Managing the Challenges of Multiple Sclerosis

By Charles Smith, M.D., Scripps Health

Nearly all of us feel fatigued at some time or another. Maybe we’re run down, sick, dehydrated, or depressed. There are many possible reasons for fatigue, and the more we understand what is causing ours, the more effectively we can treat it.

This is especially true for people who have multiple sclerosis, or MS. Fatigue is one of the most common complaints associated with MS; unfortunately, many MS symptoms can be quite complicated and require significant time to understand and treat.  Because many physicians today are limited in the amount of time they can spend with patients, it is important for people with MS to understand as much as they can about their symptoms and proactively help their doctor identify the root cause of the problem and optimal treatment more quickly.

Why are MS symptoms so complex? Consider this: MS is an immune mediated disease that attacks the central nervous system, including the brain, spinal cord, and optic nerves. As a result, symptoms can vary greatly and affect nearly everything from movement and physical functions to cognitive skills and emotions. MS is chronic, so symptoms may come and go, and range from mild to disabling.

Let’s take a closer look at fatigue. MS itself can cause fatigue; there is a condition known as MS fatigue that typically occurs in the afternoon. MS can also affect the bladder, causing some people to wake up multiple times during the night to urinate. This repeated interruption of sleep could certainly lead to fatigue. Muscle spasms are another common symptom of MS, and these can interfere with a restful night’s sleep.  About 50 percent of people with MS will have depression at some point in their lives, which can lead people to feel tired and low on energy. Moreover, medications such as interferon which are used to treat MS may actually make some patients tired as a side effect. 

So when a person with MS reports fatigue, the key is to determine the underlying cause or causes and treat accordingly. Bladder symptoms can be addressed so that the person is not waking up every few hours or more to use the bathroom. Muscle spasms and depression can be treated as well. If MS medications are contributing to fatigue, doctor and patient need to determine whether the benefits of the medication outweigh the side effects; alternative medications are now available.

Bladder or bowel dysfunction is another common MS complaint. As mentioned earlier, many patients wake up throughout the night to urinate. Incontinence can also be a concern. Years ago when I was just starting in my career, I asked a patient if she had any bladder problems, and she said no. I later learned she was incontinent several times a week, but she thought that was normal for MS and couldn’t be treated, so she didn’t tell me about it. People with MS need to understand that, in most cases, these types of problems can now be completely controlled. By being empowered with the knowledge that something can be done to improve their quality of life, patients can go back to their doctors and share information to determine the most appropriate treatment.

In the past, it was thought that cognitive problems such as memory loss and confusion were not a common concern with MS. Today, we know that 25 percent of patients may show evidence for cognitive impairment with specialized testing on the first day they are diagnosed with MS. After a patient has had the disease for five years, that number rises to 54 percent. We now know that MS-related cognitive problems are the most common reason why a person has to stop working earlier than they otherwise would.  Because they are so prevalent, we evaluate cognitive complaints much more carefully than in the past. 

Research has shown that three symptoms—fatigue, depression and cognitive impairment—most impact the quality of life of MS patients, even more so than paralysis.  Fortunately, when patients understand their symptoms and work with their doctors to assess them, appropriate treatments can resolve complaints and restore quality of life.

Charles Smith, M.D., is a neurologist with Scripps Health. Join Dr. Smith, in partnership with the National Multiple Sclerosis Society Pacific South Coast Chapter, for a free lecture series on managing common challenges of MS on August 13 (Fatigue), September 17 (Bladder, Bowel and Sexual Dysfunction) and October 8 (Cognitive Challenges) at 6:30 pm at the Schaetzel Center, Great Hall on the Scripps Memorial Hospital La Jolla campus. To register, please call 1-800-SCRIPPS.