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| [[Psychiatric]] disorders especially [[depression]] is common and can be seen in almost 50% of [[MS]] patients.<ref name="pmid8618657">{{cite journal |vauthors=Sadovnick AD, Remick RA, Allen J, Swartz E, Yee IM, Eisen K, Farquhar R, Hashimoto SA, Hooge J, Kastrukoff LF, Morrison W, Nelson J, Oger J, Paty DW |title=Depression and multiple sclerosis |journal=Neurology |volume=46 |issue=3 |pages=628–32 |date=March 1996 |pmid=8618657 |doi= |url=}}</ref> | | [[Psychiatric]] disorders especially [[depression]] is common and can be seen in almost 50% of [[MS]] patients.<ref name="pmid8618657">{{cite journal |vauthors=Sadovnick AD, Remick RA, Allen J, Swartz E, Yee IM, Eisen K, Farquhar R, Hashimoto SA, Hooge J, Kastrukoff LF, Morrison W, Nelson J, Oger J, Paty DW |title=Depression and multiple sclerosis |journal=Neurology |volume=46 |issue=3 |pages=628–32 |date=March 1996 |pmid=8618657 |doi= |url=}}</ref> |
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| === Eye Symptoms === | | ==== Ataxia and tremor: ==== |
| {{Main|Optic neuritis}}
| | Damage to the descending motor pathways in MS can increase muscle tone and rigidity in 75% of MS patients. |
| Individuals experience rapid onset of [[pain]] in one eye, followed by blurry [[Visual perception|vision]] in part or all of the [[visual field]] of that [[eye]]. [[Inflammation]] of the optic nerve causes loss of vision usually due to the swelling and destruction of the [[myelin]] sheath covering the optic nerve. This condition is called optic neuritis.
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| The blurred vision usually resolves within ten weeks, but individuals are often left with less vivid [[color vision]] (especially red) in the affected eye.
| | ==== Spasticity: ==== |
| === Bladder === | |
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| Bladder problems which can be seen in vast majority of MS patients include: incontinency, frequency, urine retention, hesitation and leaking. These symptoms have negative effect on patient life. <ref>{{cite journal |author=Hennessey A, Robertson NP, Swingler R, Compston DA |title=Urinary, faecal and sexual dysfunction in patients with multiple sclerosis |journal=J. Neurol. |volume=246|issue=11 |pages=1027-32 |year=1999 |pmid=10631634}}</ref><ref>{{cite journal |author=Burguera-Hernández JA |title=[Urinary alterations in multiple sclerosis] |language=Spanish; Castilian |journal=Revista de neurologia |volume=30 |issue=10 |pages=989-92|year=2000 |pmid=10919202}}</ref><ref>{{cite journal|author=Nour S, Svarer C, Kristensen JK, Paulson OB, Law I |title=Cerebral activation during micturition in normal men|journal=Brain |volume=123 ( Pt 4) |issue= |pages=781-9 |year=2000 |pmid=10734009}}</ref>
| | ==== Bowel and bladder dysfunction: ==== |
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| === Cognitive ===
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| Cognitive impairments are common. Neuropsychological studies suggest that 40 to 60 percent of patients have cognitive deficits;<ref>{{cite journal |author=Rao S, Leo G, Bernardin L, Unverzagt F |title=Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction |journal=Neurology |volume=41 |issue=5 |pages=685-91 |year=1991 |pmid=2027484}}</ref> with the lowest percentages usually from community-based studies and the highest ones from hospital-based.
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| Cognitive impairment, sometimes referred to as [[brain fog]], is already present in the beginnings of the disease.<ref>{{cite journal |author= |title=Attention impairment in recently diagnosed multiple sclerosis |journal=Eur J Neurol |volume=5 |issue=1|pages=61-66 |year=1998 |pmid=10210813}}</ref> Even in probable MS (after the first attack but before a second confirmatory one) up to 50% of patients have mild impairment.<ref>{{cite journal |author=Achiron A, Barak Y |title=Cognitive impairment in probable multiple sclerosis |journal=J Neurol Neurosurg Psychiatry |volume=74 |issue=4 |pages=443-6 |year=2003 |pmid=12640060}}</ref>
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| Some of the most common declines are in recent [[memory]], [[attention]], processing speed, visual-spatial abilities and [[executive functions]].<ref>{{cite journal |author=Bobholz J, Rao S |title=Cognitive dysfunction in multiple sclerosis: a review of recent developments |journal=Curr Opin Neurol |volume=16 |issue=3 |pages=283-8 |year=2003 |pmid=12858063}}</ref> Other cognitive-related symptoms are [[labile affect|emotional instability]], and [[fatigue (physical)|fatigue]], including purely [[neurological fatigue]].
