Are Your MS Treatment Options Working?
Allison Bush | Jan 20th 2016 Jun 1st 2017
- 2 A little bit, but it has been stable or improving.
- 1 Not at all.
- 4 I am unable to walk and confined to a wheelchair.
- 3 Yes, I need a walker or cane for assistance.
Do you have muscle stiffness in your legs that affects your ability to walk?
Muscle stiffness in the legs is a common symptom of multiple sclerosis (MS). Stiffness is often due to interruption in the nerve signals between the brain and the nerves that control the legs. There are several types of medication that can reduce the stiffness and the associated pain. Newer medications can also improve one’s walking ability. Often, patients need a combination of the various treatments. Some medications are taken by mouth while botulinum toxin injections - typically needed no more than every three months - may also help some patients. Each of these medications has different side effects or may not be appropriate for everyone. All of these treatments typically worked better in conjunction with a physical therapy and exercise program.
Do you have loss of sensation or weakness in your legs that causes you to fall?
There are no medications that reliably improve strength or the ability to feel things in the legs. If you are prone to falling because MS has caused leg weakness or trouble feeling your legs, treatment is focused on physical therapy and exercises to reduce the risk of falling. The therapist will determine whether you need an assistive device such as a cane or walker. Bracing weak joints may also help some patients.
Do you have urinary incontinence or frequent urinary tract infections?
Loss of bladder control is associated with urinary infections and may limit one’s ability to socialize and perform daily functions. It is important to determine the cause of your urinary symptoms to determine if the muscles are too loose, or whether your bladder is prone to spasms. Different medications will help depending on the underlying cause. Infections will also worsen any urinary symptoms. It is important to be evaluated by a urologist, who may ordered tests on your bladder function, to determine the best therapy for these problems
Do you have painful muscle spasms?
As noted above, there are several types of medications that can reduce muscle spasms due to MS. If pain is the primary symptom, then these treatments may need to be given in conjunction with pain medications as well. In severe cases, medication can be placed into the spinal fluid with a pump, although this typically works better for symptoms in the legs than the arms and hands.
Have you been hospitalized for an exacerbation of MS?
If you have had several exacerbations recently, you may want to talk to your doctor about whether you should change your MS medication. Although none of the medications are 100 percent effective at preventing attacks, some people respond better to one medication then another. It is difficult to predict which medication is best for any particular patient. Always check with your doctor before stopping your medication.
Do you have side effects from your current MS medication?
There are several types of medications used to reduce the number of MS attacks. These medications work by altering the immune system, but each has different side effects. There is little way to predict which patients will develop side effects. Some side effects include reactions to injections. The companies that make injectable medications often provide support, such as a nurse visit to the home, to patients to help manage side effects. Other medications require bloodwork periodically to monitor for side effects that the patient may not notice right away. Talk to your doctor if you feel you are having side effects from your medication. Sometimes your symptoms are due to another cause and are not related to medication.
Do you feel depressed or sad?
Depression is common amongst MS patients. There are many effective treatments available, including medications and counseling. It is important to let your doctor know, as sometimes depression can be a side effect of your MS medications. You may also have other medical problems contributing to depression, requiring more specific treatment.
Do you feel like you have no energy?
Almost all MS patients experience fatigue at some point. Your doctor may want to do blood tests to look for medical problems, such as low blood count or diabetes, which requires treatment. Sometimes, fatigue can be caused by depression.
Do you laugh or cry for no reason?
When MS attacks certain areas of the brain, patients may be prone to laughing or crying at inappropriate times, even if they are not happy or sad. This is known as pseudo-bulbar affect. It is important to talk to your doctor to see if the available treatments for these symptoms are appropriate for you.
Do people have trouble understanding your speech?
Slurred speech may be a result of loss of motor control or stiffness in muscles of the face. It is important for your doctor to determine whether your difficulty speaking is the result of MS or another problem. Speech therapy is often helpful in improving speech, while some patients may also benefit from medications to reduce the muscle stiffness.