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How to Spot the Signs of an MS Flare

More than two-thirds of the approximately 1 million people with multiple sclerosis (MS) in the United States have relapsing-remitting MS (RRMS), which means they have periods when their symptoms are severe — relapses — and periods when their symptoms are less severe, although they may not disappear completely. Some people with secondary-progressive MS, a later stage of RRMS, continue to have relapses, along with a general progression of symptoms and disability.

Is It a Flare or a Pseudo exacerbation?

The periods when new symptoms appear or old ones reappear or get worse are called MS flares, or, alternatively, relapses, attacks, or exacerbations. Flares occur because of inflammation in the central nervous system — the brain and spinal cord — causing damage to the myelin or underlying nerve fibers.

To be considered a true flare, a relapse must occur at least 30 days after the previous flare, and the new or recurring symptoms must last for at least 24 hours.

When new or worsened MS symptoms clear up in less than 24 hours, it’s called a pseudo-relapse or pseudo exacerbation. Heat, stress, fatigue, and infections are often behind pseudo exacerbations.

While the symptoms of a pseudo exacerbation are real, there is no new damage being done in the central nervous system.

True flares typically come on over several hours to several days and can last anywhere from a few days to a few weeks.

It is not always clear from the outset whether a person is experiencing a flare or a pseudo exacerbation, and sometimes watching and waiting is the only way to know.  But if you experience any new symptom that interferes with your ability to function normally, says Matthew McCoyd, MD, a neurologist at Loyola University Medical Center in Chicago, let your doctor know about it right away.

Symptoms of a Flare

The signs and symptoms of an impending MS flare include virtually any of the possible symptoms caused by MS. They vary from person to person and from flare to flare.

Many people begin to recognize certain symptoms that signal that a flare may be coming. “As unpredictable as the disease is, my signs are pretty regular,” says Cathy Chester, a writer who lives in New Jersey with her husband and son and was first diagnosed with relapsing-remitting MS in 1986.

“My feet and sometimes my fingers start tingling, and I begin to feel weak; those are usually the first signs that something is awry,” says Chester. For Chester, numbness and extra fatigue often follow those initial symptoms. “I know at that point that my body is warning me that a flare or a pseudo exacerbation is coming,” she says.

Other possible signs of an oncoming relapse include:

  • Increased fatigue
  • Tingling or numbness anywhere on the body
  • Brain fog, or difficulty thinking
  • Muscle spasms
  • Depression
  • Visual changes, such as blurring or double vision
  • Pain
  • Tremors
  • Severe balance problems
  • Severe weakness
  • Dizziness
  • Bladder changes
  • Any combination of these symptoms

Getting to know how MS usually affects you, and monitoring how you feel from day to day, can help you catch potential flares early. At the same time, being overly vigilant can have a negative effect on your mental health.

It’s best — although not easy — to find a way to strike a balance between noticing what’s happening in your body and worrying about every change or sensation.

“When I was first diagnosed, I worried a lot more when I started to get these signals, partly because everything was new,” says Chester. Now that she’s more knowledgeable about living with MS, she adds, it’s become easier to notice symptoms or changes in her body and not overreact or get stressed about them.

It’s also important to consider other possible causes of your symptoms; they may have nothing to do with MS, but they may still need to be checked out by a medical professional. To read this article in its entirety click the link: How to Spot the Signs of an MS Flare.

 

How Age Affects Multiple Sclerosis Symptoms and Progression

Most people with multiple sclerosis (MS) are diagnosed between age 20 and 50, though it can occur in children as well as in older adults, according to the National Multiple Sclerosis Society (NMSS).

About 85 percent of people diagnosed with MS are initially diagnosed with the relapsing form of the condition, usually referred to as relapsing-remitting MS, which is characterized by periods of active symptoms — sometimes called flares or exacerbations — alternating with periods of less-severe symptoms.

Eventually, as many as 90 percent of these people reach a stage known as secondary-progressive MS (SPMS), in which symptoms gradually worsen and a person experiences increasing levels of disability. That might include more difficulty walking, loss of stamina, and cognitive problems. Some people with SPMS continue to experience relapses, but many don’t.

The transition from relapsing-remitting MS to secondary-progressive MS appears to be age dependent, with the forties being the most common period to experience it, according to a review article published in April 2021 in Frontiers in Neurology.

However, the authors of the review say, because there is no consensus among experts regarding any specific diagnostic criteria for disability progression, nor are there any definitive biomarkers of progression, a diagnosis of SPMS can only be retrospective (after the fact). That limits doctors’ ability to treat MS progression in its early stages.

Age at Diagnosis and MS Progression

The thinking used to be that MS progressed more quickly in people diagnosed at an older age. Indeed, research published in the Journal of Neurology, Neurosurgery & Psychiatry found that children diagnosed with MS took longer to develop secondary-progressive disease (32 years) than adults diagnosed with MS (18 years), and they also took longer to reach disability milestones.

But the study authors note that those diagnosed as children hit disability milestones at a younger age and therefore could be considered to have a poorer prognosis.

