one person to another and must be treated on an individual basis. Any combination of exercise, lifestyle changes, medication or other treatments may be recommended. Patients may be advised to avoid tight clothing and to avoid sudden position changes or sudden stretching of the muscles.

Medications

There are several drugs that help alleviate spasticity. The most common drugs prescribed for spasticity are listed here. The two most common ones, baclofen and tizanidine, are known to be safe and effective. Baclofen is a muscle relaxant that is chemically similar to one of the body's natural neurotransmitters. Baclofen treats both spasticity and muscle rigidity. It also improves bowel and bladder function for some patients. Too much baclofen, however, can produce weakness.

Tizanidine is a drug that reduces spasticity by inhibiting the parts of the brain that tighten muscles. It works quickly to calm spasms and can have a sedating effect. Too much tizanidine can produce dizziness, however.

Diazepam or clonazepam are sometimes prescribed for use at bedtime to relieve spasms that might disturb sleep. They are also sometimes used at low doses and added to tizanidine or baclofen. People can develop dependence on these medicines, and they should be used with caution.

Dantrolene is usually used only if other drugs have been ineffective. It can have serious side effects involving the liver and the blood.

Other Treatments for Spasticity

Exercise: Some of the best non-drug treatments for spasticity are daily stretching exercises or physical therapy sessions that stretch muscles. Stretching, whether the patient is active or passive (assisted by a therapist) can also help prevent contractures, which cannot be reversed once muscles become shortened.

Nerve Block: Painful flexor spasms may be treated by injecting phenol into the affected nerve. This may relieve discomfort for as long as three months.

Baclofen pump: When oral doses of anti-spasticity agents are not effective, spasticity may be managed by implanting a programmable pump. The pump infuses baclofen directly into the spinal fluid space. This is called intrathecal baclofen.

Surgery: Surgery is rarely used to treat spasticity, but in severe cases, surgical procedures can bring relief if all other measures fail. Tenotomy involves cutting contracted tendons. Myotomy is surgery on the muscle itself. A procedure called rhizotomy is a surgical intervention at the nerve root.

Botulinum toxin (Botox): has sometimes been used to help reduce MS spasticity when nothing else works. The botulinum toxin is the most potent neurotoxin known and its use does involve some risks. Botox is currently used to treat many other conditions. While studies have shown that Botox can effectively treat MS spasticity, it is still considered experimental therapy. Botox treatments are expensive and must be repeated every few months.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

SPEECH AND SWALLOWING PROBLEMS IN MULTIPLE SCLEROSIS


Swallowing Problems

"Dysphagia" is the word for difficulty in swallowing. Dysphagia occurs most often in advanced MS. It is rare in the early stages of MS, but it may occur with an exacerbation. There are three kinds of problems that can occur.

As a result of any of these problems, patients may choke or cough while drinking or eating food, especially food that crumbles easily. When this happens the danger is that food or drink can be inhaled into the lungs (aspirated) instead of swallowed. Aspirated food or liquid can lead to pneumonia or cause an abscess to form. Sometimes patients unknowingly aspirate small amounts of food or drink. This is known as silent aspiration.

Swallowing problems can be remedied or improved with help from a speech therapist (also called a speech pathologist). The therapist may recommend changes in diet and offer guidance concerning ways to stimulate or exercise the swallowing mechanisms involved. A test called a modified barium swallow may be needed to pinpoint the exact nature of the patient's difficulties. In this procedure, the patient swallows thin liquid, thick liquid and solid material containing a substance that can be traced by a videofluoroscope.

Many patients find that small, frequent meals of foods that don't require much chewing are easier to tolerate than larger meals. Resting before meals is also a helpful technique. Patients with swallowing problems should not eat alone. They should also refrain from talking with food in their mouths. It may be helpful to alternate a bit of food with a sip of liquid so that nothing gets "stuck." When patients are no longer able to swallow food safely feeding can be done through a gastrostomy tube. The gastrostomy tube is inserted into the stomach during a brief outpatient surgery. Outside of the skin, the tube has a cap that is opened to administer supplemental liquid feedings.

People who have swallowing problems often have speech problems too. The speech therapist can also diagnose and treat these related problems.

Speech Problems

Speech problems are called "dysarthrias." Patients who experience tremor in the lips or tongue may have difficulty with speech. More often, speech problems result from lesions on the nerves in the areas of the brain and brainstem responsible for speech. Dysarthrias common to MS range from very mild to severe and affect pronunciation and rhythm. Diseases other than MS can cause dysarthias. An evaluation by a speech therapist can determine if dysarthria is due to MS.

Slurring: MS can cause people to slur their words, similar to the speech of someone who has been drinking alcohol. This occurs because the muscles of the tongue, lips, cheeks and mouth are weak and uncoordinated.

Dysphonia is a voice quality disorder. It is caused by weak or spastic mouth and throat muscles that do not coordinate well. Dysphonia includes difficulty with pitch control, causing some people to speak in a loud or explosive manner. Others speak with excessive nasality, reminiscent of someone with a cold or a nasal obstruction. Other problems include hoarse speech or breathiness. Dysphonia makes speaking more difficult for the patient, who may need to strain to communicate.

Scanning is a disorder that does not usually occur with other diseases, and is therefore a strong possible indicator of MS. Scanning speech has a disrupted pattern. Patients enunciate slowly, hesitating at the beginning of words or syllables. Scanning is more common in advanced MS.

Speech problems are treated with speech therapy rather than with medication. A speech therapist works with the patient to improve enunciation and speech patterns.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

WEAKNESS IN MULTIPLE SCLEROSIS


Weakness is a characteristic symptom of multiple sclerosis (MS). Weakness is not the same as fatigue. Fatigue is a type of exhaustion that affects the whole person; weakness is more a loss of strength and control over movement in the arms and legs. As with most MS symptoms, weakness is caused by an interruption in the flow of instructions carried over the nerve pathways.

Weakness may be experienced as a sense of "heaviness." One or both legs, may feel "heavy" and hard to move, especially late in the day. The word for one weak leg is monoparesis. When both legs are weak, patients are said to have paraparesis. Weakness is often just temporary, but it can last for an extended period. It is a good idea to take extra precautions against falls when experiencing weakness. Assistive devices like walkers, canes, braces or wheelchairs can safeguard patients from falls during periods of weakness. Patients should talk to their doctor about appropriate assistive devices.

Weakness that affects the arms or the hands may be experienced as clumsiness. Patients may have trouble gripping or lifting objects. When arm and hand weakness is temporary, rest may help. Persistent weakness may require wrist splints and assistive devices to improve strength.

If weakness is present, the co-existence of spasticity may be helpful. Spasticity can provide support that helps offset weakness. Medications to reduce spasticity, then, should be considered in light of their effect upon the patient's weakness. Other medications, however, may be appropriate, including phenol injections or oral steroids during acute exacerbations. Weakness that occurs with exacerbation is often treated with intravenous methylprednisolone sometimes followed by a course of oral steroids. Physical therapy and exercise can be helpful in maintaining function, and assistive devices such as walkers and canes can be used to preserve mobility and independence.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

TREMOR IN MULTIPLE SCLEROSIS


Tremor is an uncontrollable oscillation or trembling of some part of the body. The tremor symptomatic of MS can affect the limbs, head, voice, trunk, or even the jaw, lips or tongue. Tremor can come and go, and can vary in severity, duration and speed. This symptom can range from mildly annoying to disabling.

Tremors that result from MS occur because of inflammation and demyelination in the brain or brainstem and cerebellum. These are the areas responsible for balance, movement control, coordination and activities of the skeletal muscles. People who have tremor may also have speech and swallowing problems, since the same nerve pathways control these functions.

Types of Tremor

There are several types of MS-related tremor, which can appear as "gross" (observable) or "fine" (barely noticeable) movements.

Postural tremor occurs when the muscles are tensed to hold a position or to hold an object. This kind of tremor occurs when sitting or standing, but not when lying down.

