Multiple sclerosis is one of the leading causes of disability in young patients, according to Dr. Yadira Dacosta, a neurologist.
Daniela Osorio Rivera
Latin Agency for Medicine and Public Health News
Multiple Sclerosis (MS) is a demyelinating condition of the central nervous system that, in addition to the typical motor or sensory symptoms, can also present complications and comorbidities at the systemic level. It is very important to identify these symptoms, not necessarily neurological, in order to avoid major complications which can increase the risk of relapse and progress of the condition.
“The quality of life of the patient can be affected if it fails to identify and offer adequate treatment for these complications. Given this, the neurologist must work hand in hand with a multidisciplinary team of specialists who assist with the management and treatment of comorbidities associated with the disease, ” said the president of the Puerto Rican Academy of Neurology.
The American Academy of Neurology has established guidelines that facilitate a comprehensive evaluation that measures the level of disability of the patient. These guidelines are known as the “Multiple Sclerosis Disability Measurement Scale”. They evaluate aspects such as: risk of falls, urinary system problems, fatigue, depression, physical activity, and quality of life monitoring.
Chronic fatigue management
This is one of the most common symptoms of the condition with a prevalence of 80%, it also tends to be multifactorial, associated with the use of multiple medications. It is recommended to screen for neuropsychiatric symptoms such as depression and anxiety that could contribute to symptoms of chronic fatigue.
“Once these causes of fatigue have been adequately treated, a program should be established that includes techniques such as moderate exercise, adequate rest and management of room temperature, adequate nutrition and hydration,” explained Dr. Yadira Dacosta.
Management of cognitive disorder and depression
“Cognitive disorders have a prevalence of almost 50% in MS patients. These problems tend to manifest in late patients with the disease, although they can occur in early stages of the condition and even in clinically isolated syndrome. Formal neuropsychological evaluation is recommended annually, “said Dr. Yadira Dacosta.
Urological problems are quite common in patients with MS, usually associated with injuries to the spinal cord and brainstem. Neurogenic bladder symptoms can usually be divided into urinary retention or incontinence problems, and a formal evaluation with a urologist is recommended for any patient presenting with urinary symptoms.
“The strategies used for neurogenic bladder management are to reduce fluid intake before sleeping, avoid irritants such as caffeine, alcohol, tobacco and citrus fruits. A relatively new alternative in patients with overactive bladder is neuromodulation using percutaneous tibial nerve stimulation “, expressed the president of the Puerto Rican Academy of Neurology.
Management of sexual dysfunction
Problems of a sexual nature are very common in patients with MS, usually in men they manifest with problems of impotence or ejaculation; in women with anorgasmic problems lubrication and libido is reduced. Impotence in men is usually associated with spinal cord injuries, however, both women and names should be investigated psychological problems such as depression and anxiety, which could be contributing greatly to the problem of sexual dysfunction.
Management of neuro-muscular symptoms
The most common symptoms are spasticity and weakness, these symptoms can also be associated with pain, cramps and stiffness. These symptoms directly affect the quality of life of the patient, limiting in many cases daily activities. It is very important not to over treat spasticity since this is often the compensation mechanism in patients with weakness to be able to walk, transfer and postural support. The initial treatment for both spasticity and weakness should be a physical therapy program usually recommended by the physiatrist.
MS usually affects young patients, therefore many of these patients could face problems in the workplace. Some of the effective techniques to mitigate impact in the workplace are: reasonable accommodation and avoid long hours of work, avoid work that requires greater physical effort such as working at heights or operating with heavy equipment machinery.
“Staying hydrated and avoiding long hours of excessive heat or in the sun is crucial to avoid exacerbation of symptoms” according to Dr. Yadira Dacosta, neurologist.