Helen Tremlett, PhD, Canada research chair in neuroepidemiology and multiple sclerosis and a professor at the University of British Columbia in Vancouver, says that her work since 2006 has shown that late-onset MS does not necessarily mean “a worse outcome for the patient.”

Dr. Tremlett participated in a study published in April 2015 in the European Journal of Neurology, which investigated whether the use of the widely prescribed MS drugs known as beta interferons delays the onset of secondary-progressive MS; it found that they do not.

However, a study published in January 2019 in the Journal of the American Medical Association suggests otherwise. When researchers compared MS medications including beta interferons, glatiramer (Copaxone, Glatopa)fingolimod (Gilenya)natalizumab (Tysabri), and alemtuzumab (Campath, Lemtrada) versus no treatment at all, they found that treatment with any of these medications was associated with a lower risk of transition to SPMS.

In particular, fingolimodnatalizumab, and alemtuzumab were associated with the lowest risk of progression to SPMS, and treatment was especially beneficial when started sooner — less than five years after disease onset — rather than later.

Tremlett also coauthored a systematic review of MS research published in July 2017 in the journal Neurotoxicology that looked at risk factors associated with onset, relapses, and progression in MS. The review focused on factors that are modifiable, and among these, smoking appeared to accelerate disease progression.

A more recent study, published in April 2020 in the journal Neurology, also identified smoking, along with older age, greater disability, motor and brain stem dysfunction, and spinal lesions at the time of diagnosis, as risk factors for transitioning from relapsing-remitting MS to secondary-progressive MS. To read this article in its entirety click here: How Age Affects MS.

Your FAQs, Answered: Does Stress Affect MS? 4 More Questions

Everyone can relate to feeling stressed from time to time. It’s part of being a human.

Stress is a normal response when there’s a perceived threat to survival or your way of life. Though your body’s natural response to stress — wanting to run away from it or fight it — isn’t usually an option.

Stress isn’t always negative. Major life events like moving, starting a new job, or having a baby can cause stress too.

When stress is ongoing, it can start to affect your well-being. Stress can cause a variety of symptoms, including headaches, tension, sleep difficulty, and mood changes. Long-term stress can lead to depression and cause physical symptoms.

It’s impossible to avoid stress altogether, but you can find ways to better respond to stress. When you live with multiple sclerosis (MS), finding ways to manage your stress is an important part of managing your condition.

Does stress affect MS?

MS is an autoimmune disease. The immune system is designed to attack harmful invaders like viruses or bacteria. In MS, the immune system mistakenly attacks myelin, the protective coating on the nerves. This results in damage to the myelin.

There may be a link between stress and autoimmune diseases like MS. Researchers have found that people who have been diagnosed with stress-related conditions are more likely Trusted Source to develop an autoimmune disease. However, more research is needed to understand this connection.

Science hasn’t been able to draw a conclusive link between stress and MS flares. Stress can cause a variety of emotional and physical symptoms that can affect how you feel. If you’re already dealing with symptoms of MS or its treatments, the extra toll of stress can make you feel worse.

Does stress cause MS lesions?

MS lesions are areas of damage in the nervous system. They can be seen using magnetic resonance imaging (MRI). New lesions look different than older ones. Researchers have been studying how different factors may influence the formation of new lesions.

One study Trusted Source explored the effects of both positive and negative stressful events. Negative stress was defined as a threat to the person or their family. The study found that periods of negative stress resulted in more brain lesions. Positive stress events did not.

Another study found that stress management counseling reduced Trusted Source the number of new MS brain lesions. However, the effects did not last. There was no significant difference in lesions at the 24 week follow-up. To read this article in its entirety click here: Does stress affect your MS

MS Prognosis: Multiple Sclerosis Life Expectancy

So what is the life expectancy for people with MS? There isn’t one clear answer. The National Multiple Sclerosis Society estimates that, on average, someone with MS lives about seven years less than the general population. A study of 30,000 people in the U.S. with MS found they lived six years less, on average, than those without MS.

Multiple sclerosis itself is not the cause of death, since MS is not inherently fatal. Rather, the symptoms caused by the progression of MS can lead to other conditions that are ultimately fatal. Pneumonia, infections, and falls are common causes of death directly connected to the symptoms of MS.

“MS is not a fatal disease,” one member said. “However, this can lead to other illnesses and problems as a result of how MS can affect your life. If you become less active, you may be at risk of heart problems, or someone may fall due to mobility problems.”

MS Factors Related to Life Expectancy

There are a variety of factors related to MS prognosis. These include sex, age at disease onset, the level of recovery from the first outbreak, MS relapses, and central nervous system (CNS) involvement. In general, women with MS have a better prognosis than men, as do people who are younger at the time of MS onset. African Americans are more likely to have a primary progressive form of MS. People who recover from their first outbreak completely have a better prognosis than those who do not. Infrequent MS relapses and less cerebellar and CNS involvement are also associated with a better prognosis.