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| The cognitive impairments in MS are usually mild; and only in 5% of patients can we speak of [[dementia]]. Nevertheless they are related with unemployment and reduced social interactions.<ref>{{cite journal |author=Amato M, Ponziani G, Siracusa G, Sorbi S|title=Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years |journal=Arch Neurol |volume=58|issue=10 |pages=1602-6 |year=2001 |pmid=11594918}}</ref> They are also related with driving difficulties.<ref>{{cite journal|author=Shawaryn M, Schultheis M, Garay E, Deluca J |title=Assessing functional status: exploring the relationship between the multiple sclerosis functional composite and driving |journal=Arch Phys Med Rehabil |volume=83 |issue=8 |pages=1123-9 |year=2002|pmid=12161835}}</ref>
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| === Emotional ===
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| Emotional symptoms are also common and are thought to be both the normal response to having a debilitating disease and the result of damage to specific areas of the cental nervous system that generate and control emotions.
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| [[Clinical depression]] is the most common neuropsychiatric condition: lifetime depression prevalence rates of 40-50% and 12 month prevalence rates around 20% have been typically reported for samples of people with MS; these figures are considerably higher than those for the general population or for people with other chronic illnesses.<ref>{{cite journal |author=Sadovnick A, Remick R, Allen J, Swartz E, Yee I, Eisen K, Farquhar R, Hashimoto S, Hooge J, Kastrukoff L, Morrison W, Nelson J, Oger J, Paty D |title=Depression and multiple sclerosis |journal=Neurology |volume=46 |issue=3 |pages=628-32 |year=1996 |pmid=8618657}}</ref><ref>{{cite journal|author=Patten S, Beck C, Williams J, Barbui C, Metz L |title=Major depression in multiple sclerosis: a population-based perspective|journal=Neurology |volume=61 |issue=11 |pages=1524-7 |year=2003 |pmid=14663036}}</ref>
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| Other feelings such as [[anger]], [[anxiety]], [[frustration]], and hopelessness also appear frequently, and [[suicide]] is a very real threat since 15% of deaths in MS sufferers are due to this cause.<ref>{{cite journal |author=Sadovnick A, Eisen K, Ebers G, Paty D |title=Cause of death in patients attending multiple sclerosis clinics |journal=Neurology |volume=41 |issue=8 |pages=1193-6|year=1991 |pmid=1866003}}</ref>. Many brain-imaging studies have tried to relate depression to lesions in different brain regions with variable success. On balance the evidence seems to favour an association with neuropathology in the left anterior temporal/parietal regions.<ref>{{cite journal|author=Siegert R, Abernethy D|title=Depression in multiple sclerosis: a review |journal=J. Neurol. Neurosurg. Psychiatr. |volume=76|issue=4 |pages=469-75|year=2005 |pmid=15774430}}</ref>
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| === Fatigue ===
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| [[Fatigue (medical)|Fatigue]] is very common and disabling in MS. At the same time it has a close relationship with depressive symptomatology.<ref name="pmid12814166">{{cite journal |author=Bakshi R |title=Fatigue associated with multiple sclerosis: diagnosis, impact and management |journal=Mult. Scler. |volume=9 |issue=3 |pages=219–27 |year=2003 |pmid=12814166 |doi=}}</ref> When depression is reduced fatigue also tends to improve, so patients should be evaluated for depression before other therapeutic approaches are used.<ref name="pmid12883103">{{cite journal |author=Mohr DC, Hart SL, Goldberg A |title=Effects of treatment for depression on fatigue in multiple sclerosis |journal=Psychosomatic medicine |volume=65 |issue=4 |pages=542–7 |year=2003|pmid=12883103 |doi=}}</ref>. In a similar way other factors like disturbed sleep, chronic pain, poor nutrition, or even some medications can contribute to fatigue; and therefore medical professionals are encouraged to identify and modify them.<ref name="isbn = 1 86016 182 0">{{cite book | last = The Royal College of Physicians |title = Multiple Sclerosis. National clinical guideline for diagnosis and management in primary and secondary care | publisher = Sarum ColourView Group | date = 2004 | location = Salisbury, Wiltshire | isbn = 1 86016 182 0 }}[http://www.rcplondon.ac.uk/pubs/books/MS/MSfulldocument.pdf Free full text]([[2004-08-13]]). Retrieved on [[2007-10-01]].</ref>
