The symptoms of multiple sclerosis vary widely. They depend on the location of the demyelinating changes in the central nervous system. Medications can relieve some symptoms.
Weakness
One of the first symptoms affecting mobility is muscle weakness. The sick person feels his limbs heavy, he lifts them with difficulty and moves them. As a result of demyelination, nerve impulses are incorrectly or inappropriately transmitted from the CNS (Central Nervous System) to the muscles. As the disease progresses, the weakness can turn into paresis (para or even tetraplegia). It is very important to constantly exercise weakened muscles, take advantage of rehabilitation, because this is the only way to prevent gradual muscle wasting.
Muscle spasticity
One of the most common symptoms of multiple sclerosis is muscle spasticity. It is manifested by increased muscle tension or muscle stiffness. Spastic limbs are difficult to bend or straighten, and there may be uncontrolled painful muscle contractions. Spasticity makes it difficult to move and sit down and, if left untreated, it leads to contractures and muscle weakness. The cause of spasticity is damage to the CNS (central nervous system) and inappropriate response to stimuli. The treatment of spasticity is mainly physiotherapy and the use of oral medications (baclofen, tizanidine, tetrazepam, diazepam, tolperison). In the case of severe spasticity, botulinum toxin injections into specific muscle groups are sometimes used, as well as baclofen pumps that deliver the drug directly, which deliver the drug (baclofen) directly to the spinal canal and the spinal cord running through this canal. The pump is surgically implanted under the skin on the abdomen. It has a thin flexible catheter that leads into the spinal canal. It is equipped with a programmer that can be used to set the appropriate precise administration of the drug. Unfortunately, the baclofen pump is a cheap device, it costs about 30 thousand. PLN and the National Health Fund does not provide for the possibility of reimbursement.
Urinary incontinence problems
Another common, annoying and somewhat embarrassing problem is incontinence problems. People with multiple sclerosis develop the so-called neurogenic bladder. Demyelinating changes in the CNS, depending on their size and location, lead to disturbances in the transmission of impulses that control the bladder. Two forms of disturbance are distinguished:
– atonic bladder, without tension, resembling a balloon, which, when released from it, does not return to its previous shape and size. Since the kidneys are still producing urine and diverting it to the bladder, it is possible that the bladder is too full – you can feel it perfectly around the navel. While such an overfilled bladder does not rupture, urine can overflow. Then there is a very bothersome phenomenon of spontaneous, involuntary urination;
– spastic bladder, which is in a state of constant tension, which leads to frequent pressure with relatively low inflation. It can also lead to uncontrolled urination. The bladder does not empty completely. This causes urine debris to accumulate on the walls of the bladder, which promotes the growth of various bacteria and urinary tract infections.
Various methods of dealing with this problem are used, depending on what kind of disorders appear more often. In the case of urinary incontinence, anticholinergic drugs such as oxybutynin are used tolterodine, darifenacin, solifenacin. Depending on the degree of urinary incontinence, patients also use various absorption agents, e.g. anatomical inserts, diaper pants, diapers, absorbent pants. People with Multiple Sclerosis are eligible for a 70 percent reimbursement. prices for 60 items of the aforementioned funds per month (price limit of PLN 90).
Problems with completely emptying the bladder are much more dangerous to health. Urine remains, they are a breeding ground for bacteria, they lead to frequent inflammation of the urinary tract, not only in the lower urinary tract, but also in kidney infections. If there is a retention of urine, it is sometimes necessary to learn self-catheterization, i.e. self emptying the bladder with the help of a catheter. It is not painful, but for people with hand problems, it can be difficult. Then it is worth using the help of a nurse or inserting a catheter permanently. People with neurogenic bladder problems should be under the supervision of a urologist.
Balance disorders
“You walk like drunk” is a phrase that people with MS who have imbalances often hear. These kinds of comments force them to reach for a cane or crutch that somehow explains the wobbly gait. Difficulties with maintaining balance most often result from demyelination of the cerebellum, the area of the CNS responsible, among others, for coordination and smoothness of movement. It can also be associated with muscle weakness and dizziness. Unfortunately, pharmacological treatment of such problems is very difficult, sometimes drugs that improve cerebral circulation are administered. The most important thing is physiotherapy and safety, the use of appropriate aids in movement that will ensure stability, e.g. walking sticks, crutches, walkers. Each fall may result in fracture, immobilization and the appearance of other motor problems, aggravating disability.
me, speech disorder
Ataxia is an equally difficult cerebellar symptom to treat pharmacologically. It manifests itself as intentional tremors, imprecise or uncoordinated, inert movements. It is a symptom that makes everyday functioning very difficult, and at the same time the lack of drugs that can deal with the problem effectively. Only properly selected rehabilitation can improve the precision of movements.
Speech disorders, the so-called chanted speech is another symptom of demyelination of the cerebellum, also difficult to treat and at the same time very difficult social functioning. The patient speaks fluently, stutters slowly, divides words into syllables. Sometimes there is also blurred, slurred speech (dysarthria) resulting from disorders of the muscles of the speech organs, e.g. excessive spasticity. In all these cases, speech therapy is required. It is worth checking where the nearest speech therapy clinic that has a contract with the National Health Fund for neurologopedics and dysarthria therapy is located.
Text: Iza Czarnecka