Intention tremor occurs along with purposeful movement such as picking up an object. It does not occur at rest. Most patients who have tremor have intention tremor.

Titubation is oscillation of the head and neck.

Treatment

Tremor is probably the most difficult symptom of MS to treat. A consistently effective drug has not yet been found. Some patients have been helped to varying degrees by certain antihistamines, beta-blockers, anticonvulsant drugs, diuretics, anti-anxiety drugs, and other medications. If patients have "benign essential" or "familial" tremor, this type of tremor often responds to medication because it does not result from MS. MS-related tremor may be worsened by stress or fatigue.

A physical therapist may suggest specific exercises to help tremor. Repeating certain exercises in a patterned way may help patients increase muscle coordination and thereby gain some control over tremor.

Assistive devices such as weights can be attached to arms and legs to limit tremor. Occupational therapists can work with patients to find the best devices for their problems. Hand, arm, foot, neck or ankle braces may help provide some stability. Some experimental treatments, such as thalamic stimulation, are being tested as therapy for MS tremor. Results so far indicate that this deep brain stimulation can effectively suppress tremor for many patients. This is regarded as a relatively safe procedure.

Tremor affects people emotionally and socially as well as physically. Patients who are embarrassed by tremor may isolate themselves and become depressed. Professional counseling with a social worker, psychologist or psychotherapist can help patients become more comfortable around others.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

MOOD AND BEHAVIOR IN MULTIPLE SCLEROSIS


Topics:

From the moment it is first diagnosed, MS can have a profound emotional impact. Both the patient and his or her family may have difficulty accepting that an unpredictable and incurable disease will influence the course of their lives. Initially, a lack of knowledge about MS can create even more anxiety. Adjustment takes place slowly, as accurate information is acquired and supportive care begins.

Further down the road, as MS imposes changes upon the patient's lifestyle, emotional adjustment must continue. MS can affect every area of life, including employment, parenting, marriage and recreational or educational pursuits. Changes in these areas can create stress and frustration, impact finances and stimulate intense emotions.

A person with MS requires good medical care. He or she also needs significant emotional support from friends and family, and ideally, a caring professional counselor and an MS support group as well.

Depression

Depression has been called "a normal reaction to an abnormal situation." MS can alter longstanding lifestyle norms for any patient, and not surprisingly, depression is a common reaction to the many changes MS imposes. Depression that occurs as a reaction to circumstances is a normal part of the way human beings grieve loss. This kind of "reactive" depression is different from depression that results from biochemical causes.

Patients with MS also commonly experience depression as a result of their disease. MS destroys the myelin that covers the nerve fibers deep inside the brain, which can affect emotions. Depression can also occur as a side effect of some medications given for MS. Depression can sometimes arise from a combination of physical, emotional and social factors.

Regardless of the cause of depression, it should always be taken seriously. Medication may be considered as an option, especially when depression lasts more than a few weeks. It is always important to discuss depression with a physician or counselor. Suicidal statements should be reported to a member of the patient's healthcare team. A referral to a psychotherapist or psychiatrist may be recommended.

Here is a list of many possible symptoms of depression. No one will experience all of these symptoms, and symptoms can vary in intensity or appear sporadically.

Depression can intensify some of the physical symptoms of MS, such as fatigue, pain, or sexual dysfunction. Several of the antidepressant medications used to combat depression also coincidentally help alleviate some of the physical pain that accompanies MS.

There are many medications for treating depression. Medications can only be prescribed by a physician, and are sometimes used along with psychotherapy sessions.

Mood Swings

Patients treated with corticosteroids may experience mood swings of variable intensity. MS itself can also cause mood swings. Mood swings differ from depression in that the patient also experiences extreme "highs" as well as extreme "lows." Feelings of elation or being "on top of the world" alternate with depression and feeling worthless. The manic portion of the disorder may include symptoms such as:

If bipolar disorder is mistaken for depression, the patient will not receive the proper medication. Bipolar disorder, also called manic-depressive illness, is a brain disturbance that causes unusual ups and downs in a person's mood, energy, and ability to function. Bipolar disorder requires treatment for the manic part of the disorder as well as for the depressive part. Without the correct medication, patients are likely to have an increase in episodes and a worsening of the condition. With proper treatment, however, stable, satisfying relationships and productive work become more likely.

Laughing/Weeping Syndrome

MS can damage areas of the brain pathways responsible for emotion. When these areas become demyelinated, patients may experience uncontrollable laughter and inappropriate euphoria, or sudden weeping and despair. These episodes, known as emotional lability or laughing/weeping syndrome, are beyond the control of the patient. Emotional lability can be treated with an antidepressant.

Support

It is always encouraging to find others who have "been there" and to learn how they and their families cope with problems similar to our own. Foundations and local MS support groups also offer ways to broaden knowledge and build friendships with others who truly understand what it is like to live with MS. Today, other kinds of emotional support are also available to patients, their families and/or caregivers. The World Wide Web has created wonderful support options that were not previously available, such as Web-based chat groups, e-mail newsletters and interactive learning opportunities.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

WHEN SHOULD I CALL THE DOCTOR?


Multiple sclerosis (MS) can be challenging for both patients and their families. Many MS problems, however, can be resolved or at least improved with the help of a healthcare professional. Generally speaking, it's a good idea to talk to a nurse or doctor about any aspect of MS that causes unusual discomfort or concern. Many times, a simple suggestion or a change in medication can help make patients more comfortable. Other times, prompt medical attention is needed.

Patients experiencing any of these problems should contact their physician:

Exacerbation

An exacerbation is also called an attack, flare up, or relapse. It is a significant change from a patient's normal condition. An exacerbation is defined as:

Bladder Discomfort

Bladder discomfort may be caused by infection. A urinary tract infection (UTI) occurs when bacteria multiply within the urinary tract. Anyone can get a UTI, but women get more UTIs than men do. This is because the female urethra is shorter, which makes it easier for bacteria to spread. Urine left in the bladder fosters infection because bacteria multiply freely in stagnant urine. For this reason, UTI is common among patients with MS who have bladder problems that affect their ability to completely empty the bladder. Patients who use a catheter are prone to UTI as well.

Symptoms can include:

A UTI requires a course of antibiotics, usually for 7 to 10 days. The patient will probably be advised to increase fluids and told to drink cranberry juice to increase the acidity of urine. Pain relief medication may be given as well.

Depression

Depression is common with chronic illness and should always be taken seriously. Symptoms usually include a loss of interest in daily activities and/or feeling great sadness. Other symptoms might include:

The good news is that depression is a treatable illness. There are several medications that can be prescribed for depression. Psychotherapy, either alone or in combination with medication, may also be helpful. Identifying and treating depression is in the best interest of the patient and their family.

Pain

Pain is not a significant problem for all patients with MS, but many patients from time to time, experience some type of pain or discomfort. Women are more likely than men to have pain with MS. The pain of MS is different from pain that comes from infection or injury. MS-related pain is neurogenic. That is, it results from an abnormal flow of nerve impulses in the central nervous system. All of the various kinds of pain experienced with MS can be decreased or controlled with medication or other treatments.

Dizziness or Vertigo

Dizziness is a general term for a sense of lightheadedness or the feeling of being off balance. Vertigo is the illusion of movement when no movement is taking place. Objective vertigo is the feeling that the external world is revolving around the patient. Subjective vertigo makes the patient feel as though he or she were revolving. Some people describe this kind of vertigo as a sensation of floating or spinning. Vertigo can make it hard to maintain balance while standing or walking. Some patients experience nausea or vomiting along with vertigo.

Dizziness and vertigo may occur if MS has caused the brainstem to become inflamed or demyelinated. The brainstem plays a key role in balance. It coordinates the eyes, limbs and trunk. Inflammation of the inner ear may also be involved in dizziness or vertigo. MS can damage the nerve pathways that originate in the inner ear, which help maintain equilibrium.

