Multiple Sclerosis

Multiple sclerosis (MS) occurs when the cellular structure around nerve fibers – the myelin sheath – breaks down, perhaps due to inflammation. Damage to that insulating layer impairs transmission of nerve signals between the body and brain or in the brain itself. The resulting symptoms depend on where the damage has occurred.

Multiple sclerosis symptoms may include:
- Fatigue
- Difficulty with walking and balance
- Numbness or tingling
- Spasticity
- Weakness
- Vision problems
- Dizziness
- Bladder or bowel problems
- Chronic pain
- Cognitive difficulty (1)

About 400,000 people in the United States are estimated to have MS. It affects women more than men, and often arises between the ages of 20 and 40. (2)

Doctors diagnose MS through taking a medical history, a physical exam, a neurological exam, MRI, and other tests. Drugs may slow the progression of the disease. In patients who have relapsing-remitting MS, some medications may lower the rate of relapse (or “flares”). Injections of glatiramer or beta interferons may be used to slow the progression. Medications to treat flares in relapsing-remitting MS include corticosteroids; immune-acting compounds such as dimethyl-fumarate, fingolimod, or teriflunomide; and infusion treatments such as alemtuzumab, natalizumab, and for severe MS, mitoxantrone. (2)

Other treatments may ease symptoms and improve quality of life. For instance, a number of neuromodulation treatments may address particular neurological issues. MS patients whose symptoms include urge incontinence may be offered sacral neuromoduation for lower urinary tract symptoms such as overactive bladder, or percutaneous tibial nerve stimulation. Meanwhile, people with MS who have chronic pain have been offered spinal cord stimulation, stimulation of the dorsal root, deep brain stimulation of the posteromedial hypothalamus, and peripheral nerve stimulation. Finally, intrathecal baclofen has been reported to help relieve spasticity in MS, and also to aid in pain relief. (3-7)

References:

1. More common symptoms. Multiple Sclerosis Society. (Accessed Oct. 21, 2016).

2. Ann Pietrangelo (May 5, 2016). Understanding Multiple Sclerosis (MS). Healthline. Accessed Oct. 21, 2016.

3. Minardi D, Muzzonigro G. Sacral neuromodulation in patients with multiple sclerosis. World J Urol. 2012 Feb;30(1):123-8. doi: 10.1007/s00345-011-0669-0. Epub 2011 Mar 15. PubMed PMID: 21400258.

4. Burkey AR, Abla-Yao S. Successful treatment of central pain in a multiple sclerosis patient with epidural stimulation of the dorsal root entry zone. Pain Med. 2010 Jan;11(1):127-32. doi: 10.1111/j.1526-4637.2009.00764.x. PubMed PMID: 20447296.

5. Franzen et al. Deep brain stimulation of the posteromedial hypothalamus: indications, long-term results, and neurophysiological considerations. Neurosurgical Focus. 2010 Aug;29(2):E13.

6. Farhan M, Richeimer S. Peripheral Neuromodulation in Multiple Sclerosis Related Trigeminal Neuralgia. http://www.epostersonline.com/nans2015/node/111. North American Neuromodulation Society 19th Annual Meeting. Dec. 10-15, 2015.

7. Baclofen. Multiple Sclerosis Society. Accessed Oct. 21, 2016.

Reviewed Feb. 10, 2017
Marc Russo, MBBS, DA(UK)FANZCA, FFPMFANZCA
Executive Officer, International Neuromodulation Society, 2011-2019
Hunter Pain Clinic, Broadmeadow, NSW Australia

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