Question: What types of problems most often interfere with sleep for individuals with MS?
Answer: High quality sleep is generally recognized as an important health benefit for everyone, and this is especially true for people with MS. Poor quality sleep can increase MS symptoms such as fatigue, pain, daytime sleepiness, anxiety, and depression, as well as difficulties with memory and concentration. Unfortunately, more than half of those with MS have some kind of a sleep disorder or sleep dysfunction, which is a higher proportion than for those in the general population.
Question: What are your recommendations for people with MS who are experiencing fatigue?
Answer: Fatigue is the most common symptom of multiple sclerosis. Although fatigue occurs in the general population, it’s more common and often more problematic in people with multiple sclerosis. The first approach should be to investigate the cause of fatigue with your clinician or neurologist. When MS is the only cause for the fatigue, it is labeled primary fatigue.
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: 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.
Featuring Barry A. Hendin, MD MSAA’s Chief Medical Officer
Question: How often is an MRI recommended, and is it still needed when symptoms have not worsened?
Answer: Although there is a wide variation in the use and frequency of magnetic resonance imaging (MRI) testing in neurological practices, it may be helpful to begin by considering why we get MRI scans for people with MS.