The different types of MS have different prognoses. Relapsing-remitting multiple sclerosis (RRMS) typically has a better prognosis than primary progressive multiple sclerosis (PPMS) or secondary progressive multiple sclerosis (SPMS). Since RRMS allows complete or partial recovery from symptoms before relapse, there is less disability associated with it. Secondary progressive MS, which occurs when someone with a previous RRMS diagnosis has worsening symptoms, indicates a more systemic condition. Since primary progressive MS does not follow the pattern of relapse and recovery, and more neurological symptoms occur with it, it is associated with the poorest prognosis of all. One member reported feeling guilty when a friend with a more progressive form of MS passed away: “I felt guilty because he had PPMS, and I didn’t, and I had a life still in front of me.”

A rare type of MS is associated with a very dire prognosis — Marburg-type MS, sometimes referred to as fulminant multiple sclerosis. This condition progresses even more rapidly than PPMS and can lead to death in weeks or months.

Other Factors That Influence Prognosis

MS isn’t the only issue some people are dealing with. Other medical conditions and comorbidities can affect the disease course.

One study found the most common comorbid conditions for people with MS were high cholesterol, high blood pressure, gastrointestinal disorders, thyroid disease, anxiety, depression, and chronic lung disease. Almost 30 percent of those with MS had either high cholesterol or high blood pressure. Up to 20 percent had some form of gastrointestinal disorder. Thyroid disease was present in 12 percent to 17 percent, and anxiety, depression, and chronic lung disease were each present in 5 percent to 10 percent of those studied. All of those conditions are associated with a decrease in life expectancy (including depression and anxiety). To read this article in its entirety click here: MS Prognosis: Multiple Sclerosis Life Expectancy

B-Cell Therapy for Multiple Sclerosis

What Is B-Cell Therapy?

B-cell therapy (also called B-cell depletion therapy) is a treatment for people with multiple sclerosis (MS). It targets cells called B cells that damage nerves in your brain and spinal cord.

B-cell therapy isn’t a cure, but it can:

  • Ease symptoms
  • Help prevent relapses
  • Slow the course of your disease

How B-Cell Therapy Works

B cells are a type of white blood cell. They make antibodies — proteins that fight viruses and bacteria. B cells normally can’t cross from your blood into your brain or spinal cord. If you have MS, some B cells enter your brain and spinal cord and attack the myelin sheath that protects your nerves.

B-cell therapy uses drugs called monoclonal antibodies to attack these cells. These meds stick to the surface of B cells. This kills the cells, helps ease inflammation, and plays a part in slowing down nerve damage.

B-cell therapy might affect other parts of your immune system as they fight MS. That’s because B cells affect other immune cells called T cells. T cells usually kill viruses and bacteria. But when you have MS, B cells recruit T cells into your brain. There, they cause inflammation.

When your number of B cells goes down, your amount of T cells that cause inflammation goes down, too. At the same time, your level of something called regulatory T cells goes up. Regulatory T cells turn off inflammation. They may even help slow your immune system’s attacks on your body.

B-Cell Therapy Types

The FDA has approved two B-cell therapy drugs.

Ocrelizumab (Ocrevus) treats relapsing forms of MS, including:

  • Clinically isolated syndrome
  • Relapsing-remitting MS
  • Active secondary progressive MS in adults
  • Primary progressive MS in adults

It may lower relapses and slow the disease. You get ocrelizumab through an infusion at a hospital or clinic. This puts the medicine directly into your bloodstream. You’ll receive two doses, 2 weeks apart. Then you’ll get one dose every 6 months.

Ofatumumab (Kesimpta) is a shot you give yourself at home. Your doctor will teach you how. You’ll have an injection once a week for 3 weeks, skip 1 week, and then inject one dose per month.

These drugs are new versions of the cancer med rituximab (Rituxan). Rituximab isn’t approved to treat MS, but doctors sometimes prescribe it as an “off-label” treatment. With rituximab, you’d get the medication through an IV in a doctor’s office. You’d get two doses, 2 weeks apart. Then, every 6 months, you’d have two more doses, 2 weeks apart.

B-Cell Therapy Side Effects

Infusions sometimes cause an allergic reaction. Your doctor might call it an infusion reaction. If it happens, it’s usually during your first dose.

You might have:

  • Itching
  • Rash
  • Nausea
  • Hives
  • Headache

These symptoms are often mild but can be severe. You usually get your first dose of these medicines across two sessions to make it less likely that you’ll have a reaction.

With any of these treatments, you could be more prone to infections like colds, bronchitis, and herpes. So, it’s important to take steps to stay healthy.

Some researchers believe that these treatments can also give you a slightly higher chance of some cancers, especially breast cancer. But experts aren’t sure of the connection.

In very rare cases, they may lead to progressive multifocal leukoencephalopathy (PML), a rare brain infection that can be fatal.
Before you try B-cell therapy, your doctor will go over all the possible side effects to make sure you know the risks and benefits of treatment.

WebMD Medical Reference

Why Don’t My MRI Images Match My Symptoms?

This is the burning question asked over and over – often we feel a physical decline due to our multiple sclerosis, but when the neurologist orders a new MRI to check our progress, the report often comes back ‘unchanged.’ I certainly don’t want my MRI to show new disease activity but I am always looking for an explanation as to why my walking has slowed or my fatigue has increased.