Anti-motion drugs can reduce dizziness or vertigo. If dizziness gets worse when changing positions, physical therapy may help. A physical therapist can teach exercises that help compensate for dizziness.

References:

Accordant Health Services. Core materials.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

COGNITIVE PROBLEMS IN MULTIPLE SCLEROSIS


Until about 25 years ago doctors thought that multiple sclerosis (MS) produced only physical symptoms. Since 1980, however, research findings, supported by diagnostic advances like magnetic resonance imaging (MRI), have shown conclusively that MS also produces cognitive changes.

Cognitive symptoms may be present at the onset of the disease, or, more often, they may appear after a person has had MS for some time. Cognitive symptoms do not necessarily correlate with the severity of physical symptoms. A person with severe physical disability may have no cognitive problems, while a person with no physical symptoms could have severe cognitive problems.

Types of Cognitive Problems

Cognitive problems may include difficulty with:

Some people have problems with word retrieval or slurred speech. People generally have no problems drawing conclusions or discerning the differences in the meanings of words. The ability to concentrate on simple tasks, known as "simple attention span," is not likely to be affected either.

To varying degrees, thinking problems can affect a person vocationally and socially. On a personal level, they may interfere with driving, family responsibilities like cooking, or even personal hygiene. Of those with cognitive difficulties, about 80% have mild symptoms. The remaining 20% have symptoms serious enough to interfere with employment and routine activities of daily life. The cognitive symptoms of MS can cause four main types of thinking problems:

DRUGS & CONDITIONS

DIZZINESS AND VERTIGO IN MULTIPLE SCLEROSIS


Patients with multiple sclerosis (MS) sometimes experience dizziness or vertigo, two painless but annoying conditions. Dizziness is a general term which patients use to describe a variety of sensations, including a sense of lightheadedness or the feeling of being off balance. Vertigo is a more specific condition. It is an illusion of movement when no movement is taking place. Vertigo can make it difficult to maintain balance while standing or walking. Some patients experience nausea or vomiting along with vertigo.

Dizziness and vertigo often occur because MS has caused the brainstem to become inflamed or demyelinated. The brainstem plays a key role in balance, coordinating the eyes, limbs and trunk of the body. Inflammation of the inner ear may also be involved in dizziness or vertigo. MS can damage the nerve pathways that originate in the inner ear, which also has an important role in maintaining equilibrium.

If dizziness or vertigo become especially bothersome, medication may help. Anti-motion drugs usually alleviate these symptoms. Meclizine or skin patches that deliver scopolamine may be prescribed. Corticosteroids are sometimes prescribed for the most severe cases. In cases where dizziness gets worse when changing positions, physical therapy may help. A physical therapist can help patients with this problem by teaching them special exercises that gradually help compensate for dizziness.


Last Modified Date: March 01, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

OPTIC NEURITIS MULTIPLE SCLEROSIS


The word "optic" refers to vision or to the eye. The second cranial nerve, which connects the brain and the eye, is called the optic nerve. The optic nerve carries impulses from eye's retina to the brain, which translates them into images, giving us sight. Neuritis means "inflammation of nerves." Optic neuritis, then, is an inflammation of the optic nerve. This condition is also known as "retrobulbar neuritis" when it affects the back part of the optic nerve and "papillitis" when it affects the optic nerve head.

When optic neuritis causes the optic nerve to become inflamed or demyelinated, sight is usually affected. Optic neuritis can be caused by a number of diseases, including multiple sclerosis (MS). Optic neuritis is one of the most common symptoms of MS. Many people with MS report that their first symptom was a vision problem. More than half of all patients with MS experience optic neuritis at some point during the course of their disease.

Optic neuritis usually affects only one eye, and is often painful. Symptoms can be temporary, lasting between 4 and 12 weeks. A variety of symptoms can occur, including:

It is possible to have a "subclinical" episode of optic neuritis, meaning that there are no observable symptoms of the condition. When there are no symptoms, the condition can be detected though the visual evoked potentials test. This painless diagnostic test measures the time it takes for nerve impulses to travel from the retina of the eye to the occipital lobe of the brain. Electrodes are placed on the scalp of the patient, who watches lights or patterns flash across a screen. The visual stimulation creates electrical impulses that travel to the brain. When optic neuritis is present the impulses travel more slowly than normal.

Optic neuritis may resolve itself or medication can be given to reduce inflammation and restore vision more quickly. Treatment usually begins with a short course of methylprednisolone administered intravenously for 3-5 days. This is followed by a tapered 10-14 day course of oral steroids. The intravenous methylprednisolone can be administered at home by a visiting nurse or in an outpatient facility.


Last Modified Date: March 01, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

OSTEOPOROSIS AND MULTIPLE SCLEROSIS


The bones store about 99% of the calcium in the body. The remaining one percent travels in the blood. This "free" calcium is used for many body functions such as muscle contraction, nerve functioning and blood clotting.

The Process of Osteoporosis

As with all other body tissues, the bones are constantly being broken down and rebuilt. Cells called osteoclasts dig holes into the bone and thereby release calcium into the bloodstream. Cells called osteoblasts refill the holes with new calcium and other substances. This process of breakdown and rebuilding usually occurs at equal rates. In some circumstances, the process of breakdown begins to out pace the process of rebuilding. This imbalance leads to a condition called osteoporosis.

Osteoporosis is a disease of the bones in which the amount of calcium slowly decreases. As a result of this calcium loss, the bones become very brittle and may break easily.

Risk Factors for Osteoporosis

Osteoporosis occurs as part of the natural aging process, usually beginning around age 40. Both men and women are affected. However, women are affected to a greater extent after menopause due to the decreased production of estrogen. Women who have had ovarian surgery or who entered menopause before age 45 are at even higher risk for osteoporosis. Other factors also increase the risk of osteoporosis. These risk factors include:

Patients who take high doses of steroids such as prednisone for long periods of time are at increased risk for osteoporosis. Other drugs, including immunosuppressive drugs such as methotrexate and cyclosporine, can also increase bone loss, leading to osteoporosis.

Reducing the Risk of Osteoporosis

The risk of osteoporosis can be reduced. It is especially important for patients who take medications that increase bone loss to take preventive measures.

Diet

As much as possible, diets should be rich in calcium. The best source of calcium is dairy products. Other sources include dark green vegetables, shrimp, canned salmon and sardines, black strap molasses, calcium-fortified tofu and almonds.

Decreasing the amount of caffeine in the diet may reduce the risk of osteoporosis for some patients. Decreasing heavy consumption of alcohol may also help reduce risk.

Supplements

In many cases, patients who take certain medicines will also need to take calcium and Vitamin D supplements. Vitamin D is necessary for the body to use the calcium. The percent of calcium in a supplement depends on the type or form of the calcium. The percent of calcium in each form of supplement is listed below. Although calcium citrate has less calcium, the body can usually use this form more easily and with fewer side effects.

Supplement Percent of Calcium
Calcium carbonate 40%
Calcium phosphate 33%
Calcium citrate 25%
Calcium lactate 9%
Calcium gluconate 9%

Exercise

Regular, weight-bearing exercise can help slow the progression of osteoporosis. Physical therapists can help patients with MS choose appropriate exercises.

Stop Smoking

Quitting smoking decreases the risk of many diseases, including osteoporosis. There are many programs available to help patients who want to stop smoking but who have yet been able to stop. Information on these programs may be available through the patient's doctor, pharmacist, and other health-related organizations.


Last Modified Date: March 01, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

SEXUAL DYSFUNCTION IN MULTIPLE SCLEROSIS


Multiple sclerosis (MS) generally occurs during young adulthood when sexuality is of prime concern. Sexual problems are common among patients with MS. Difficulties often begin early in the course of the disease, with both men and women experiencing diminished desire or ability to participate in sex. This can be distressing for both the patient and his or her partner.

Even though sexual difficulties are so common among patients, both physicians and patients are often reluctant to discuss this issue. However, since sexual function is very important to the patient's quality of life, it should be addressed along with the other aspects of the disease. This is especially important because so many sexual problems can be resolved.

