Complications of Multiple Sclerosis

From fatigue to sexual dysfunction, multiple sclerosis can come with a debilitating set of symptoms. You may know someone living with multiple sclerosis, but do you know how they are affected by MS?

9 Common MS Symptoms

Multiple sclerosis symptoms and complications often relate to where myelin and nerve damage occurs in the body. Many organs and systems in the body can be affected. Common issues include:

Fatigue: According to the National Multiple Sclerosis Society, many people living with multiple sclerosis suffer from fatigue. MS-based fatigue can be difficult to diagnose at first as many diseases also cause fatigue, but in MS, heat is known to make the problem worse. According to Dr. Chitnis, "fatigue is a chronic symptom of MS that can be disabling, but it can be treated with medication."

Loss of Mobility and Spasticity: Multiple sclerosis can attack the part of the brain that regulates motor function. This problem is what Rick Sommers, diagnosed with MS in 1994, calls "a predisposition to being clumsy" — meaning that it causes frequent stumbles and missteps and may eventually cause a more severe disability. "Will I end up in a wheelchair?" is still a question frequently asked by people newly diagnosed with multiple sclerosis, and though many people living with MS will need assistance from adaptive technologies at some point in their lives, doctors are now reporting that the outlook is better than ever. Chitnis says that currently "the goal of treatment is to prevent disability."

Bowel and Urinary Dysfunction: "Urinary symptoms are common in people living with MS and usually involve urgency or frequency issues," Chitnis says. Incontinence, or an involuntary loss of urine, can also appear in MS patients, not necessarily due to the direct action of multiple sclerosis but due to a combination of MS complications such as a less-active lifestyle and the side effects of medications, says Chitnis.

Cognitive Issues: Problems with processing thoughts, concentration, memory, or other issues related to mental awareness or judgment are widespread among people living with MS and have been gaining more attention recently. Jeffrey Gingold, diagnosed in 1996, suffers from cognitive issues as a result of his MS. "Because it's a mental condition," he says, of the cognitive effects of MS, "there's more of a stigma attached. People are reluctant to talk about it." Still, Gingold believes this perception is gradually changing. In the past, he says, "even health care providers sometimes had a tendency to write such issues off as stress or a menopause-related problem, for women." Now, people are taking the common cognitive symptoms of multiple sclerosis more seriously.

Depression: Depression can be caused by a number of factors in people with multiple sclerosis. Chitnis says the relationship between depression and MS is complex: For people predisposed to depression, some of the medications that are used to slow the progression of multiple sclerosis can make symptoms of depression worse; for other people, the shock of being diagnosed with a chronic illness can lead to depression. In addition, she says, depression can develop as a direct result of multiple sclerosis, occurring when the part of the brain that regulates emotions is attacked and damaged.

Sexual Dysfunction: Sexual dysfunction is a common complaint among people living with MS. Sexual problems in people with MS can result from a multiple sclerosis attack on the part of the brain that controls sexual function or the nerves that send impulses to the sex organs. Or, they can come as a result of a combination of other MS complications. Depression and fatigue, for instance, are often linked to lessened sexual desire. And spasticity and loss of mobility, which are common in MS, can cause discomfort during sexual activity.

Speech Problems: Speech issues can appear in people living with MS if multiple sclerosis attacks the part of the brain that controls verbal communication or the nerves that send communication between the mouth and brain. Speech problems take the form of slurred or nasal-sounding speech, and changes in cadence, such as additional pauses between words and syllables where none are usually found.

Lung Issues: Your brain automatically regulates certain essential bodily functions such as breathing and your heart beat, even while you're sleep. If multiple sclerosis damages the part of the brain that controls such automatic functions, serious problems can result. If you have MS and you're having difficulty breathing, don't delay seeing a doctor or even going to the emergency room.

Osteoporosis: People with MS are at increased risk for osteoporosis, a disease that causes thinning of the bones. Because the condition also creates mobility and spacticity problems, some people with MS are more prone to falling, which also increases their chances of breaking a bone. In addition, steroid drugs are frequently prescribed to treat flare-ups of MS symptoms and, while they do an effective job of bringing MS symptoms under control, they can also increase the risk for osteoporosis.

While multiple sclerosis complications will vary from person to person, understanding these common risk factors can help you and your doctor in creating a disease management plan that works best for your individualized needs.

Steroid Treatment for Multiple Sclerosis

It’s likely that the vast majority of us on this site have had at least one infusion of corticosteroids for our Multiple Sclerosis. Names like methylprednisone (Solu-Medrol) and dexamethasone (Decadron) are not unfamiliar to those of the compromised myelin. I promised a discussion on the topic in a posting a few weeks back, and the time has come.

Corticosteroids are synthetic replications of natural hormones produced in our adrenal glands. They seem to have an anti-inflammatory function and were some of the first drugs used to combat MS attacks, going back decades.

Corticosteroids differ from anabolic steroids in almost every way, other than they are derived from a hormone (male testosterone). When being administered corticosteroids, one need not worry about the side effects we read about when athletes use these drugs.

In layperson’s terms (not that we’re of the lay persuasion when it comes to MS), this form of drug helps to shrink the swelling around an active lesion in the central nervous system. Current evidence shows that, months out from an exacerbation (attack), a person is likely to be in the same place clinically with the disease, with or without the use of corticosteroids.

Doctors, or at least the ones I have spoken with about the topic, say they’ll continue to use these steroids during acute exacerbations because patients demand they do something.

In most cases, a 3-5 day infusion of high-dose corticosteroids (likely with a few days of oral taper) does relieve many of the symptoms of the attack. When I write “most cases,” that’s most attacks, not most patients. Some patients will respond well most of the time, and the drugs will do nothing for others. Of course, I write in clinical generalities.

For patients with active disease, it is not uncommon to be placed on monthly “pulse” doses of these drugs. The theory here seems to be, if a big dose helps when inflammation is uncontrolled, small doses will keep it in check. For people I have talked with in this category, treatment seems to have them in a better place than without.

All of this is leading up to the side effects, as you might have imagined. The National MS Society Sourcebook on the topic states the following:

“Possible side effects include stomach irritation, elevated blood sugar, water retention, restlessness, insomnia and mood swings…The side effects of long-term continuous steroid use are serious and well-documented. These include stomach ulcers, weight gain, acne, cataracts, osteoporosis (thinning of the bone), deterioration of the head of the thigh bone and chemical diabetes.”

“Mood swings”: that’s a nice way of saying ‘roid rage!

As many of you have understood from the past two weeks, I have experienced some of that “deterioration of the head of the thigh bone” called avascular necrosis and have had a 10cm rod cut, drilled and hammered into the head of my femur. Not something I had ever considered when I was going in for my six three-day infusions of Solu-Medrol in the first 18 months after diagnosis.

I’m not bitter (well, maybe a little aftertaste…) but I wanted to use this bully pulpit to open the conversation for others who dislike using these drugs, but don’t know what else to use, or worse, have a doctor who “forces” them on you.

Let’s see where this discussion takes us, shall we?

By the way, for those who were wondering: I am, today, two weeks out from surgery. I am only using a cane to get around and need very little (if any) pain medication. The surgeon is very happy with the recovery thus far. We’ll not know if this worked for a couple of months (bone could still collapse…well, it will, eventually, we’re just hoping to buy 3-5 years here).