My neurologist took the time to explain

At my last Ohio State University MS clinic visit, my neurologist, Aaron Boster, took the time to talk to me about this question. He could have just given me the answer ‘because of Clinical Radiographic Paradox,’ and left me dumb founded, but instead, he took 20 minutes to explain it in detail. I’m sure the other patients waiting to see him might have been irritated at the delay, but this was important to me, and I hope is also useful to you, the reader.

Dr. Boster didn’t acknowledge that glazed overlook in my eyes as he said the first large medical terms and went into quite a bit of medical detail for an explanation. I took notes as he talked, and here is what I took away from our conversation in my own simplified language –

Clinical Radiographic Paradox

Clinical Radiographic Paradox occurs when on clinical examination there are symptoms that do not match the MRI images. Dr. Boster said that MRIs for diagnostic purposes are lesion-centric, focusing only on what can be seen by MRI imaging in the normal-appearing white matter of the brain. The MRI at the strength commonly available and the current software packages and training doesn’t capture images of the grey matter.

White matter vs. grey matter

The white matter is where the demyelinated axons are located, and that is what shows with current imaging techniques – the MRI only looks at this area of the brain. The brain’s grey matter also contains axons (the non-myelinated type) and all sorts of other critical parts that control speech, motor control, and memory, to name a few. All of those can be problems for people with MS but don’t show on MRI scans.

Physical and subjective symptoms

Dr. Boster also talked about the difference between physical and subjective symptoms – the subjective ones often deal with the MS Quality of Life index (MSQLI) – those things that make our lives better or worse. We can have no new disease activity but still have increased difficulties if our MSQLI is bad. Do we have support from our family and friends? Is depression from our personal health situation a factor? Does our financial situation impact our MSQLI? This list can go on and on, and I imagine you can add a few more.

Those problems can all manifest themselves as physical or subjective symptoms. Subjective symptoms require the neurologist to stop and really listen to the patient describe the problem and come up with a plan to treat those MSQLI items, too.

As I have often said, I am not the scientific, technical person of the group around here. If you would like to read more about this, I can recommend this article: Clinical correlates of grey matter pathology in multiple sclerosis .

No single test tells the whole story

The most important take-away I have from this conversation with Dr. Boster is no single thing tells the whole story when it comes to treating Multiple Sclerosis: our MRI, the doctor’s neurological exam, and the patient telling their story to the treating physician all come together to explain our current condition.

 

Multiple Sclerosis and Joint Pain

Multiple sclerosis (MS) is a progressive immune-mediated disorder that causes a person’s body to mistakenly attack the central nervous system (brain, spinal cord, optic nerve).

When a person has MS, their central nervous system (CNS) becomes acutely inflamed. This inflammation damages the nerves by wearing away the protective layer of myelin that insulates the nerve fibers and facilitates the transmission of central nervous signals.

After enough damage is done to the myelin and nerve fibers, the transmission of signals becomes interrupted and can even be halted completely. As a result of this degeneration, a variety of debilitating symptoms develop.

Indirect joint pain

The nerve and musculoskeletal damage associated with MS results in progressive pain that can leave a person with a variety of symptoms, such as:

The two types of pain people with MS experience are nerve pain and musculoskeletal pain. Both types indirectly contribute to aching joints and body pains. While MS doesn’t directly affect the joints, it does affect other areas that can lead to joint and body pain. For example:

  • A loss of energy leads to physical deconditioning, resulting in weakened and vulnerable muscles.
  • A loss of balance and stiff limbs results in an uneven gait that affects the joints.
  • A weak posture results in painful pressure in the lower back.
  • Frequent muscle spasms affect mobility and general flexibility that support the joints.

Indirect joint pain associated with MS is usually more severe around the hips and back, as well as the legs. Energy, posture, flexibility, and balance all play important roles in joint pain.

While there is no cure for multiple sclerosis, there are ways to manage and mitigate pain using medications, physical therapy, and lifestyle changes.

MS joint pain management

According to the Multiple Sclerosis Association of America, about 50 percent of people identify pain as a major symptom after being diagnosed with MS, and about 48 percent of people report experiencing chronic pain.

While everyone with MS experiences pains differently, there are some general remedies, therapies, and medications that can be used to find what is right for you.

Some everyday methods you can use to improve symptoms of joint and muscle pain include:

In addition, many people do well with physical therapy to help manage stiffness, balance, spasticity, and spasms. A physical therapist can help pinpoint problems with weak or tight muscles that can lead to joint pain in MS.

The physical therapist can teach you stretching and strengthening exercises that will improve the joint pain. A physical therapist can also evaluate gait problems and even recommend modifications that will help you walk better and put less stress on your joints.

Medication

When it comes to medications, the overstimulated nerves with MS are commonly treated with antiepileptic drugstricyclic antidepressants, and anti-spasticity drugs.

Opioids can be prescribed in more extreme cases, but painkillers are not as effective with treating the symptoms of MS and are generally avoided.