Common Problems

The most common sexual problem among men is the inability to get or maintain an erection. Other problems include decreased sexual desire, loss of sensation in the penis, and difficulty or inability to ejaculate.

According to one study, the most common problem experienced by women is a decrease in sexual desire. Other problems include a lack of vaginal lubrication, difficulty reaching or feeling orgasm, painful intercourse and difficulty becoming aroused. Some women indicated that once engaged in sexual activity, however, they did experience it as pleasurable.

Causes for Sexual Dysfunction

MS can cause sexual dysfunction either directly or indirectly. Direct causes result from the disease itself. Indirect causes are secondary physical symptoms and psychological issues that interfere with sexual function.

Direct Causes

Sexual arousal begins in the brain. MS damages the nerve pathways from the brain and spinal cord to the rest of the body. If the nerves that send messages to the sex organs become demyelinated, sexual dysfunction can be a direct result.

Indirect Physical Causes

Many MS symptoms can inhibit sexual expression. Fatigue and weakness can diminish sexual desire. Spasticity can cause cramping or spasms in the legs that makes sexual activity uncomfortable or impractical. Sensations of pain can override sensations of pleasure. Bowel and bladder problems can also interfere with sexual activity.

Indirect Psychological Causes

From a psychological standpoint, human sexuality is complex. MS can complicate matters a bit further. People with MS must battle fatigue and cope with the stress of living with a chronic illness. Along the way, many emotions may come into play, including anxiety, depression, anger and lowered self-esteem. Some patients also feel embarrassed about various aspects of their condition. Psychological stresses such as these can affect sex drive, sexual performance and sexual self-esteem.

Other Factors

Sedatives can contribute to the loss of sexual desire. Patients should be aware that sedatives can reduce libido and should use these medications cautiously. Alcohol should also be avoided, or at least limited, when there is concern about reduced sex drive.

Solutions for Sexual Dysfunction

There is good news about sexual dysfunction and MS--much can be done to help resolve these problems. Help is available for both the emotional and physical aspects of sexual problems.

A professional counselor, psychologist or sexual therapist may be able to help with problems like depression, stress or fatigue, which can contribute to the loss of sexual desire. Sometimes anti-depression or fatigue-fighting medication will be recommended. It helps to remember that people who don't have MS find their sexuality disrupted by these things too.

Problems that are purely physical can likely be remedied or greatly improved. A variety of possible solutions exist for men with erectile dysfunction. Penile implants, inflatable devices, vacuum pumps and a variety of medications, administered in a variety of ways, have provided solutions for many men. Some drugs, like papaverine or phentolamine, are injected to increase blood flow to the penis. Sildenafil, vardenafil, tadalafil are taken orally. A tiny suppository of alprostadil can be inserted into the urethra via a thin plastic tube. A button at the top of the tube releases the medication, and within about 10 minutes a man will achieve an erection that lasts a half-hour to an hour.

Women who experience vaginal dryness can solve the problem by with water-soluble personal lubricant products like K-Y Jelly. Products that are not water-soluble, such as petroleum jelly, should not be used because they can lead to infection. Women usually use too small an amount of lubricant. A generous amount is recommended.

There are some simple things that can be done to help:

The best way to approach sexual problems is with open discussion. By sharing feelings and working together, a couple will find mutually agreeable creative solutions. Communication strengthens the bond with one another. Failure to discuss sexual problems can be damaging to the relationship.

Fertility and Conception

MS does not impair fertility for men or women. However, some sexual problems may make it more difficult for men to father babies. Couples who want to have children may wish to consult with a urologist to solve any problems that hinder conception.


Last Modified Date: March 01, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

URINARY TRACT INFECTION IN MULTIPLE SCLEROSIS


A urinary tract infection (UTI) is a bacterial infection of the urethra, bladder, ureters or kidneys. When infection is confined to the lower urinary tract (the bladder) it is called cystitis. If infection spreads to the upper urinary tract (the kidneys) it is called pyelonephritis, and is considered more serious. Inflammation of the urethra, the channel between the bladder to the outside of the body, is urethritis. While UTIs are painful, with prompt treatment they rarely become serious.

What Causes Urinary Tract Infections?

Urine is naturally sterile--it contains no bacteria or viruses. It also has natural properties that inhibit the growth of bacteria. UTIs occur when organisms enter the urinary tract from outside and multiply within the urinary tract. Anyone can get UTIs, but women are more prone to them because the female urethra is shorter, allowing bacteria to spread more easily. One in five women will get a UTI in her lifetime and infections will recur in many. Sexually active women are more likely to get UTIs because intercourse can introduce bacteria into the urethra. Most infections are caused by Escherichia coli (E. coli) bacteria, which are abundant in the intestinal tract and therefore in the rectal area. Women also get UTIs from vaginal organisms such as chlamydia and the herpes simplex virus. Using a diaphragm for birth control has been linked to more UTIs in women. After menopause women may become more prone to UTIs. This is because the reduction in estrogen thins the urethra and the base of the bladder.

When UTI symptoms occur in men, acute prostatitis should be considered, since its symptoms are similar to those of a urinary tract infection. Most of the time, male UTIs are caused by bacteria that enter the urethra during sexual activity. Gonorrhea and chlamydia bacteria cause most UTIs in men.

UTIs are common among patients with MS who have bladder problems that affect their ability to void. Urine left in the bladder fosters infection because bacteria multiply freely in stagnant urine. For this reason, those with "failure to empty" dysfunction, which retains urine in the bladder, may be prone to UTIs. Those with "conflicting bladder" have both retention and emptying problems due to spasms, and are also prone to urinary tract infection. For both men and women, the use of a catheter increases the risk for UTI.

What Are the Symptoms of a Urinary Tract Infection?

Symptoms can include:

How is a UTI Diagnosed?

After a review of the patient's symptoms and a physical examination, which may include a pelvic exam for women, lab tests will be ordered. A urine analysis that reveals white blood cells and bacteria confirms UTI. A urine culture may be ordered to test for sensitivity to specific antibiotics.

What is the Treatment?

A UTI requires a course of antibiotics, usually for 3 to 10 days. Most UTIs are treated with amoxicillin, nitrofurantoin, sulfamethoxazole-trimethoprim or ciproflaxacin. Patients are usually also advised to increase fluids and specifically instructed to drink cranberry juice. Researchers have discovered that cranberry juice changes the shape of E. coli bacteria in a way that prevents them from attaching to the wall of the bladder. This allows the bacteria to be more easily "rinsed out" during urination. Vitamin C (at least 1000 mg/day) may also be recommended because it increases urine acidity. Pain relief medication may be prescribed as well. Symptoms begin to decrease after the first 24 hours of treatment.

Severe infections are treated in a hospital with intravenous antibiotics. An infection that has spread to the kidneys can enter the bloodstream and become life threatening. Patients with recurrent UTIs or severe UTIs with kidney involvement should be seen by an urologist or nephrologist.

Can Anything Be Done to Avoid Urinary Tract Infections?

Patients should be evaluated for neurogenic bladder problems and follow the recommendations of their physician. Beyond that, there are a number of precautions that can be taken to help avoid urinary tract infections. Here are some general tips:

Additional tips just for women:


Last Modified Date: March 01, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

HOW IS MS TREATED?


A cure for multiple sclerosis (MS) has not been found yet. However, aggressive ongoing research has already produced effective drug therapies for treating the underlying disease and for managing symptoms. MS patients now benefit from drugs that can reduce both the severity and frequency of exacerbations (also called relapses or flare-ups). Other drugs help slow the progression of the disease.

It is now known that MS damages nerve fibers located beneath myelin that is undergoing destruction. Because the damage inflicted upon the nerves is permanent, it is now recommended that patients seek treatment as soon as they are diagnosed with MS.

To date, MS research has focused on three main goals: preventing or slowing the destruction of myelin; minimizing patients' symptoms; and restoring myelin that has already been damaged or destroyed. The drugs currently prescribed for MS have resulted from research in the first two areas.

