Question: What types of exercises are best to help with mobility and walking issues in MS?
Answer: A number of different exercises can improve and maintain walking and mobility skills along with safety. Many of these exercises can be learned through formal physical therapy or through online programs. They can include exercises focused on range of motion and flexibility. Alternatively, they may focus on strengthening through resistance training. Some exercises are directed toward general cardiovascular health and others focus primarily on balance. Although any of these forms of exercise may be useful, specific exercise for an individual should focus on an individual’s exact needs.
Question: Does spasticity in MS ever improve on its own and what are the best treatments for this symptom?
Answer: First, it may help to define spasticity in simple terms. Spasticity is an increase in muscle tone due to an imbalance between excitatory and inhibitory influences on nerve flow along the motor pathways of the brain and spinal cord. Symptoms can vary from mild discomfort to severe pain and disability. Activities of daily living, quality of life, upper extremity function, and gait, can all be affected.
As with all MS symptomatology, spasticity can vary in intensity. It can improve or worsen, depending upon MS relapses, progression, or outside influences – including events, such as urinary tract infections. Fortunately, many interventions can help to reduce spasticity and improve comfort and function.
Question: What types of medications are prescribed for pain in MS and what types of
complementary and alternative medicine (CAM) may be helpful?
Answer: Management of pain includes but is not limited to prescription medications. Our initial goal is to assess the cause of the pain and then to try to manage the pain itself. Pain in multiple sclerosis (MS) can come from lesions in the central nervous system (CNS), which produce very specific symptoms of intermittent facial pain (called trigeminal neuralgia) or burning and itching discomfort in various parts of the body.
Question: Is anxiety a common symptom of MS, and if so, what are the signs and symptoms?
Answer: Anxiety is, indeed, a common symptom of MS. It is estimated to occur in almost half of the MS population, at some point. It often coexists with depression but can occur independently of depression. Unfortunately, anxiety is under-recognized and undertreated due to the clinical emphasis on depression alone.
Featuring Barry A. Hendin, MD MSAA’s Chief Medical Officer
Barry Hendin, MD
Question: How does psychological therapy, either alone or in conjunction with medication, make a difference for someone with MS who is experiencing depression?
Answer: This question highlights the fact that there is more than one approach to treating psychological problems. Anyone may experience depression, but this symptom is more common in people with MS. Much of this is biologically determined, meaning that depression in MS is often caused by changes in the central nervous system (CNS), but we’re also aware that situational problems may occur in anyone’s life, including those with MS.
Antidepressant medications from a psychiatrist (or other appropriate clinician) can be very helpful for the biological aspects of depression. But for many people, an additional benefit may be derived from psychotherapy or “talk therapy” with a psychologist or counselor. This psychological support can help individuals to develop strategies to navigate complex situational issues.
Beyond these professional interventions, there are several things that people with MS are able to do independently. For many, exercise can reduce depression. For others, mindfulness, yoga, or meditation may be helpful. And for everyone, focusing on the other aspects of wellness, which include maintaining a healthy diet and healthy social relationships, can’t be emphasized enough!
Please note that anxiety may occur along with depression and is also more common in the MS population. Many of the approaches to treating depression are also useful in reducing anxiety, but as with depression, this symptom should be diagnosed by a professional and treated accordingly.
Barry A. Hendin, MD is a neurologist and Director of the Multiple Sclerosis Center of Arizona. He is also Director of the Multiple Sclerosis Clinic at Banner University Medical Center and Clinical Professor of Neurology at the University of Arizona Medical School.
Featuring Barry A. Hendin, MD MSAA’s Chief Medical Officer
Barry Hendin, MD
Question: What strategies can you recommend to help with cognitive issues?
Answer: First, let’s define cognition. Simply, it is all of the processes involved in learning, remembering, and expressing knowledge. It involves how we perceive, how we think, and how we convey knowledge verbally and nonverbally.
Although many people with MS, and at all stages of MS, express cognitive symptoms or problems, they are generally mild in nature. The most common complaints that I hear involve difficulties in memory, multitasking, learning new information, and processing speed.
Some cognitive changes may be due to MS itself. Often, however, the problems are due to, or are compounded by, other factors such as poor sleep, medication effect, pain, or depression. The first strategy, therefore, is to assess the contribution of mood, pain, medications, and sleep – and then treat them appropriately.