Muscle pain can be treated with muscle relaxers, and joint pain can be treated effectively with nonsteroidal anti-inflammatory drugs (NSAIDs).

Always discuss any changes in your treatment or pain management plan with your doctor.

Takeaway

Balance, energy, and muscle problems are all very common with MS, and the nerve and musculoskeletal damage can contribute to the development of painful joints and aching muscles.

With the right combination of physical therapy, medication, and lifestyle changes, you can manage your MS and a lead rich, enjoyable life.

 

MS and Brain Fog: What You Need to Know

MS and the brain

Your brain is about 20 percent myelin. When MS interferes with the function of this myelin, it can disrupt the neuronal activity in your brain. As a result, more than 50 percent of people with MS experience some cognitive changes.

Sometimes cognitive changes are the first sign that you have MS, although these types of changes are more likely to occur later on, as the condition progresses. These changes can happen with any type of MS but are more common in progressive MS.

Some of these changes can affect:

  • concentration and attention
  • information processing
  • memory
  • prioritizing and planning
  • verbal fluency
  • visual spatial ability

According to one study, roughly 40 percent of those with MS will have only mild symptoms, but 5 to 10 percent will have moderate to severe symptoms. Those with progressive MS tend to experience more severe cognitive changes than those with relapsing-remitting MS.

During an MS flare, inflammation can trigger new cognitive challenges, or intensify the ones you already have. Sometimes these flare-related changes are permanent, but they can also resolve once the flare has passed and the inflammation has subsided.

Brain fog

Brain fog is a term used to describe how your brain doesn’t seem to work as well as it once did. It’s also sometimes referred to as “cog fog,” the shortened version of cognition fog.

When you experience brain fog, you might forget words, lose your keys, or miss an appointment. Your job performance or schoolwork may be affected, or you might be challenged by everyday tasks, like decision making.

Brain fog can be your first MS symptom, or it can appear after you have a diagnosis. Brain fog can interrupt your daily routine by causing you to become absentminded. Strategies to manage brain fog include:

  • writing to-do lists
  • using voice-to-text technology to keep notes
  • using timers and alarms
  • using a family calendar
  • saving difficult tasks for when you’re most alert
  • reducing background noise when you need to concentrate
  • designating a specific area in the home for important items, like mail and keys
  • avoiding multitasking
  • taking frequent breaks to recharge

If you have an MS diagnosis and begin to notice cognitive changes, it’s important to talk with your doctor to assess the situation. Early screening and ongoing monitoring can help those with MS manage their symptoms.

Treatment

Cognitive changes can vary widely from person to person, depending on how severely the brain has been affected.

Once a doctor has determined your cognitive strengths and deficits, they may recommend a cognitive rehabilitation program to help prevent symptoms from worsening. In some cases, these programs can result in some improvement.

These programs usually consist of:

  • restorative activities, including learning and memory exercises
  • compensatory activities, to help make up for functions that no longer work so well, such as using a central calendar, and using notes or checklists to remind yourself of important events

According to some central nervous system stimulants may also be helpful in improving attention, processing speed, and memory problems.

In addition, many disease-modifying treatments (DMTs) for MS reduce the accumulation of new demyelinating lesions, so it seems likely they may be able to help stabilize cognitive changes. However, more studies are needed to determine their effectiveness in this area.

Someday, a combination of rehabilitative programs, symptomatic treatments, and DMTs may help to modify the course and impact of cognitive changes related to MS.

Lesions

Brain lesions cause brain fog. The more brain lesions a person with MS has, the greater the number of cognitive changes they will likely experience.

MS lesions are areas of injury that occur on nerve cell myelin. They appear when white blood cells and fluid trigger inflammation that damages the myelin and the axons underneath.

Lesions affect the transmission of nerve impulses. They can slow nerve signals or block them completely. The signal interference they cause can happen intermittently or constantly.

There is no specific order or pattern for MS lesions to occur, which is why not everyone with MS has the same symptoms. Lesions can vary greatly in size and shape. They can develop anywhere in the central nervous system (CNS), and their location determines the changes you experience.

Treatment aimed at slowing the formation of new lesions can also help to slow the rate of cognitive changes.

If you begin to experience cognitive changes or have concerns about developing them, talk with your doctor. They can perform a short screening test, and depending on the results, they may refer you to a specialist for a more comprehensive evaluation.

A comprehensive evaluation will help point out exactly what specific cognitive functions are affected. It’s also important to make sure that these changes are related to demyelination and aren’t the result of other issues, such as fatigue, medication, or mood changes due to depression, anxiety, or stress.

Areas of the brain impacted by MS

MS is a condition affecting myelin. The area of your brain containing the most myelin is called white matter. This is the area underneath the grey matter surface. Grey matter contains most of the neuronal cell bodies, while the myelin-coated axons extend through the white matter and connect areas of grey matter.

Previously, MS was thought to affect mostly white matter in the brain. This is because grey matter doesn’t have as much myelin, so grey matter lesions are hard to see in medical imaging. Since newer imaging technology can detect some grey matter lesions, we now know that MS affects both white and grey matter.