Drugs that help slow the overall disease are overviewed in this article. Other drugs may be used for specific symptoms and are discussed in other articles.

Interferons

Interferons are immune proteins created naturally by the body. Whenever a virus attacks the body, the body defends itself against the attack by creating beta interferons, which help prevent the multiplication of viruses. Interferons also help regulate the immune system.

Avonex®, Betaseron® and Rebif® are genetically modified beta interferons, manufactured through recombinant DNA technology. They are immune modifying drugs. Patients who use these drugs still experience exacerbations, but they occur less often, don't last as long, and are less severe. It is believed that these drugs are effective against MS because they help regulate the immune system to decrease attacks on the myelin.

Betaseron (Interferon beta-1b) was approved by the Food and Drug Administration In 1993. It was the first drug capable of decreasing the frequency of exacerbations for relapsing-remitting patients. MRI scans have also shown that Betaseron lessens the increase in volume of brain lesions and helps keep new lesions from forming. Betaseron is taken by subcutaneous (under the skin) injection every other day.

In 1996 the FDA approved Avonex (Interferon beta-1a) for treating relapsing-remitting patients. Avonex has been proven to slow the progression of relapsing MS and to reduce the frequency of exacerbations. Avonex is taken once a week as an intramuscular injection. A recent study shows that it is beneficial to begin Avonex after the first demyelinating event, even prior to a diagnosis of clinically definite MS. In the study, patients who received Avonex had a reduction in the volume of their existing brain lesions, and compared to a placebo group, developed fewer new lesions.

Rebif, another form of Interferon beta-1a, received FDA approval in 2002 for treating relapsing forms of MS. Rebif is given as a subcutaneous injection three times a week. Like Avonex, Rebif has been proven to slow the progression of relapsing MS and to reduce the frequency of exacerbations.

Copaxone®

In 1996 the Food and Drug Administration also approved a non-interferon drug for the treatment of relapsing-remitting MS. Copaxone, (glatiramer acetate) is as effective as the interferons in curbing exacerbations, and it has also been found to reduce new brain lesions. It is thought that Copaxone stimulates the production of certain cytokines, which affect autoimmune activity and protect the myelin surrounding the nerve fibers. Copaxone is taken every day as a subcutaneous injection.

Novantrone®

Novantrone (mitoxantrone) is the first drug approved by the Food and Drug Administration for secondary-progressive MS. It is also approved for progressive-relapsing or worsening relapsing-remitting MS. Novantrone received FDA approval on October 13, 2000. Novantrone is a type of chemotherapy. Clinical trials have shown that Novantrone reduces the number of relapses and decreases the progression of MS in advanced cases. This drug is infused into a vein for 5-15 minutes every three months.

There is a risk of heart damage with Novantrone. Doctors test the heart before the first dose, throughout treatment, and after Novantrone is stopped. There is a limit to how much Novantrone can be taken during a person's lifetime. Most patients reach this limit after 8-12 doses over a 2-3 year period. You and your doctor should both keep track of how much Novantrone you get.

Tysabri®

Tysabri (natalizumab) was first approved by the FDA in 2004. It is believed to prevent potentially damaging immune cells from reaching the central nervous system. In February of 2005 natalizumab was voluntarily withdrawn from the market because of a viral brain infection called progressive multifocal leukoencephalopathy, or PML. This usually fatal infection occurred in three patients (two MS and one Crohn's disease) who were also taking other drugs that affect the immune system.

Natalizumab was reapproved by the FDA in 2006 monotherapy for patients with relapsing forms of MS, and two more cases of PML were reported in 2008. It is used in patients who do not respond to medicines like interferons. Natalizumab is available only under a restricted TOUCH™ Prescribing Program with strict guidelines and strong warnings to potential recipients. This drug is infused into a vein every four weeks.

Corticosteroids

Corticosteroids reduce inflammation. They may also suppress the immune system's attack on myelin and improve the conduction of nerve impulses. These drugs are effective in relieving symptoms during a severe attack, but they have no long-term value. They also cause a number of side effects when used for long periods. For these reasons doctors limit the use of corticosteroids to instances where they are really needed.

Azathioprine

Azathioprine is a useful treatment for people who have many relapses and need steroids. This drug also has its unwanted side effects, so the lifetime dose must be closely watched.


Last Modified Date: March 01, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

WHY DO I NEED SO MANY DOCTORS?


As a patient with multiple sclerosis you may see three or four doctors--or maybe even more! Like many patients, you've probably dared to wonder, "Are all of these doctors really necessary? Do multiple doctors really mean better care for me?"

Almost always, the answer to both questions is yes!

Today, no one doctor can know everything about every illness. This is especially true when it comes to complex chronic illnesses like multiple sclerosis. Due to the growing complexity of modern medicine, many physicians choose to specialize in a particular area of interest. They become experts within their chosen discipline and are frequently called upon to cooperate with other doctors in the care of chronically ill patients. This "team of experts" approach assures that patients receive state-of-the-art medical care.

In addition to a primary care doctor your MS healthcare team might include any or all of these specialists:

To experience the maximum benefits of seeing multiple medical experts, all of your doctors have to know about each other! You can help make it easy for your team of doctors to share information with one another. Provide each doctor with a list of all the other doctors you see. Include the name of the doctor, the name of the practice, the address and the phone number. Whenever you have an appointment ask the doctor to send his or her notes to the other physicians on the list. Ask your doctors to consult with one another whenever they--or you-- feel it would enhance your care.


Last Modified Date: March 01, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

YOUR MS HEALTHCARE TEAM: TIPS FOR IMPROVING COMMUNICATION


If you've got multiple sclerosis, you probably have several doctors. In addition to your primary care doctor and a neurologist, there's a good chance you also see some other specialists. For example, like many people with MS, you might consult an urologist, a speech therapist, a psychiatrist or an ophthalmologist. At each doctor's office, physician's assistants, nurses and various other professionals also participate in your care.

As your healthcare team expands, how can you be sure all of these people are working together in a coordinated way?

The answer is communication! Good communication among healthcare team members assures your best care. As the patient, you are the "hub" in the network that connects everyone on your healthcare team. Here are some tips you can use to keep all the members of your healthcare team "on the same page."

Provide each of your doctors with a list of all the other doctors you see. Include the name of the doctor, the name of the practice, the address and the phone number. The easiest way to do this is to get business cards from your doctors and lay them all out on a photocopy machine. Make copies and give one to each doctor. If you can't get business cards, you can compile the list on a computer and print out copies. Or, you can compile it by hand and photocopy it. Be sure to print clearly!

Ask your doctors to send each other copies of the notes they make during your appointments. Your doctors should also be willing to consult with each other whenever necessary, or upon your request. Ask your doctors to send you copies of their notes for your file. You can bring your file with you to clinic visits.

It is your responsibility to make sure that each doctor has the information that is vital to your care. For example, be sure each physician knows:

When seeing several doctors, you may occasionally receive advice that seems to conflict with or contradict what other doctors have told you. When this happens, ask for clarification. Sometimes different doctors will explain the same thing from the perspective of their medical specialty. But other times, doctors will genuinely have different points of view. If you need to make important decisions about your care, and your doctors don't seem to agree, you can seek another opinion from a different doctor.

Combining the perspectives of several doctors may be quite helpful in planning or modifying your treatment. Don't worry about offending your doctors by requesting another opinion. Good healthcare is all about sharing information and pooling expertise. It's also enhanced by good relationships with your healthcare team. That's why it's always appropriate to remind your doctors--or any member of your healthcare team--that you value their expertise and partnership!


Last Modified Date: March 01, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

INFECTION AND DISEASE-MODIFYING DRUGS


The benefits of disease-modifying drugs are great for some people with Multiple Sclerosis (MS). Drugs like Avonex, Betaseron, Novantrone, Copaxone and Rebif can actually change the course of MS. They can reduce damage to the nervous system and decrease the number of flares. Disease-modifying drugs keep disability at bay in many people.

