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Understanding Multiple Sclerosis (MS)

What is Multiple Sclerosis?


Multiple Sclerosis (MS) is a type of condition where our immune system attacks the myelin sheath, a fatty substance that insulates our nerves from other electrical impulses and also increases the speed of electrical impulses can travel. The term multiple would suggest that it would affect several areas within the central nervous system which consist our brain and spinal cord, Therefore, the electrical signals sent in people with MS are slower because of the thinning of the myelin sheath resulting in a communication problem with the brain and the rest of the body as well as muscle control. In certain cases, MS could also affect the optic nerves in the eyes causing vision and balance impairment.






Demographics


In Malaysia, Multiple Sclerosis is a very rare condition as its estimated prevalence is one to two per 100,000 in a multiracial population in Malaysia. Some factors which increase the chance of getting this condition are familial heredity with females to male ratio (5:1) including all races [1]. It also affects mainly the age group between 20 to 40 years of age.


Classification

Here are four categories of classifications for MS [2]:

· Relapsing-remitting MS (RRMS) is marked by frequent exacerbations; it is the most common form of MS.

· Secondary-progressive MS (SPMS) is seen when RRMS patients enter a phase in which attacks and remissions are not easily identifiable.

· Primary-progressive MS (PPMS) is identified by symptoms and a lack of relapses; it is most commonly diagnosed later in life.

· Primary-relapsing MS (PRMS) affects the smallest group of patients and is characterized by both progression and relapses.


Clinical presentation

Based on Multiple Sclerosis Society UK, some of the common signs and symptoms are as follow [3]:


Visible symptoms

. Loss of balance

. Dizziness

. Stiffness or spasms

. Tremors

. Speech problems


Invisible symptoms

. Fatigue

. Pain

. Bladder and vision problems

. Difficulty swallowing


Memory, thinking, emotions

. Cognitive (memory) problems

* Mental health (depression, stress, anxiety, irritation)


* Mental health often goes untreated as MS patients do not appear to show it but family members can try to pay attention to them for example, any mood changes, appetite loss, or any irrational behavior should not be waved off as they are just acting up for attention.



As those are just some common signs and symptoms for MS, please seek proper medical attention or a specialist for proper diagnosis of the problem.

Physiotherapy management


Comparing healthy people to people with MS, they have reduced aerobic capacity and muscle strength as they get tired easily. Nevertheless, a physical therapist treating MS patients need to have patience and constant mini-breaks from exercises so that they are able to recover. Exercises that could be done with MS patients consists of:


· Moderate Endurance training

· Resistance training

· Combined endurance and resistance training

· Personalised exercise for MS patients


Studies have also shown that the personalized exercise program have significant effects on MS patients and has the potential to improve the outcome but high-quality data are uncommon


[5].

Other therapies that would help with MS other than physiotherapy is:



Living with MS

When a person is diagnosed with MS, he/she has to understand that there would not be any cure [2]. There would be phases of relapsing and remitting so we can help them by treating them based on symptoms for that phase as clinical presentation varies from person to person. Another thing to keep in mind is that, as the condition progresses, the complaints of fatigue and reduced muscle strength would be more pronounced. Family members could seek physiotherapy treatment for the maintenance of their function to avoid worsening of the condition.


Other than that, most people overlook the fact of how MS could affect family member's quality of life (emotionally, mentally and physically) [6]. Based on the severity of MS condition, they range from being independent where he/she could take care of themselves to a certain extent with minimal help from their family members, or dependent as they are on the wheelchair and needs more supervision from family members in doing their daily activities like bathing, eating, change of clothes just to give an example. Therefore, family support is very important as people with MS would still want to lead a near-normal lifestyle without burdening their family members.

In summary, early diagnosis and intervention could help slow down the progression of this condition. That being said, as this is a condition that will last a lifetime with no cure, the patient must not lose hope and try to live their life as best they can, while family members must support them and not lose patience.


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References

1. Viswanathan, S & Rose, N & Arip, Masita & Dhaliwal, J & Puvanarajah, S & Rafia, M & Muda, S. (2013). Multiple Sclerosis in Malaysia: Demographics, Clinical Features, and Neuroimaging Characteristics. Multiple sclerosis international. 2013. 614716. 10.1155/2013/614716.

2. Gohil K. Multiple Sclerosis: Progress, but No Cure. P T. 2015 Sep;40(9):604-5. PMID: 26417181; PMCID: PMC4571850.

3. MsSocietyUK. “MS Symptoms and Signs.” Multiple Sclerosis Society UK, www.mssociety.org.uk/about-ms/signs-and-symptoms.

4. “Physiotherapy Works: Multiple Sclerosis (MS).” The Chartered Society of Physiotherapy, www.csp.org.uk/publications/physiotherapy-works-multiple-sclerosis-ms.

5. Döring, A., Pfueller, C. F., Paul, F., & Dörr, J. (2011). Exercise in multiple sclerosis -- an integral component of disease management. The EPMA Journal, 3(1), 2. https://doi.org/10.1007/s13167-011-0136-4

6. Uccelli, Michele Messmer. “The Impact of Multiple Sclerosis on Family Members: a Review of the Literature.” Neurodegenerative Disease Management, vol. 4, no. 2, 2014, pp. 177–185., DOI:10.2217/nmt.14.6.



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