Evaluation and Treatment of Symptoms

There are many symptoms of multiple sclerosis. Some symptoms are not readily apparent (fatigue, cognitive problems, numbness and tingling, bladder problems, etc.), while others can be very apparent (weakness and decreased balance). New symptoms you have not had before can mean a relapse is occurring. It’s very important to tell your neurology team when new symptoms occur. In addition, older symptoms that return can mean you are having a flare. Flares can occur when you become fatigued, develop infections, are under stress, or have a procedure done. Communicating your symptoms and their severity to your neurology team is very important so that treatment options can be discussed. In addition, some of these symptoms may indicate disease progression.

It’s important to talk to your healthcare provider about all symptoms, even if you’re not sure if it is MS-related. They can help determine what is MS-related and what should be discussed with your primary care provider.

These are some common symptoms and treatment options:
  • Fatigue
Fatigue occurs in more than 80 percent of patients with MS. It can range from annoying to debilitating. Strategies to help with fatigue include getting enough sleep, exercising regularly, having your doctor check your B12 level (and for men testosterone level), pacing yourself, and avoiding heat. There are also medications that can help with fatigue.

  • Balance
Being off-balance may include feeling lightheaded, a heaviness in your legs, or as if you are about to fall. Physical therapy to assess walking and help develop a home exercise program or recommend assistive devices can help. There is a medication available that helps improve walking speed that your doctor can discuss with you, if appropriate.

  • Muscle Tightness
Spasticity is another name for muscle tightness in MS. This tightness feels quite uncomfortable and can sometimes make your arm or leg muscles shake when you don’t want them to or stiffen from even a simple touch or stretch. You need a certain amount of muscle tightness to be able to stand and walk, but in excess it can worsen function and produce pain. There are medications and stretching exercises that can help control this.

  • Numbness and Tingling
This usually occurs in the arms and/or legs, but can also occur in the face, chest or waist. Sometimes simply resting or getting to a cooler place will help. There are medications that can help with this as well.

  • Bladder Problems
Urgency, frequency and hesitancy are all common complaints with regards to the bladder. One of the first evaluations to be done is to check for a bladder infection, which can cause these same symptoms. Medications are available to help; however, treatment should also focus on nondrug therapy, such as avoiding caffeinated products and alcohol, and drinking more water. Sometimes you may be referred to a urologist for further evaluation and management.

  • Bowel Problems
Bowel dysfunction can produce constipation or diarrhea. Both of these symptoms should be discussed with your neurologist, and sometimes a gastroenterologist will be advised for management. Sometimes the medications given to treat other conditions in MS can aggravate constipation. Treatment initially should be management of diet, including drinking plenty of fluids and increasing fiber, but be sure to tell your doctor about any home remedies or over-the-counter products you are taking, as some can worsen these symptoms.

  • Vision Problems
Optic neuritis, an inflammation of optic nerve due to a lesion developing somewhere along the tract of this nerve, is a condition that can present itself at any time in the course of the disease. Symptoms can include a darkening of the vision, being unable to see colors as clearly, and pain with eye movement. If these symptoms occur, it’s important to contact your neurologist and possibly an ophthalmologist as soon as possible for evaluation. Treatment for optic neuritis typically includes IV medication. The other common vision problem is intermittent blurriness. Blurry vision is typically worsened by heat, illness and stress. You should have a normal eye examination if this occurs. Treatment for vision blurring is usually rest, cooling and treating any infections present.

  • Memory Problems
Difficulty remembering appointments, names and/or directions is unfortunately common in MS. More than 50 percent of patients with MS have problems with memory. Be sure to discuss this symptom with your neurologist if it is a concern for you. There are strategies that can help. Your neurologist may recommend an occupational therapist for memory testing, and perhaps neuropsychological testing. Neuropsychologists are specially trained to evaluate memory and thinking problems, and they can provide strategies to help manage any problems they find.

  • Depression
More than 50 percent of patients with MS experience depression. Symptoms can include sleeping too much or too little, eating too much or too little, feeling anxious, feeling hopeless, having thoughts of suicide, or a combination of the above. Depression is a chemical imbalance in the brain but may also have something to do with the location of the MS lesions. It is very important to talk to your neurologist and primary care physician about depression. There are treatments, including counseling, available.

  • Intimacy
Sexual problems can also occur in MS. Symptoms can include lack of sensation and can be aggravated by fatigue. If you are having any problems with sexual function, please talk to your neurologist.

  • Relationship Problems
Because of the many symptoms of MS, including fatigue and cognition, relationships can be challenged. Caregivers sometimes must take on additional duties at home as well as work, which can put a strain on the relationship. In addition, it’s sometimes difficult for caregivers to understand MS, because symptoms may not be readily visible. Communication is very important for keeping your relationship strong. If you feel that your relationship is suffering, talk to your neurologist. Help is available depending on your needs.