Cognitive impairment symptoms depend on the presence of lesions in specific brain areas. For example, lesions in the brain’s frontal lobe region can interfere with executive function skills like decision making and prioritizing. Lesions located near the cortex may cause memory issues.

Does MS show up on a brain MRI?

MRI technology can detect MS lesions. This type of scan is used to diagnose MS as well as monitor its progression by keeping track of any new lesions that may have occurred since diagnosis.

An MRI scan can also reveal if any existing lesions have increased in size. In addition, it allows doctors to monitor the location of lesions and the areas of the brain that may be potentially affected.

The specific location of lesions may also give doctors information about possible related cognitive issues to watch for.

Takeaway

MS symptoms are caused by the location of lesions, which slow or block nerve signals. They can occur anywhere in the CNS at any time, so symptoms can vary widely for people with MS.

If you have MS lesions in your brain, you might experience cognitive issues, also known as brain fog. About half of people with MS experience these cognitive changes.

If you begin to experience cognitive changes, it’s important to talk with your doctor and be screened to understand what’s causing them.

In addition to treatments that may help stabilize or improve symptoms, doctors can also recommend strategies to manage these changes, including using timers, making lists, and taking notes. Taking breaks to rest your mind can also help.

The Role of the Gut Microbiome in Multiple Sclerosis

What Is the Gut Microbiome?

 

In addition to our own cells, our bodies contain trillions of microorganisms — bacteria, viruses, fungi, and archaeal cells — collectively called microbiota. Their combined DNA is called the microbiome. Some may be harmful, but most are beneficial.

“These bacteria help us digest our food, provide essential vitamins, and assist in the development of our immune and nervous systems,” says Sarkis Mazmanian, PhD, a professor of microbiology at the California Institute of Technology in Pasadena. “Many of them protect us from disease.” The vast majority of those bacteria live in our digestive system, as do more than 70 percent of all the white blood cells in the body. Hence the gut, which includes the large and small intestines, is a major organ of both the digestive and immune systems. That’s because the bacterial composition of the human gut plays a role in healthy immune functioning in the body.

“The gut is the second largest site of exposure of the body to the outside world after the skin, which is a largely impermeable barrier,” explains Daniel Mielcarz, PhD, a research scientist of microbiology and immunology at Dartmouth’s Geisel School of Medicine in Hanover, New Hampshire, and coauthor of a study review on the gut microbiome published in Current Treatment Options in Neurology in April 2015.

“In most people, a delicate homeostasis develops, with the immune system ignoring commensal (normal) bacteria and food proteins, but actively eliminating pathogens,” Dr. Mielcarz says. “In some people, an imbalance develops, leading to inflammatory bowel diseases like Crohn’s disease and ulcerative colitis, and growing evidence from animal models and clinical studies in humans shows that these imbalances can play a role in systemic illness as well.”

healthy gut microbiome, then, helps keep the body healthy. But that imbalance Mielcarz mentions has also been linked to a wide range of other conditions, including acne, asthma and allergies, obesity, diabetes, eczema, cancer, and others. The challenge is that scientists are only beginning to understand the microbiome, and they don’t necessarily know what a “healthy” bacterial composition might be yet.

 

How Might MS and the Gut Microbiome Be Linked?

 

An imbalance in gut bacteria might set off alarm bells that lead the body to overreact and attack itself — causing autoimmune disease. Researchers cannot say for an absolute fact that the microbiome is linked to autoimmune disease, but more and more evidence is pointing in that direction.

“We know that MS is caused by a combination of genetic and environmental factors, but these are only partially understood,” says Ilana Katz Sand, MD, an assistant professor of neurology and associate medical director of the Corinne Goldsmith Dickinson Center for MS at Mount Sinai Hospital in New York City. “Most of the environmental contribution to MS remains unexplained.”

Given the interactions between gut microbiota and the immune system, it’s plausible “that certain microbes could improperly stimulate the immune system and contribute to MS,” Dr. Katz Sand says.

But there is still a lot to learn.

“Our knowledge about the connection between the gut microbiome and multiple sclerosis is still very limited,” Dr. Mazmanian says. “However, several groups are now studying whether the microbiome impacts MS in humans and mouse models.”

 

What the MS-Gut Research Shows

 

More and more studies are finding links between the microbiota in the gut and MS. Unpublished study results presented at the 2015 annual meeting of the American Academy of Neurology found differences in the bacterial composition of children with MS versus those without. Another study presented at the same meeting found reduced multiple sclerosis-like symptoms in mice when the mice were given yeast, and yet another study presented at the 2014 annual meeting found changes in the gut bacteria of people with MS when they had certain treatments.

Some studies in mice cannot be replicated in humans, says Mielcarz, but they’ve still revealed an important and surprising link between gut bacteria and the progression of central nervous system disease.

“We now have some early evidence in MS patients that certain bacteria that are thought to be pro-inflammatory are overrepresented, while others that are thought to be anti-inflammatory are underrepresented,” Katz Sand adds.

