Contents
The appearance of specific symptoms in multiple sclerosis depends on the location of the demyelinating lesions in the brain and spinal cord. Their number, size and distribution can be so different that, as neuroscientists say, no two people with MS (sclerosis multiplex) suffer from the same disease.
Multiple sclerosis affects not only the ways of moving, but also how a person sees, hears, feels the world, their emotions, possibilities of action, intimate life – in a word, almost all aspects of life.
Trouble seeing
Vision problems in the form of retrobulbar optic neuritis can be one of the first symptoms of multiple sclerosis. The most common symptom of optic neuritis is visual impairment and even blindness in one eye, eye pain that increases with eye movements. Treatment takes place in a hospital setting, usually intravenous infusions of corticosteroids and injections of corticosteroids into the retrobulbar space. Usually, visual acuity returns, but there are times when some gaps remain and there may be less color vision.
Another visual symptom, but not due to demyelination of the optic nerve, is double vision (diplopia). The sick person then sees, in addition to the existing object, another which is a duplication of an existing one. This image may be less clear, weaker. Usually, it is a problem resulting from stereoscopic vision impairment related to the malfunctioning of the retrobulbar muscles, which are responsible for eye movement and synchronization of both eye movements. Double vision is usually temporary and resolves on its own. It may require, if it is a new, sudden symptom (relapse) of steroid therapy in a hospital setting.
Nystagmus is one of the troublesome and difficult to treat symptoms. It is based on the involuntary rhythmic movements of the eyeballs. It usually occurs as a result of demyelination in the cerebellum, which corresponds, among others, to for motor coordination. A person with nystagmus may have difficulty reading, having a sense of image mobility. As before, if it is a sudden symptom, it requires medical consultation and steroid therapy. In other cases, some preparations increasing cerebral microcirculation, such as piracetam (eg Nootropil, Biotropil) can help.
Hearing problems
Multiple sclerosis rarely leads to hearing difficulties. Sometimes, however, demyelination causes tinnitus or difficulties with the perception of sounds at certain frequencies, and the sounds seem to be indistinct, as if they were behind a wall. In the event of a sudden onset of such problems, you should see a doctor as soon as possible, who will probably prescribe steroid therapy. Hearing loss can be managed to some extent with the use of well-chosen hearing aids. Unfortunately, they are expensive and the National Health Fund co-financing is very low. A digital camera usually costs over PLN 4. Co-financing – PLN 560. You can also get a grant from PCPR, a maximum of PLN 1200 per hearing aid.
You should also remember that the hearing aids help to hear sounds at all picked up by the ear. If a frequency is not registered at all, the hearing aid will not help “recover” it.
Paresthesia and sensory symptoms
People with MS often experience unpleasant skin sensations: tingling, numbness, less sense of touch or, on the contrary, situations where the slightest touch causes pain. It happens that they perceive the temperature differently, both warm and hot. Paresthesia can appear on both the extremities and the torso or face. They are usually of a temporary nature, but may be a symptom of an exacerbation of the disease and then require steroid therapy.
Pain
For many years it has been held that people with MS are fortunate enough to feel no pain. This is not true. A number of symptoms can cause pain: spasticity, especially spastic muscle contractions and spasticity-related contractures. Neuralgias also appear, including trigeminal neuralgia and cutaneous hyperalgesia. Severe headaches are not uncommon. Unfortunately, neurologists often underestimate this symptom, while pain greatly worsens the quality of life.
Treatment of pain depends on where it is located and what is causing it. In the case of chronic pain, especially neuralgia, it is worth using the help of a specialist in the pain treatment clinic. You may need to use nerve blocks in combination with appropriate medications. Persistent painful contractures are sometimes surgically treated.
Mood swings
Symptoms of multiple sclerosis may also appear in other spheres of functioning. Emotional problems and depression are frequent. It is estimated that people with MS commit suicide seven times more than the rest of the population. Emotional disorders (most often it is mood swings) and depression can be both organic (location of demyelination areas in the CNS) and situational. It is not difficult to imagine the reasons for mood lability. The smallest improvement gives hope for stopping the disease, and the slightest decrease in functioning, failure related to disability, falling out of the cup from the weaker hand, causes despair. These symptoms can be difficult in everyday life, badly affect relationships with loved ones who often perceive these sudden outbursts of anger or despair as directed against themselves. It should be remembered that the basis for such behavior of a person with MS is not the relationships and behavior of relatives, but – multiple sclerosis, the course of the disease, its unpredictability. For this reason, the support of a psychologist is very important in life with multiple sclerosis. It is useful not only for the sick person, but also for their relatives.
