Multiple sclerosis & Treatment
What happens in Multiple Sclerosis?
Multiple Sclerosis (MS) is a inflammatory disease of the brain and spinal cord, that involves an immune-mediated process in which the body’s immune system (particularly T cells) abnormally turns on against the central nervous system. The exact trigger or target that the immune system is trying to attack, remains unknown and there currently is no cure. It is thought that environmental factors can predispose a person who is genetically susceptible to develop MS.
In MS, the immune system preferentially attacks the fatty sheath around nerves called myelin, as well as the nerve fibres themselves. The damage leaves scar tissue called sclerosis, and because of this variable damage that can occur at various parts of the brain and spinal cord, a mixture of symptoms are experienced.
Common symptoms include temperature mediated fatigue, tremors, visual disturbances, sensory changes and difficulties with balance or coordination. Reduced voluntary coordination in movement is called ataxia. Others may also exhibit increased tone (muscle resting tension) or spasticity (increased resistance to movement faster than gravity).
Understanding the 4 types of MS
This type is characterised by clearly defined “attacks” that result in a sudden reduction in neurological function called relapses. This is followed by partial or complete recovery of symptoms called remission periods. Most people diagnosed with MS are in this category.
This type usually follows on after a Relapse-Remitting course. Neurological function begins to take on a more predictable and progressive course without any periods of remission.
This type is characterised by a a gradual worsening of neurological function from the start, and may have periods of mild improvement or greater than expected worsening, without distinct periods of remission.
The rarest of the four types, this type presents with worsening of neurological function from the start, but punctuated by distinct relapses on a background of gradual decline in function without remission.
How is MS commonly treated?
Most people with MS have a trusted neurologist who can help them understand how their particular form of MS and where the lesions are may impact on their life ahead of them. Given the changing nature of MS, it is important to be honest and clear about what is happening so early intervention can help alter the course of the disease.
People with MS are often on disease modifying medications that help to reduce the level and areas of inflammation in the central nervous system, reduce the severity and frequency of attacks which may help slow the progression of the condition with the aim of delaying disability.
The more time that we can delay the symptoms, the greater the opportunity to build physical reserve and plan and adjust to it.
Other medications can help manage pain, fatigue, bladder problems, cognitive problems and sexual dysfunction.
What can neurological physiotherapy help?
While physiotherapy cannot directly reduce sclerosis on the central nervous system, it can improve the function of the person with MS through a variety of ways.
Effective physiotherapy depends on the knowledge of the affected part of the central nervous system. Lesions in the left parietal lobe cause different problems to lesions in the spinal cord. Knowing the differences is key to being able to offer effective treatment, as well as predicting the expected difficulties a person may have and hence making a clinical decision about which systems therapy should be aimed towards.
Physiotherapy can help with improving balance and coordination.
In order to truly improve balance, the physiotherapist needs to understand the components that make up balance and maximise the performance of remaining systems, as well as pitch the difficulty perfectly on the system most affected by the MS. A range of exercises and movement and sensory based retraining can be used.
Physiotherapy can help manage tonal problems.
Spasticity is a commonly described neurological sign in people with MS, which can be problematic because it can make movement feel very stiff, painful or uncontrollable. With the help of a neurologist or rehabilitation physician, spasticity can respond very effectively with systemic oral medications (such as baclofen) or with locally injected medications (such as botulinum toxin A – otherwise known as botox) in conjunction with physiotherapy. This is because these drugs can reduce the level of spasticity to enable more opportunity to develop more fluid movement patterns to enable better walking or running and improve quality of life.
Physiotherapy can help with improving paralysis.
Because MS is a disease of the central nervous system, the peripheral nervous system remains intact. This means that there is potential for the muscles of the arms and legs that have reduced “command” to move with the help of training and electrical stimulation. Sometimes electrical stimulation can be used a training tool for the development of motor control and local muscle strengthening to reduce the effect of non-use during relapse, and other times it could also be used permanently to treat foot drop.
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