Researchers need to confirm these findings and then determine how they might influence clinical practice. To dig even more deeply into this area of research, a group of researchers from four different institutions formed the MS Microbiome Consortium in 2013.

 

Does That Mean Gut Bacteria Are the Secret to Curing MS?

 

Almost certainly not. If gut bacteria are playing a role in MS, as scientists suspect and as evidence is suggesting, they’re not doing it all on their own. Several other factors have been linked to multiple sclerosis, such as smokingvitamin D deficiency, and high sodium intake.

“As with any promising early research, there are sure to be less scrupulous people trying to sell MS treatments related to the gut microbiome that have not been subjected to rigorous clinical trials,” Mielcarz says.

He adds, “While there may at some point be effective therapeutics targeting the gut microbiota, as of now, anyone trying to sell something along those lines is doing something unproven at best — and dangerous at worst.”

 

What Comes Next for Multiple Sclerosis and the Gut?

 

Research is likely to head in two major directions, according to Mielcarz. One is “a more personalized approach in which the gut microbiome and genetic risk factors are analyzed together, potentially revealing subsets of MS patients that were previously unknown. The other is continuing to find and understand how gut microbiota influence immune functioning.”

“Over the next few years, we should be able to determine whether a person’s individual microbiome signature may be helpful as a diagnostic test for MS, as well as whether that signature has any prognostic value regarding disease severity going forward,” Katz Sand says. “We should also be able to discern whether the presence or absence of certain microbes predicts response to particular MS treatments.”

The goal is to find out whether medications or procedures, such as fecal transplants, can manipulate the microbiome to benefit patients with MS. Researchers will investigate how diet, antibiotics, probiotics, and prebiotics all affect the microbiome and its influence on multiple sclerosis.

“As of now, most research into the gut microbiome in MS is in the exploratory phase, with studies focusing on describing the microbiome of MS patients” compared to healthy people, Mielcarz says. While many of those studies appear to show a link between the microbiome and MS, it’s possible that those changes in the gut are a result of multiple sclerosis and not a cause of it.

Mielcarz adds, “It is difficult to predict timelines in the pharmaceutical business, but I would think it likely that a microbiome-modifying or microbiome-derived agent may enter clinical trials within the next five years.”

 

MS and Sleep Disorders

One of the common themes among the patients that I have talked to is sleep disorders. Many say that the chronic fatigue they experience with MS leads to problems with sleep. They also mention that they have trouble staying awake during the day, but are wide awake at night. This interruption of sleep cycle is can greatly affect all areas of a person’s life. In this article, we will explore the relationship between MS and sleep disorder’s

Fatigue is one of the most common symptoms reported with multiple sclerosis, occurring in about 80 percent of people living with MS. Fatigue can cause problems at home, in personal relationships and at work. The effects of chronic fatigue can spill out of the home and into everyday life, affecting performance and decision making that could lead to termination of employment. Fatigue can also impair driving ability and other tasks that require concentration and clear thinking. Probably one of the most understated effects of chronic fatigue is the affect it has on moods and how those mood swings can be damaging to personal relationships.

Healthline reports that, “getting a better night’s sleep can help you fight related fatigue, as well as battle the physical toll MS can take on your body.” The Healthline report goes on to suggest that establishing a sleep routine can help reduce fatigue and the physical toll that that MS can take on you. The problem with establishing a sleep routine is that many of us have problems falling asleep. We are tired during the day, but as soon as the lights go off, we are wide awake. Have you ever found yourself telling someone that you are just too tired to sleep?

If this sounds like you, then you may have a sleep disorder. A common sleep disorder associated with MS is narcolepsy. Narcolepsy is a central nervous system disease which causes periods of sleeplessness, sleep attacks and extreme daytime drowsiness. According to a separate Healthline report, “The Center for Narcolepsy at Stanford University School of Medicine reports that one in every 2,000 Americans has narcolepsy.” Recent research shows that brain lesions associated with MS can be a contributing cause to an onset of narcolepsy. Dr. Rosenberg, a sleep medicine specialist, reports, “MS is listed as the fourth most common cause of narcolepsy that is associated with other disorders.”

Narcolepsy can also cause comorbid conditions like cataplexy. According to the National Niemann-Pick Disease Foundation, “cataplexy is an abrupt temporary loss of voluntary muscular function and tone, evoked by an emotional stimulus such as laughter, pleasure, anger, or excitement.” For those of you with a sleep disorder and MS, cataplexy can strike at the most inopportune moments like during sexual intercourse due to the emotional stimulus. There is a probability that if you have a sleep disorder and MS that sexual activity can trigger a narcoleptic response. If your partner does not understand the disease, then the potential exists for your partner to feel like they are the problem. Even though it is tough to discuss intimacy with your partner, communication is critical when MS leads to sexual dysfunction.

While narcolepsy is a common sleep disorder with MS, there are also other sleep disorders that you may experience as well including insomnia, rapid eye movement sleep behavior disorder, restless leg syndrome and frequent urination. There are also sleep breathing disorders which may prevent you from getting a good night’s sleep.