While these drugs can improve quality of life, they are associated with an increased risk of infection. For example, disease-modifying drugs can reduce levels of infection-fighting blood cells. Some are associated with urinary tract infections. Because they are injected, all of these drugs have the potential to cause skin infections.

If you take disease-modifying drugs, be alert for four types of infection: respiratory, urinary tract and skin infections, as well as gum disease. The following early detection and prevention tips can help you avoid the discomfort and complications that go with unwanted infections.

Respiratory Infections

Patients who take disease-modifying drugs may be more likely to get respiratory tract infections like common colds and the flu. Unchecked, these infections can progress to pneumonia and other unwanted complications. If you notice any of these symptoms, report them to your doctor.

Symptoms of Respiratory Infections

Tips For Prevention

This page contains prescription brand name drugs that are registered or trademarks of pharmaceutical manufacturers that are not affiliated with Caremark.

Urinary Tract Infections

Urinary tract infections are bacterial infections of the urethra, bladder, ureters or kidneys. These infections are common in people with MS. This is because the disease can interrupt signals from the brain to the bladder, causing some urine to be left behind after urination. Retained urine provides a rich environment where bacteria can grow. To catch a urinary tract infection early, be on the lookout for the following symptoms:

Symptoms of Urinary Tract Infection

If you experience any of the symptoms listed above, call your doctor. He or she may refer you to a urologist. Otherwise, try to prevent a urinary tract infection by following the tips below.

Tips for Prevention

Skin Infections

Most disease-modifying drugs are injected under the skin or into muscle. Repeated puncture of the skin provides opportunities for bacteria to get into the body. If you do your own injections, follow the tips below to prevent infection, and alert your doctor if you notice any of these symptoms.

Symptoms of Skin Infections

Tips for Prevention

Dental Health

Taking good care of your teeth can also reduce your risk of infection. Healthy gums do not usually bleed during brushing or flossing. When they do, it provides a way for bacteria to enter the body and cause infection. Tell your dentist if your gums bleed. Also, let your dentist know what medicines you are using when you go for dental care. Below are some tips to help you prevent dental problems.

Tips for Good Dental Health

If you notice signs of infection, do not try to treat them yourself. Discuss possible infections with your doctor. If you get a prescription for medicine, take it exactly as prescribed. Don't stop taking a medicine just because you feel better. This could lead to repeated infections that are more difficult to treat.

There are many steps you can take to improve wellness. Early detection and prevention of infections are simple steps that go a long way toward maintaining your current health.


Last Modified Date: March 01, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

BLOOD PRESSURE AND MS: QUESTIONS AND ANSWERS


Q. What is blood pressure?

A. Every beat of your heart forces oxygen-rich blood into the aorta, the largest artery in your body. When the heart contracts, the blood in the aorta is at its maximum pressure. Between heartbeats, blood is at its minimum pressure. A blood pressure reading records these two pressures, which are displayed as a fraction. The top number is the maximum pressure (systolic); the bottom number is the minimum pressure (diastolic).

Blood pressure can vary from one moment to the next. Emotions, posture, physical activity, medications, sleep, and other things can cause blood pressure to change.

Q. How can I find out what my blood pressure is?

A. Blood pressure is measured with a sphygmomanometer. This medical instrument has an inflatable cuff that is placed around the upper arm. The upper arm is the best place to take a blood pressure reading because it is approximately the same elevation as the aorta. Blood pressure is expressed as "millimeters of mercury" (mm Hg). This is a measurement of how high mercury rises in a tube under the force exerted by the blood pressure.

Your doctor's office probably checks your blood pressure at each visit. Between visits you can use blood pressure machines available for customers at many pharmacies. You can also purchase a sphygmomanometer for home use.

Q. What do the blood pressure numbers mean?

A. Both of the numbers in a blood pressure reading are important indicators of heart and blood vessel health. Blood pressure of less than 120 over 80 is considered a normal reading for adults. If you have diabetes, a normal blood pressure goal is 130/80. Values of 120-139 over 80-89 are considered "prehypertensive." These people are at higher risk for developing hypertension and need to monitor their blood pressure more closely. A blood pressure equal to or greater than 140 over 90 is considered high. Blood pressure that is lower than your normal value can result from dehydration, internal bleeding, blood loss, or shock from heart failure.

High blood pressure makes the heart work harder and weakens it over time. It also increases the chances of heart attack, stroke, kidney failure or congestive heart failure. Elevated blood pressure usually has no symptoms. Readings in the "high" range (140/90 or greater) could signal current or potential problems. Monitor your blood pressure and tell your doctor if your blood pressure readings are 140/90 or higher.

Q. Can stress affect my blood pressure?

A. Stress is a factor for high blood pressure. Our minds and bodies respond to stress in much the same way that we respond to physical dangers. Stress stimulates the release of the same powerful hormones that enable a person to either flee to safety or defend himself in a crisis. This is the classic "fight or flight" response. A chronic illness like hemophilia can create not only physical stress, but also financial, social, emotional, and occupational stresses. Any of these or any combination of these stresses can indeed affect blood pressure.

You may not be able to eliminate all of the stress that accompanies MS. What can change, however, is the way you think about stressful events and circumstances. This is the basic idea behind many of the complementary and alternative treatments categorized as "body/mind medicine." (See the "Pain, Stress and Mood" and the "Complementary and Alternative Medicine" sections of the Accordant Library for information on managing stress.)

Q. Why is it important for patients with MS to monitor blood pressure?

A. In MS, blood pressure changes can accompany medications taken to address certain symptoms. Tizanidine, a medication taken to combat spasticity, is chemically related to drugs that reduce high blood pressure. Therefore, patients taking this drug may experience a drop in blood pressure. Desmopressin, a medication given to control frequent urination, may increase blood pressure.

If you have MS and are taking medications like these, it is important to pay close attention to your blood pressure. Your doctor may ask you to monitor your blood pressure and to report readings that exceed a specific range. Always follow your doctor's advice concerning blood pressure.


Last Modified Date: March 01, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

TIPS FOR MANAGING STRESS


Everyone deals with stress. In modern society, stress is unavoidable! However, some of us have a lot more stress than others do. Over-stressed people tend to be:

Does this list describe you? If so, you've probably got too much stress in your life. If you're feeling over-stressed, try this:

Make a mental list of the specific circumstances, responsibilities and relationships that cause your stress. Which stressful aspects of your life can be changed? Which cannot be changed? Knowing the difference will help empower you to effectively deal with your stress.

Stresses that cannot be changed must instead be managed. Managing stress is possible because even when we can't change our circumstances, there are always two things we can change. We can change the way we choose to react to a circumstance, and we can change the way we take care of ourselves in that circumstance. We always have the power to make choices--even under stress. Stress puts both physical health and emotional well-being at risk. The more stress we face, the more important our choices become.You don't have to be victimized by stress! You can make many smart choices that will eliminate, reduce or effectively manage your stress. Here are some practical tips.

Make Choices that Conserve Your Time and Energy

Make Choices that Help You Fight Stress

Make Choices that Provide Emotional Nurture

"Think Differently!"

References

National Mental Health Association. Stress: Coping With Everyday Problems. http://www.mentalhealthamerica.net/go/information/get-info/stress/stress-coping-with-everyday-problems


Last Modified Date: September 10, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

EXERCISE AND MS


Exercise is very important for patients with multiple sclerosis (MS). Recent studies show that exercise can yield real improvements in quality of life for patients. Studies also show that people with MS can exercise more than was believed possible even a decade ago. There are at least five ways exercise positively impacts the health of people with MS.

Muscle strength increases with exercise. Studies show that patients' performance of daily tasks improves with exercise. Walking pace and stair climbing ability, for example, are improved by exercise.

Fatigue is a common problem for patients with MS. The severe fatigue of MS can be improved by exercise. (See tips below).

Bowel and bladder function is enhanced by exercise.