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| === Mobility Restrictions ===
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| Restrictions in [[mobility]] (walking, transfers, bed mobility) are common in individuals suffering from multiple sclerosis. Within 10 years after the onset of MS one-third of patients reach a score of 6 on the [[Expanded Disability Status Scale]] (requiring the use of a unilateral walking aid),and by 30 years the proportion increases to 83%. Within 5 years the Expanded Disability Status Score is 6 in 50% of those with the progressive form of MS.<ref>{{cite journal |author=Weinshenker BG, Bass B, Rice GP, ''et al''|title=The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability |journal=Brain|volume=112 ( Pt 1) |issue= |pages=133-46 |year=1989 |pmid=2917275 |doi=}}</ref>
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| In MS a wide range of impairments may exist which can act either alone or in combination to impact directly on a person's balance, function and mobility. Such impairments include [[fatigue (medical)|fatigue]], [[Muscle weakness|weakness]], hypertonicity, low exercise tolerance, impaired balance, [[ataxia]] and [[tremor]].<ref>{{cite journal |author=Freeman JA |title=Improving mobility and functional independence in persons with multiple sclerosis |journal=J. Neurol. |volume=248 |issue=4 |pages=255-9 |year=2001|pmid=11374088 |doi=}}</ref>
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| === Pain ===
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| [[Pain]] is a common symptom in MS; appearing in 55% of patients at some point of their disease process; specially as time passes.<ref>{{cite journal |author=Stenager E, Knudsen L, Jensen K |title=Acute and chronic pain syndromes in multiple sclerosis. A 5-year follow-up study |journal=Italian journal of neurological sciences |volume=16 |issue=9 |pages=629-32 |year=1995 |pmid=8838789|doi=}}</ref>. It is strong and debilitating and has a profound effect in the [[quality of life]] and [[mental health]] of the sufferer.<ref>{{cite journal |author=Archibald CJ, McGrath PJ, Ritvo PG, ''et al'' |title=Pain prevalence, severity and impact in a clinic sample of multiple sclerosis patients |journal=Pain |volume=58 |issue=1 |pages=89-93 |year=1994 |pmid=7970843 |doi=}}</ref>
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| It usually appears after a lesion to the ascending or descending tracts that control the transmission of painful stimulus. such as the [[anterolateral system]], but many other causes are also possible.<ref>{{cite journal |author=Clanet MG, Brassat D |title=The management of multiple sclerosis patients |journal=Curr. Opin. Neurol. |volume=13 |issue=3 |pages=263-70 |year=2000 |pmid=10871249|doi=}}</ref>
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| Most frequent pains reported are [[headache]]s (40%), dysesthetic limb pain (19%), back pain (17%), and painful [[spasm]]s (11%).<ref>{{cite journal |author=Pöllmann W, Feneberg W, Erasmus LP |title=[Pain in multiple sclerosis--a still underestimated problem. The 1 year prevalence of pain syndromes, significance and quality of care of multiple sclerosis inpatients]|language=German |journal=Der Nervenarzt |volume=75 |issue=2 |pages=135-40 |year=2004 |pmid=14770283|doi=10.1007/s00115-003-1656-5}}</ref>
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| [[Acute (medical)|Acute]] pain is mainly due to [[optic neuritis]].<ref>{{cite journal |author=Kerns RD, Kassirer M, Otis J|title=Pain in multiple sclerosis: a biopsychosocial perspective |journal=Journal of rehabilitation research and development|volume=39 |issue=2 |pages=225-32 |year=2002 |pmid=12051466 |doi=}}</ref> [[Subacute]] pain is usually secondary to the disease and can be consequence of being too much time in the same position, urinary retention, infected skin ulcers and many others. [[Chronic (medical)|Chronic]] pain is very common and the harder to treat being its most common cause dysesthesias.