Depression
Depression requires the help of not only a psychologist but also a psychiatrist. It may result from both changes in physical functioning and the need to change life plans, both professional and family. Sometimes it is also associated with the demyelination of certain areas of the CNS and the associated decreased secretion of serotonin, a neurotransmitter responsible, among others. for the mood. In any case, depression should be treated as a very serious, often fatal disease that, fortunately, can be managed with proper treatment and therapy. A situation where a depressed person with MS talks about suicide should never be underestimated. It is true that the statistics do not record suicide attempts, but only cases of death as a result of an attempted death, but these data are also frightening: about 15% of patients with severe depression die by committing suicide.
Diagnosing depression is not difficult. It is assumed that at least 4 of the following symptoms should occur:
- Depressed mood for most of the day
- decline in interests and inability to experience pleasure
- a marked increase or decrease in weight
- insomnia or constant excessive sleepiness
- slowness of movement or excessive mobility
- feeling of constant fatigue
- lowered self-esteem, unjustified guilt
- decline in intellectual performance and concentration
- recurring thoughts of death and suicide
The mere willingness or command to “pull yourself together” will not help depression. Usually, drug treatment and psychotherapy are necessary. Fortunately, the latest preparations do not have many side effects and deal with depression quite effectively. However, it is important to know that most of them do not work immediately and only after 3-6 weeks of taking. Therefore, do not be discouraged by the initial lack of effects, they will come gradually.
Tiredness
About 70% of people with MS complain of suddenly overwhelming fatigue. It has little to do with the fatigue you usually feel after strenuous work. It is a feeling of total powerlessness that prevents any action, both physical and intellectual. Exceeding this limit as part of “training” does not result in improved functioning. On the contrary, the fatigue worsens and other symptoms of the disease exacerbate. This symptom is probably due to the fact that due to demyelination, the signal from the CNS has to overcome the existing barriers, which is associated with a lot of effort. In addition to resting and learning to properly manage your energy resources, it is sometimes recommended that you take amantadine, modafinil or antidepressants by mouth. However, pharmacology is not always effective. Equally important are: support for relatives, psychotherapy and rehabilitation.
Cognitive impairment
Problems with concentration, attention, choosing the right vocabulary, planning, short-term memory may coexist with chronic fatigue and depression, and may also be a symptom in itself. At the same time, people with MS do not have the same problems as people suffering from, for example, Alzheimer’s disease. A person with MS may not remember where they put the keys a moment ago, but – they will always know what the keys are for; she may have trouble remembering the names of her cousin’s children, but – she will always know who they are.
Unfortunately, treatment is limited to improving the cerebral microcirculation. Much greater effects are achieved by rehabilitation of cognitive functions: memory, concentration, vocabulary exercises, etc. All word games and activities are useful here, including some logical computer games. It is also important to use all the amenities and help: electronic or computer calendars, for example, writing down purchases or important things to do.
Intimate life
Many people with MS have sexual problems. They are manifold. Sexual dysfunction specialists in MS divide into three groups: primary, secondary and tertiary. (Folley, 3). The basic ones result from changes in the central nervous system, and more specifically from disturbances in the flow of information between the brain, spinal cord and genitals. These include: decreased libido, inability to achieve orgasm, difficulty erecting in men, and vaginal dryness in women. Secondary are also physiological in nature, they are associated with the symptoms of the disease that can affect sexual life, e.g. problems with the intestines, bladder, fatigue, spasticity, paresis, difficulty concentrating. Finally – tertiary problems, i.e. mental and cultural problems: lowering self-esteem, physical attractiveness, social barriers, lack of acceptance of changing roles in a relationship.
Most of these problems can be resolved with the proper help of specialists and good communication with your partner. Of course, they often require medical consultation, sometimes pharmacotherapy (in case of problems with erection) or support from a therapist, learning the art of talking about these difficult topics.
Text: Iza Czarnecka