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Insidious Progression of MS: More Than Just Relapses and RemissionsBy: HaranMultiple sclerosis (MS) is an insidious disease where destructive lesions in the brain and spinal cord interfere with practically every physical process in the body. No two people have the exact same set of symptoms, which can range from the annoying to the disabling. And that's why many MS specialists are saying that the management of MS symptoms should also vary from person to person. In MS, the body mistakenly attacks its own myelin, the fatty tissue that insulates the nerves in the central nervous system, leading to attacks or flare-ups of MS symptoms. Disease-modifying drugs are given to decrease the frequency of those attacks and to slow down the progression of the disease.

"But treating the pathology of MS does not necessarily translate into treating symptoms of the disease," says Heidi Crayton, MD, co-director of the Multiple Sclerosis Center at the town University Multiple Sclerosis Center in Washington, DC. "I believe it is when people's symptoms aren't being addressed that they stop taking their disease-modifying drug, because they don't feel any better."

Treating MS symptoms can help people not only stay on their disease-modifying drugs but also feel better. And effective symptom management, Dr. Crayton says, starts with good doctor-patient communication. In an MS center, the neurologist will oversee symptom management, but outside of a center, the neurologist might refer a patient to other specialists or to the primary care doctor. Healthology talked with Dr. Crayton to get an overview of MS symptoms and to find out how addressing even minor symptoms can make the difference.

What are the most common MS symptoms?Most people have symptoms from their MS that affect their quality of life on a day-to-day basis. Probably the most common symptoms are fatigue, spasticity, bladder and bowel dysfunction, cognitive dysfunction (problems with thinking and remembering), sexual dysfunction and pain. The symptoms can occur by themselves or in conjunction with other symptoms and when they build up, MS becomes a lot more disabling.

How do you approach the treatment of such a wide range of symptoms?Doctors and patients often get very overwhelmed and are not quite sure where to start. It really is a kind of a negative feedback loop. For instance, if somebody's fatigued and depressed, they're not very likely to exercise. And, as the level of exercise decreases, spasticity increases and so does constipation. And if you're more spastic and constipated, you have a full colon, so you usually develop bladder problems. And if you have bladder problems, you're probably not getting good sleep. And if you're not getting good sleep, then you usually experience cognitive deficits. And cognitive deficits feed into fatigue and depression. So it is a very vicious cycle and you just have to dive in.

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