Depression is reduced by regular exercise. In studies with patients who have MS, exercise stimulated a more positive mental outlook. Patients who exercised also got involved in more social activities. Exercise helps people feel empowered against MS.

Contractures can be reduced or prevented with exercise. Contractures are permanent muscle contractions. Joints are "frozen" in either a flexed or extended position. A contracture occurs if opposing muscle groups become too weak to counteract the muscle contraction.

Special Tips and Cautions:

Why You Need Exercise

People who exercise are usually healthier and happier than those who don't exercise. They are also more likely to live longer and to have a more positive outlook. For these reasons, exercise has now become an important part of the treatment plan.

The Benefits of Exercise

Regular exercise, designed around a patient's physical abilities and limitations, yields many benefits.

Cardiovascular health is improved. Regular exercise helps lower blood pressure. It also increases "good" cholesterol, improves circulation and helps reduce the risk of heart disease.

Muscles around the joints get stronger. This reduces strain on the joints and helps protect them. Flexibility is better and stiffness is reduced.

Bones get stronger. Weight bearing exercise applies tension to muscle and bone. Weight bearing exercise can increase bone density by as much as 2 - 8% a year, helping to prevent osteoporosis.

Weight control is enhanced by exercise. Keeping a normal weight helps prevent health problems like heart disease and high blood pressure.

Stress is reduced by exercise. Exercise promotes relaxation and reduces tension. Over time, exercise increases the body's capacity for dealing with stress.

Mental functions may be improved. Math skills, creativity, reaction time, imagination and other mental skills have been linked to aerobic exercise.

Depression and anxiety are decreased. Exercise prompts the release of endorphins, the body's natural "feel good" chemicals. Studies show that as fitness improves, endorphins are released faster during exercise.

The digestive tract benefits from exercise. Those who exercise often are less likely to have constipation, indigestion or ulcers.

Other benefits include sleeping better at night, less fatigue and more energy.

Types of Exercise

Exercise can be therapeutic or just for fun. A therapeutic exercise program is one designed to achieve specific health benefits for the patient. A physical therapist, occupational therapist or physician can help patients design exercise programs that are right for them. A balanced program may include three kinds of exercise.

Exercise Tips


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

MS AND STRESS


Human beings experience stress as a response to change. While everyone experiences stress, people with a chronic illness like multiple sclerosis (MS) often have more stress than healthy people do. Chronic illnesses may require people to make significant changes in many, or perhaps most, areas of their lives.

MS has the potential to create stress in some or all of these ways:

  1. The illness itself a fixed and ongoing stress. MS symptoms are also aggravated by other stresses. This creates a cycle: having the disease is stressful. Life stresses can worsen symptoms, creating even more stress.
  2. Financial stress may result from the expenses connected with the illness. Medications, assistive devices, in-home care etc. can drain finances while simultaneously affecting the ability to earn wages.
  3. The effects of the disease upon the body and one's perception of his or her own body can affect self-esteem, creating emotional stress.
  4. The pain that may accompany MS is physically and emotionally stressful. Some patients experience pain in the joints, muscles or back. Muscle spasms can also occur. A very small percentage of patients experience the intense pain of trigeminal neuralgia, a disorder of the 5th cranial nerve. Others experience dysesthesias, which are sensations of burning or aching.
  5. MS may create various degrees of dependency, due to weakness or mobility problems. The need to depend on help from others is stressful for some people.
  6. MS may require a person to change jobs or to stop working. Employment-related stresses can impact one's sense of being productive and ability to contribute to the support of self or family. This can be emotionally stressful.
  7. MS can cause social stress. Sufferers may be excluded or avoided. They may not be able to participate in some activities or to keep pace with family or friends. This can create a sense of isolation and/or a sense of being "different."
  8. MS often causes emotional stress that is serious enough to require medication. Many patients experience depression. Depression may result from medications used to treat the disease, or from the changes that have affected self-image. Fatigue is also very common. Being too tired to do things can be stressful for the person with the disease. Healthy people may not understand that depression and fatigue are related to the disease. This can cause relationship stress.
  9. Fear is stressful. Patients may fear the course of their disease. They may fear pain, weakness, the future or various other things.
  10. MS can put stress on marriages and families. Roles may need to change. The well partner may have to be the wage earner, and caregiver while taking care of the home too. He or she may feel overburdened. The partner with the illness may feel guilty, angry or less important. MS may affect sexual intimacy and the ability to "connect" emotionally with one's spouse and family.

Coping with Stress

It is very important for people with MS to learn how to cope with stress. Experts say that the key to managing stress is how we think about the things that cause us stress. Patients are encouraged to distinguish between things that can and cannot be changed. When things can't be changed, the patient's thinking must change. Many people have learned to combat stress by mastering relaxation methods. Books and tapes, support groups, counseling, exercise, humor, breathing techniques and sometimes medication can help. In addition, patients can make choices that help reduce some of life's routine stresses. This starts by identifying stressors and then taking steps to reduce as much stress as possible.


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

MS AND A HEALTHY DIET


The Dietary Guidelines for Americans is published every five years by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture. The guidelines provide consumers with information based on scientific evidence to help them promote health and reduce risk for major disease through diet and exercise. Eating the right foods and being physically active are fundamental to a healthy lifestyle.

Foods provide a variety of nutrients the body needs to function properly. As such, the guidelines recommend that nutrient needs be met primarily through consuming foods. Dietary supplements may be useful additions to the diet when the diet alone cannot provide all necessary nutrients in sufficient amounts.

A calorie is the amount of energy provided by food. The number of calories needed in the diet each day varies for different people based on age, gender, activity level and health status. Routinely consuming more calories than the body needs each day will lead to weight gain. If you consume 100 calories more than you burn every day, you will gain one pound in a month! Routinely consuming fewer calories than the body needs each day will lead to weight loss. Regular physical activity along with a healthy eating plan will help people achieve and maintain a healthy weight.

A healthy eating plan includes a variety of nutrient-rich foods every day. Foods should come from each of the five food groups, grains, vegetables, fruit, milk, and meat and beans. At least half the grains consumed should come from whole grains. Foods from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) should be consumed several times a week.

A healthy eating plan also limits the amount of saturated fats, trans fats and cholesterol. Salt (sodium) and sugars should also be limited. Those who choose to drink alcoholic beverages should do so sensibly.

The Dietary Guidelines note that food-related health is not limited to what people eat. Food safety is also important. Steps should be taken to avoid the germs that cause food-related illness. In particular,

A healthy eating plan can help manage some symptoms related to MS. Many people with MS suffer from constipation. Increasing daily consumption of fresh fruits and vegetables, and adding high fiber foods like oat bran may help. Talk with your doctor and/or dietitian about any changes you may need to make to your diet.

Diet, Nutrition, and MS

Do diet and nutrition play a role in causing MS? Some doctors and researchers are sure that they do. Others are equally sure that they do not. Can MS be improved with diet and nutrition? Again, the answer depends upon which doctors, researchers or patients you talk to.

Certainly, what we eat does directly affect our health, and good health is unlikely apart from good nutrition. Whether what we eat can cause, prevent or alter the course of MS, however, remains uncertain. More information about diet, nutrition and MS will no doubt emerge over time as research continues.

One field of practice within complementary and alternative medicine (CAM) focuses on preventing illness, maintaining health, and reversing the effects of chronic disease through diet or nutrition. Many people with MS, and many in the healthcare professions as well, are vitally interested this area of alternative medicine, which includes orthomolecular medicine, nutritional supplementation and special diets.

Theories: Can Diet Cause MS?

One of the most puzzling aspects of MS is its uneven distribution across the latitudes of the world. This has contributed to the diet-related theories about what may cause MS. Here are some of the theories about diet and MS:

Special Diets for MS

Numerous kinds of special diets have been proposed as therapeutic for MS. Some diets exclude gluten or certain other nutrients, based on the assumption that MS is related to a food allergy. Others include excessive or even toxic amounts of certain vitamins. People have tried vegetarian diets, fasting diets, high fiber diets, and many of the famous "fad" diets. None of these diets has demonstrated the ability to cure or slow the progress of MS.