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| ==== Trigeminal Neuralgia ====
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| [[Trigeminal neuralgia]] or "tic douloureux", is a disorder of the [[trigeminal nerve]] that causes episodes of intense pain in the [[eye]]s, [[lip]]s, [[nose]], [[scalp]], [[forehead]], and [[jaw]]. It affects 1 to 2% of MS patients during their disease.<ref>{{cite journal |author=Brisman R |title=Trigeminal neuralgia and multiple sclerosis |journal=Arch. Neurol. |volume=44|issue=4 |pages=379-81 |year=1987 |pmid=3493757 |doi=}}</ref><ref>{{cite journal |author=Bayer DB, Stenger TG |title=Trigeminal neuralgia: an overview |journal=Oral Surg. Oral Med. Oral Pathol. |volume=48 |issue=5 |pages=393-9 |year=1979 |pmid=226915|doi=}}</ref>
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| The episodes of pain occur paroxysmally, or suddenly; and the patients describe it as trigger area on the face, so sensitive that touching or even air currents can bring an episode of pain.
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| ==== Dysesthesias ====
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| [[Dysesthesias]] are disagreeable sensations produced by ordinary [[Stimulus (physiology)|stimuli]]. The abnormal sensations are often described as painful feelings such as burning, wetness, itching, electric shock or pins and needles; and are caused by lesions of the peripheral or central sensory pathways.
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| === Sexual ===
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| [[Sexual dysfunction]] (SD) is one of many symptoms affecting persons with a diagnosis of [[multiple sclerosis]] (MS) and other neurological disease. SD in men encompasses both erectile and ejaculatory disorder. The prevalence of SD in men with MS ranges from 75 to 91% (O'Leary et al., 2007). [[Erectile dysfunction]] appears to be the most common form of SD documented in MS. SD may be due to alteration of the ejaculatory reflex which may be affected by neurological conditions such as MS <ref>O'Leary, M., Heyman, R., Erickson, J., Chancellor, M.B.: Premature ejaculation and MS: A Review, Consortium of MS Centers, http://www.mscare.org, June 2007</ref>
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| === Spasticity ===
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| [[Spasticity]] is characterised by increased stiffness and slowness in [[Limb (anatomy)|limb]] movement, the development of certain postures, an association with weakness of voluntary [[muscle]] power, and with involuntary and sometimes painful [[spasm]]s of limbs.<ref name="isbn = 1 86016 182 0">{{cite book | last = The Royal College of Physicians |title = Multiple Sclerosis. National clinical guideline for diagnosis and management in primary and secondary care | publisher = Sarum ColourView Group | date = 2004 |location = Salisbury, Wiltshire | isbn = 1 86016 182 0 }}[http://www.rcplondon.ac.uk/pubs/books/MS/MSfulldocument.pdf Free full text]([[2004-08-13]]). Retrieved on [[2007-10-01]].</ref>
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| === Transverse Myelitis ===
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| {{Main|Transverse myelitis}}
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| Some MS patients develop rapid onset of [[paresthesia|numbness]], weakness, [[bowel]] or [[Urinary bladder|bladder]] dysfunction, and/or loss of [[motor neuron|muscle]] function, typically in the lower half of the body. This is the result of MS attacking the [[spinal cord]]. The symptoms and signs depend upon the level of the spinal cord involved and the extent of the involvement.
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| Prognosis for complete recovery is generally poor. Recovery from transverse myelitis usually begins between weeks 2 and 12 following onset and may continue for up to 2 years in some patients and as many as 80% of individuals with transverse myelitis are left with lasting disabilities.
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| === Tremor and Ataxia ===
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| {{Main|Tremor}}
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| [[Tremor]] is an unintentional, somewhat rhythmic, muscle movement involving to-and-fro movements (oscillations) of one or more parts of the body. It is the most common of all involuntary movements and can affect the hands, arms, head, face, vocal cords, trunk, and legs.
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| [[Ataxia]] is an unsteady and clumsy motion of the limbs or torso due to a failure of the gross coordination of muscle movements. People with ataxia experience a failure of muscle control in their arms and legs, resulting in a lack of balance and coordination or a disturbance of [[Gait (human)|gait]].
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| Tremor and ataxia are frequent in MS. They present in 25 to 60% of patients. They can be very disabling and embarrassing, and are difficult to manage.<ref>{{cite journal |author=Koch M, Mostert J, Heersema D, De Keyser J |title=Tremor in multiple sclerosis|journal=J. Neurol. |volume=254 |issue=2 |pages=133-45 |year=2007 |pmid=17318714 |doi=10.1007/s00415-006-0296-7}}</ref> The origin of tremor in MS is difficult to precise but it can be due to a mixture of different factors such as damage to the [[cerebellar]] connections, weakness, [[spasticity]], etc.
