Holistic approach to multiple sclerosis

A MULTI-DISCIPLINARY approach aimed at limiting and overcoming disability is the key to ensuring that patients with multiple sclerosis (MS) have a chance of leading full and rewarding lives despite the irreversible damage caused by the rare and chronic disease.

MS patients experience a wide range of neurological deficits, from depression, sexual dysfunction, and fatigue, loss of sensation in the arms, leg or face to complete or partial loss of vision, muscular spasms and bladder and bowel difficulties.

“While currently there is still no known cure, the life expectancy of patients with MS is now nearly the same as that of unaffected people and a multidisciplinary approach can limit disability with physical therapy and the management of cognitive deficits such as depression, erectile dysfunction, spasticity, muscular pains and bladder spasms,” said consultant neurologist Prof Tan Chong Tin at a panel discussion in a talk entitled Straight Talk: Debunking MS Misconception and Myths.

“Dealing with the physical, practical and emotional demands of MS is not easy for those affected by the disease or for their families and caregivers. However, with treatment, many people with MS can and do find ways to cope with their disease,” he added.

The talk aimed at raising awareness of the various issues affecting people with MS was organised by the Multiple Sclerosis Society and Serono.

MS is a chronic neurological disease that involves the central nervous system, specifically the brain, spinal cord and optic nerves and it affects neurons, the cells of the brain and spinal cord that carry information, create thought and perception and allow the brain to control the body. Surrounding and protecting these neurons is a fatty layer known as the myelin sheath, which helps neurons carry electrical signals. MS causes gradual destruction of myelin (demyelination) throughout the brain and spinal cord, causing various symptoms depending upon which signals are interrupted.

Multiple sclerosis refers to the multiple scars (or sclerosis) on the myelin sheaths. It is thought that MS results from attacks from an individual’s immune system on the nervous system and is therefore categorised as an autoimmune disease.

According to Dr Victor Chong Heng Thay, adviser to the Multiple Sclerosis Society of Malaysia, MS could take several different forms, with new symptoms occurring in discrete attacks or slowly accruing over time.

“Between attacks, symptoms may resolve completely, but permanent neurological problems often persist. Although much is known about how MS causes damage, its exact cause remains unknown. MS currently does not have a cure, though several treatments are available which may slow the appearance of new symptoms,” he added.

MS primarily affects adults, with an age of onset typically between 20 and 40 years, and is more common in women than in men.

Dr Chong said members of the Chinese community in Malaysia are five times more likely to get MS than Malays and it is common in Chinese women in their 30s compared to the other communities.

MS affects two to three per 100,000 of the population and it is estimated that about 500 Malaysians suffer from the disease.

Individuals with MS may experience a wide variety of symptoms. The initial attacks are often transient, mild (or asymptomatic), and self-limited. They often do not prompt a health care visit and sometimes is only identified in retrospect once the diagnosis has been made based on further attacks.

The most common initial symptoms reported are: changes in sensation in the arms, legs or face (33%), complete or partial vision loss (16%), weakness (13%), double vision (7%), unsteadiness when walking (5%) and balance problems (3%).

Dr Chong said 15% of individuals have multiple symptoms when they first seek medical attention.

Other symptoms and physical findings common in MS are double vision, speech difficulties, tremors, and clumsiness of the hands, abnormal muscle spasms, bladder and bowel difficulties and sexual dysfunctions.

Cognitive impairments are also common. These include difficulty performing multiple tasks at once, difficulty following detailed instructions, loss of short-term memory, emotional instability and fatigue.

According to Assoc Prof Dr Stephen T. Jambunathan, emotional symptoms are common and are the normal response to having a debilitating disease or a result of damage to the nerves that generate and control emotions.

Speaking on Psychological Issues in MS, Prof Jambunathan said the most common condition, clinical depression, was a product of both causes. Feelings such as anger, anxiety, frustration, and hopelessness were also common and MS patients are 7.5 times more likely to have suicidal tendencies.

Depression is a persistent disturbance of mood with complex roots in an individual’s physiology and psychology and it has marked symptoms. People with MS and other chronic illnesses experience depression more than the general population as a result of the burden of changes in daily life and loss of function.

“Recognising depression is not always easy because some of the physical and mental symptoms are common to MS as well. The relationship bewteen fatigue, cognitive problems and depression can be confusing. Whether one becomes depressed in reaction to MS, or depression is a part of the biology of MS, there are effective interventions.

“While there are some who feel that depression is a character flaw, it is not. There is treatment for depression and it is curable,” said Prof Jambunathan.

Speaking on MS and Intimacy, Datuk Dr Raihanah Abdul Khalid, a consultant neurologist, said that 40-80% of women and 50-90% of men with MS had sexual complaints or concerns.

She said that prevalence of sexual dysfunction in people with MS was higher compared to other chronic diseases and almost five times more than in the general population.

The primary cause of sexual dysfunction is the demyelinating lesions in the brain which directly impair sexual feelings while secondary causes are as a result of MS symptoms or through the use of drugs for treatment.

Psychological, social and cultural issues that interfer with sexual feelings include thoughts such as: “Disabled people aren’t sexually attractive”, “I can’t be both a caregiver and a lover”, to “Sex is the last thing on my mind now especially with MS.”

Datuk Dr Raihanah said measures such as education and support, medical symptom management, communication skills training between partners and patients and the medical team and counselling focussing on intimacy and sexuality are useful in helping MS patients cope with sexual dysfunction.

“The use of medication to relieve patients of painful paraesthesiaes, sexual aids, exercises, body mapping and counselling has been proven to enhance intimacy in people with MS,” she added.
The panellists were unanimous that management of reversing the deficits caused by MS damage is very important and a multidisciplinary approach to treatment through the involvement of therapists, psychologists and psychiatrists is the key to limiting and overcoming disabilities caused by the disease.

Excerpt from The Star


Anti-Cholestrol Drug Lessens Multiple Sclerosis In Mice
The New Sunday Times, 17 November 2002
Experiments in mice suggest that statins, drug normally used to lower cholesterol, may also prevent or lessen paralysis in people with some forms of multiple sclerosis, said researchers. However, they warned that people with multiple sclerosis should not start taking statins in hopes of fighting the disease saying the drugs must still be tested on humans for that use. It may not work and could even make the disease worse.The research team hopes to begin tests next year in people with very early signs of the disease; the patients will be given Lipitor, the statin used in the mice.

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