Managing symptoms of ms

Balance and Coordination

Physical therapists, occupational therapists, and physiatrists (rehabilitation physicians) are specially trained health professionals who design programs that help maintain balance, coordination, walking ability, and movement.
The goal of treatment is to promote safety in mobility and transfers, maximal independence and function, and an improved quality of life. These specialists can provide exercises that improve range-of-motion, overcome balance and coordination problems, and increase overall endurance.
A lightweight ankle-foot brace or orthotic can sometimes be effective in overcoming the instability of weakness in the foot or foot drop. A weighted cane or a walker is the best method for helping mobility and assure a safe gait with proper balance.

Tremor

Tremors are one of the most difficult symptoms of MS to treat. Some medications may calm shaky movements of the head, arms, and legs, but they often have side effects that limit their use. Many of the medicines used to treat tremors cause drowsiness.
Sometimes, physical devices can be used to help stabilize the neck and head or the hands. A rehabilitation evaluation should be done to see if tremor can be reduced by specific activities and exercises or by assistive devices.

Select list of medications commonly used to treat tremors:

Klonopin® (Clonazepam)
Isoniazid® (INH)
Inderal® (Propranolol)
Mysoline® (Primidone)

Spasticity

The decision to treat spasticity depends on how much it interferes with a person’s level of comfort, mobility, body positioning and daily activities.

Physical therapy may be prescribed to assess and to treat spasticity. In addition, most spasticity responds well to drugs. However, many of the medications used to reduce spasticity may cause drowsiness and possibly muscle weakness.

Baclofen, which is the standard first-line treatment of spasticity, can be taken orally. If oral medications prescribed in ever-increasing doses are not effective or produce unwanted side-effects, baclofen may be administered through a pump implanted under the skin (intrathecally), which delivers the medication in small doses over the course of the day. This is an expensive surgical procedure only prescribed when standard therapies do not produce desired results.

Another medication used for this problem is tizanidine whose main side-effects include sleepiness. Both these oral medications are usually started at low doses and gradually increased over time to produce symptomatic relief.

Select list of medications commonly used to treat spasticity:

Oral baclofen
Intrathecal baclofen
Zanaflex® (Tizantidine)
Catapres® (Clonidine)
Valium® (Diazepam)
Botox injections for small muscle groups

Bladder Problems

Bladder symptoms are common in people with MS. People may experience urinary urgency, frequency, incontinence (wetting oneself) or retention (difficulty passing urine).

Bladder function tests can pinpoint the source of bladder problems so the correct medication is appropriately prescribed. In addition, urologic follow-up may involve testing of the bladder muscle strength and muscle tone so that the proper intervention may be prescribed. Rather than restricting fluids to disguise the problem, it is recommended that people with MS talk to their healthcare providers for follow up. Restricting fluids can cause urinary tract infections and affect bowel function as well.

It is also recommended that people self-monitor for changes in urinary function and check the color of their urine. For example, suddenly darkened urine with no symptoms might be an early indication of an oncoming infection.

Urinary tract infections, which are caused by an overgrowth of bacteria in the urine, are treated with antibiotics. Testing the urine can reveal the type of organism causing the infection, so the correct antibiotic is selected. Burning on urination and foul smelling urine should be investigated, as they are likely signs of a urinary tract infection.

In some cases, urine must be emptied manually by threading a small tube (Foley catheter) through the urethra and into the bladder.

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