However, one nutritional approach that may benefit patients is a diet low in saturated fat. Dr. Roy Swank of the department of neurology at the Oregon Health Sciences University in Portland developed such a diet specifically for people with MS. One hundred forty-four patients with minimum, moderate or severe MS followed Dr. Swank's diet for 34 years. Those who consumed no more than the prescribed amount of daily fat, 20 grams, experienced significantly less deterioration over the years than those who exceeded 20 grams a day. The people in this study who fared the best were those who had the least amount of disability when they first began the diet. It must be emphasized that this was not a scientifically controlled study; the effectiveness of this diet in MS has not been established.

A well-balanced low fat diet is a healthy diet, within accepted dietary norms. Because it poses no nutritional risks, a low fat diet can be safely used by patients with MS.

Orthomolecular Medicine and MS

Orthomolecular medicine might also be called nutritional medicine. This form of alternative medicine advocates treating disease and maintaining health with the optimum concentrations of substances that naturally occur in the body. An orthomolecular physician's first line of treatment is always with nutrients that occur in nature or are manufactured by the body: vitamins, minerals and hormones. Drug therapy is reserved only for special cases.

Orthomolecular doctors disagree with the standardized RDA (recommended daily allowance) nutrition values set by the government. They believe that because people are biochemically unique, nutritional needs are not necessarily the same for everyone. In addition, since the RDA is intended for healthy people, they feel that sick people have nutritional requirements that exceed the RDA. Orthomolecular physicians normally prescribe nutrients in combination or in high doses.

The current thinking of mainstream medicine is that because there is no evidence connecting MS to a deficiency in vitamins or other nutrients, there is no need to supplement a normal, well-balanced diet. At most, according to conventional medicine, patients may want to add a daily multivitamin pill.

Diet and the Symptoms of MS

There is presently no diet that can cure multiple sclerosis. However, there are a number of diet-related ways to ease some of the symptoms of MS.

Bowel Problems

Many patients with MS experience constipation. This problem is often solved by adding fiber and fluids to the diet, and increasing exercise. Six to eight glasses of water a day is recommended, along with about 30 grams of fiber. Fresh fruits and vegetables, whole grains, bran, legumes and lentils are good sources of fiber. Fiber should be added to the diet very slowly—accompanied by increased water intake—to avoid bowel discomfort. Foods known to contribute to constipation, such as hard cheese, nuts and chocolate, should be consumed in modest portions.

Bladder Problems

People with bladder problems tend to shy away from fluids. This can actually create more problems. Constipation, dehydration and nutritional deficits can result from an inadequate fluid intake. Six to eight glasses of fluid are needed daily regardless of bladder problems. Diuretics (substances that promote the formation of urine) should be avoided, however, a doctor may prescribe diuretic medicine for other medical conditions. Alcohol and beverages that contain caffeine, such as coffee, tea, soft drinks and chocolate drinks are diuretics to avoid that can irritate the bladder.

Beverages that increase the level of acidity in urine can help prevent bladder infections. Cranberry, apple, apricot and prune juice can help protect against bladder infections. Beverages that have the opposite effect, making the urine more alkaline, should be avoided. These include orange, grapefruit and tomato juice, milk and products that contain sodium bicarbonate. Foods like lima beans, potatoes and milk products also make the urine more alkaline and should be limited.

Fatigue

Fatigue is often a problem for people with MS. Good nutrition can help fight fatigue. When energy is low, some people prefer to eat six small meals throughout the day rather than three large ones. Junk snack foods should be avoided. Instead, snack on low fat, high nutrition foods that can help maintain energy: yogurt, hummus, soup, string cheese, and fruit.

Mobility Problems

Immobility can result in weight gain. Extra weight contributes to fatigue, which in turn may result in more immobility. Maintaining a normal body weight benefits the overall health of patients. It is important to stay aware of the caloric value and the nutritional value of the foods and beverages being consumed. A dietitian can provide guidance about food choices and weight control.

Chewing and Swallowing Problems

When chewing or swallowing becomes difficult, certain foods can help. Thicker beverages are easier to swallow than thin ones. Milk shakes, puddings, sherbets and sauces are good choices. Soft textured foods are easier to chew. Cooked, stewed, mashed or blended fruits and vegetables require less effort to eat than fresh ones. Crumbly foods such as crackers, chips and cake can cause choking and should be avoided. If chewing and swallowing are tiresome, smaller meals spread throughout the day may make it easier to maintain good nutrition.

An Emotional Boost

There are many aspects of MS that are beyond a patient's control. Diet is one area, however, where the patient is free to exercise complete control. Anyone can choose to improve his or her overall health through diet. A nutritious low fat diet also has emotional and psychological benefits. Patients who use a healthful diet to control weight, improve energy, or reduce symptoms will also feel a greater sense of control over their disease.

 


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

DRUGS & CONDITIONS

SUPPORT RESOURCES


There are numerous foundations, organizations, support groups and web sites dedicated to providing MS patients and their families with excellent information and support. Here are some you may wish to contact:

The National Multiple Sclerosis Society

"The National Multiple Sclerosis Society is dedicated to ending the devastating effects of multiple sclerosis." This group offers information about MS, research, web broadcasts, and local MS support chapters.

The National Multiple Sclerosis Society
733 Third Avenue, Third Floor
New York, NY 10017
Telephone: 1-800-Fight-MS (1-800-344-4867)
E-mail: info@nmss.org
Website: http://www.nmss.org/

Consortium of MS Centers

Consortium of MS Centers
359 Main Street, Suite A
Hackensack, NJ 07601
Tel: 201-487-1050 Fax: 201-678-2290
Website: http://www.mscare.org/index.cfm
For website general information, please email info@mscare.org

The Multiple Sclerosis Foundation

"Founded in 1986, the MSF is the oldest national MS support organization that focuses on both complementary and conventional health care options to address the varied symptoms associated with this lifelong neurological disorder." This foundation offers toll-free phone support, networking and referral services, an in-house library and a free quarterly news magazine, The MSFocus.

The Multiple Sclerosis Foundation
6350 North Andrews Avenue.
Fort Lauderdale, FL 33309-2130
Administrative Offices, Fund Raising, Donations, Advertising
Call toll-free (within USA): 800-225-6495
or Fort Lauderdale area 954-776-6805
(9 a.m. – 5 p.m. Eastern Standard Time)
Fax: 954-938-8708
E-mail: admin@msfocus.org

Program Services Assistance, MS Helpline
Call toll-free (within USA): 888-MSFOCUS
or Fort Lauderdale area 954-776-6805
(9 a.m. – 7 p.m. Eastern Standard Time)
Fax: 954-351-0630
E-mail: support@msfocus.org

The Myelin Project

"The Myelin Project aims to accelerate research on myelin repair. Myelin, the white matter insulating the nerves, allows the conduction of impulses from one part of the body to another. It can be destroyed by hereditary metabolic disorders such as the leukodystrophies, and in acquired diseases such as multiple sclerosis."

The Myelin Project Headquarters
1400 Wallace Boulevard, Suite 258
Amarillo, Texas 79106
800-869-3546 or (806) 356-4693
Email: candace.root@myelin.org
Fax: (806) 356-4694
Website: http://www.myelin.org/

Multiple Sclerosis Association of America

"The Multiple Sclerosis Association of America is dedicated to enhancing the quality of life of people coping with multiple sclerosis - those with MS, their families, their friends."

Multiple Sclerosis Association of America
National Headquarters
706 Haddonfield Road
Cherry Hill, NJ 08002
Telephone: 1-800-532-7667
E-mail: webmaster@msassociation.org
Fax: (856) 661-9797
Website: http://www.msaa.com/

 


Last Modified Date: March 1, 2009 © Accordant Health Services, a CVS/Caremark company. All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.