Multiple sclerosis (MS) is a life-long chronic disease of the central nervous system. It affects mainly young women (ages 20 to 50) and is an unpredictable condition that can range from being relatively benign to being totally disabling. Some people with MS may be mildly affected while others may lose their ability to write, speak, or walk. The problem occurs due to multiple areas of inflammation and scarring (sclerosis) in the central nervous system. When this happens, communication between the brain and other parts of the body is disrupted. About 250,000 to 350,000 people in the US have MS.
Although the cause of MS is not known, some of the causes of MS currently under investigation include the following:
- autoimmune disorders
- environmental factors
- genetic factors
Symptoms of MS are erratic and may be mild or severe. It is common to have an attack followed by a period of recovery - this is called exacerbations and remissions. Other times, symptoms are progressive and may appear in various combinations, depending on the area of the nervous system affected.
Initial symptoms of MS may include:
- blurred or double vision
- red-green color distortion
- pain and loss of vision due to optic neuritis (inflammation of the optic nerve)
- difficulty walking
- paresthesia (abnormal sensation or pain, such as numbness, prickling, or "pins and needles")
Other symptoms of multiple sclerosis may include any/all of the following (to a varying degree):
- muscle weakness in the extremities
- difficulty with coordination (impaired walking or standing may result; partial or complete paralysis is possible)
- spasticity (increased muscle tone leading to stiffness and spasms)
- loss of sensation
- speech problems
- hearing loss
About 50 percent of all people with MS experience cognitive impairments related to their disease. The effects of these impairments may be mild or severe and may include difficulty with any of the following:
- poor judgment
Fortunately, pregnancy does not appear to speed up the course or worsen the effects of MS. However, it is thought that women who have unrecognized MS may be more likely to begin having symptoms during pregnancy. Some studies have found that MS symptoms decrease in pregnancy and increase during the postpartum (after delivery) period.
The disabling effects of the disease may make it physically difficult for the mother to carry a pregnancy. Muscle weakness and coordination problems may increase the likelihood for falls. Fatigue may worsen. Paralysis and wheelchair dependence may increase the risk for urinary tract infections.
Women in labor with MS may not have pelvic sensation, and may not feel pain with contractions. This may also make it difficult for them to tell when labor begins. Delivery of the baby may be more difficult in women with MS. While labor itself is not affected, the muscles and nerves needed for pushing can be affected. This may make Caesarian section surgery, forceps, and vacuum-assisted deliveries more likely.
Pregnant women with MS need close monitoring of the disease and of fetal well-being. More frequent prenatal visits are often needed. There is no established treatment that alters the course of MS. However, medications may be used in pregnancy including steroids and anti-inflammatory drugs. A procedure called plasmapheresis (a method for removing toxic elements from the blood) has been used in investigative trials for treatment of MS. Consult your physician for more information.
A rehabilitation program for people with MS is designed to meet the needs of the individual patient, depending upon the type and severity of the symptoms and the amount of impairment. Active involvement of the patient and family is vital to the success of the program.
The goal of MS rehabilitation is to help the patient to return to the highest level of function and independence possible, while improving the overall quality of life - physically, emotionally, and socially.
In order to help reach these goals, MS rehabilitation programs may include the following:
- exercises and activities to help improve motor skills, restore activities of daily living (ADLs), and help the patient reach maximum independence
- exercises that promote muscle strength, endurance, and control
- management of bowel or bladder control
- use of assistive devices such as canes, braces, walkers
- methods to improve communication skills for patients who have difficulty speaking
- cognitive retraining
- vocational counseling
- adapting the home environment for ease of function, safety, accessibility, and mobility
- patient and family education
Rehabilitation programs for patients with MS can be conducted on an inpatient or outpatient basis. Many skilled professionals are part of the rehabilitation team, including any/all of the following:
- internist and other specialists
- rehabilitation nurse
- physical therapist
- occupational therapist
- speech/language therapist
- social worker
- recreational therapist
- case manager
- vocational counselor
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