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| == Factors Triggering a Relapse ==
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| <gallery>
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| Image:Symptoms of multiple sclerosis.png|Main symptoms of multiple sclerosis.
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| </gallery>Multiple sclerosis relapses are often unpredictable and can occur without warning with no obvious inciting factors. Some attacks, however, are preceded by common triggers. In general, relapses occur more frequently during spring and summer than during autumn and winter. Infections, such as the [[common cold]], [[influenza]], and [[gastroenteritis]], increase the risk for a relapse.<ref>{{cite journal |author=Confavreux C |title=Infections and the risk of relapse in multiple sclerosis |journal=Brain |volume=125 |issue=Pt 5|pages=933-4 |year=2002 |pmid=11960883 |doi=}}</ref>
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| [[Stress (medicine)|Emotional]] and physical stress may also trigger an attack,<ref>{{cite journal |author=Buljevac D, Hop WC, Reedeker W, ''et al'' |title=Self reported stressful life events and exacerbations in multiple sclerosis: prospective study|journal=BMJ |volume=327 |issue=7416 |pages=646 |year=2003 |pmid=14500435 |doi=10.1136/bmj.327.7416.646}}</ref><ref>{{cite journal|author=Brown RF, Tennant CC, Sharrock M, Hodgkinson S, Dunn SM, Pollard JD |title=Relationship between stress and relapse in multiple sclerosis: Part I. Important features |journal=Mult. Scler. |volume=12 |issue=4 |pages=453-64 |year=2006 |pmid=16900759|doi=}}</ref><ref>{{cite journal |author=Brown RF, Tennant CC, Sharrock M, Hodgkinson S, Dunn SM, Pollard JD |title=Relationship between stress and relapse in multiple sclerosis: Part II. Direct and indirect relationships |journal=Mult. Scler. |volume=12|issue=4 |pages=465-75 |year=2006 |pmid=16900760 |doi=}}</ref> as can severe illness of any kind.
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| Statistically, there is no good evidence that either [[Physical trauma|trauma]] or [[surgery]] trigger relapses.<ref>{{cite journal|author=Martinelli V |title=Trauma, stress and multiple sclerosis |journal=Neurol. Sci. |volume=21 |issue=4 suppl 2 |pages=S849-52|year=2000 |pmid= 11205361 |doi=}}</ref> People with MS can participate in sports, but they should probably avoid extremely strenuous exertion, such as marathon running. Heat can transiently increase symptoms, which is known as [[Uhthoff's phenomenon]]. This is why some people with MS avoid saunas or even hot showers.
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| However, heat is not an established trigger of relapses.<ref>{{cite journal |author=Tataru N, Vidal C, Decavel P, Berger E, Rumbach L |title=Limited impact of the summer heat wave in France (2003) on hospital admissions and relapses for multiple sclerosis|journal=Neuroepidemiology |volume=27 |issue=1 |pages=28-32 |year=2006 |pmid=16804331 |doi=10.1159/000094233}}</ref>
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| [[Pregnancy]] can directly affect the susceptibility for relapse. The last three months of pregnancy offer a natural protection against relapses. However, during the first few months after delivery, the risk for a relapse is increased 20%–40%. Pregnancy does not seem to influence long-term disability. Children born to mothers with MS are not at increased risk for [[congenital disorder|birth defect]]s or other problems.<ref>{{cite journal |author=Worthington J, Jones R, Crawford M, Forti A |title=Pregnancy and multiple sclerosis--a 3-year prospective study |journal=J. Neurol. |volume=241 |issue=4 |pages=228-33 |year=1994 |pmid=8195822|doi=}}</ref>
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| Many potential triggers have been examined and found not to influence relapse rates in MS. Influenza [[vaccination]] is safe, does not trigger relapses, and can therefore be recommended for people with MS. There is also no evidence that vaccines for [[hepatitis B]], [[varicella]], [[tetanus]], or [[Bacille Calmette-Guerin]] (BCG—immunization for [[tuberculosis]]) increases the risk for relapse.<ref>{{cite journal |author=Confavreux C, Suissa S, Saddier P, Bourdès V, Vukusic S |title=Vaccinations and the risk of relapse in multiple sclerosis. Vaccines in Multiple Sclerosis Study Group |journal=N. Engl. J. Med. |volume=344 |issue=5|pages=319-26 |year=2001 |pmid=11172162 |doi=}}</ref>
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| ==References== | | ==References== |