If you have MS and suffer from a sleep disorder, all is not lost. There are many treatment options, including holistic alternatives. Please tell your doctor immediately if you suffer from a sleep disorder. You may qualify for a sleep study, which allows a doctor to monitor you while you sleep to evaluate what is happening to your brain and body during sleep. Whatever the cause of your disorder, treating it will go a long way to helping you in your battle with MS.

Multiple Sclerosis and Joint Pain

Multiple sclerosis (MS) is a progressive immune-mediated disorder that causes a person’s body to mistakenly attack the central nervous system (brain, spinal cord, optic nerve).

When a person has MS, their central nervous system (CNS) becomes acutely inflamed. This inflammation damages the nerves by wearing away the protective layer of myelin that insulates the nerve fibers and facilitates the transmission of central nervous signals.

After enough damage is done to the myelin and nerve fibers, the transmission of signals becomes interrupted and can even be halted completely. As a result of this degeneration, a variety of debilitating symptoms develop.

Indirect joint pain

 

The nerve and musculoskeletal damage associated with MS results in progressive pain that can leave a person with a variety of symptoms, such as:

The two types of pain people with MS experience are nerve pain and musculoskeletal pain. Both types indirectly contribute to aching joints and body pains. While MS doesn’t directly affect the joints, it does affect other areas that can lead to joint and body pain. For example:

  • A loss of energy leads to physical deconditioning, resulting in weakened and vulnerable muscles.
  • A loss of balance and stiff limbs results in an uneven gait that affects the joints.
  • A weak posture results in painful pressure in the lower back.
  • Frequent muscle spasms affect mobility and general flexibility that support the joints.

Indirect joint pain associated with MS is usually more severe around the hips and back, as well as the legs. Energy, posture, flexibility, and balance all play important roles in joint pain.

While there is no cure for multiple sclerosis, there are ways to manage and mitigate pain through the use of medications, physical therapy, and lifestyle changes.

MS joint pain management

 

According to the Multiple Sclerosis Association of America, about 50 percent of people identify pain as a major symptom after being diagnosed with MS, and about 48 percent of people report experiencing chronic pain.

While everyone with MS experiences pain differently, there are some general remedies, therapies, and medications that can be used to find what is right for you.

Some everyday methods you can use to improve symptoms of joint and muscle pain include:

In addition, many people do well with physical therapy to help manage stiffness, balance, spasticity, and spasms. A physical therapist can help pinpoint problems with weak or tight muscles that can lead to joint pain in MS.

The physical therapist can teach you stretching and strengthening exercises that will improve the joint pain. A physical therapist can also evaluate gait problems and even recommend modifications that will help you walk better and put less stress on your joints. To read this article in its entirety click on link: MS and joint pain

MS and Brain Fog: What You Need to Know

Your brain is the most complex organ in your body. It performs a long list of functions critical for life.

This is possible because of electrical impulses that travel through nerve cells called neurons. Each neuron has a tail-like axon that carries those impulses to the next cell. Axons have a protective covering called myelin, which speeds up the signal transmission.

If you have multiple sclerosis (MS), your immune system mistakenly targets the myelin in your brain and spinal cord. This interferes with the transmission of nerve impulses and causes MS symptoms.

 

MS and the brain

Your brain is about 20 percent myelin. When MS interferes with the function of this myelin, it can disrupt the neuronal activity in your brain. As a result, more than 50 percent of people with MS experience some cognitive changes.

Sometimes cognitive changes are the first sign that you have MS, although these types of changes are more likely to occur later on, as the condition progresses. These changes can happen with any type of MS but are more common in progressive MS.

Some of these changes can affect:

  • concentration and attention
  • information processing
  • memory
  • prioritizing and planning
  • verbal fluency
  • visual spatial ability

According to one study, roughly 40 percent of those with MS will have only mild symptoms, but 5 to 10 percent will have moderate to severe symptoms. Those with progressive MS tend to experience more severe cognitive changes than those with relapsing-remitting MS.

During an MS flare, inflammation can trigger new cognitive challenges, or intensify the ones you already have. Sometimes these flare-related changes are permanent, but they can also resolve once the flare has passed and the inflammation has subsided.

 

Brain fog

Brain fog is a term used to describe how your brain doesn’t seem to work as well as it once did. It’s also sometimes referred to as “cog fog,” the shortened version of cognition fog.

When you experience brain fog, you might forget words, lose your keys, or miss an appointment. Your job performance or schoolwork may be affected, or you might be challenged by everyday tasks, like decision making.

Brain fog can be your first MS symptom, or it can appear after you have a diagnosis. Brain fog can interrupt your daily routine by causing you to become absentminded. Strategies to manage brain fog include:

  • writing to-do lists
  • using voice-to-text technology to keep notes
  • using timers and alarms
  • using a family calendar
  • saving difficult tasks for when you’re most alert
  • reducing background noise when you need to concentrate
  • designating a specific area in the home for important items, like mail and keys
  • avoiding multitasking
  • taking frequent breaks to recharge

If you have an MS diagnosis and begin to notice cognitive changes, it’s important to talk with your doctor to assess the situation. Early screening and ongoing monitoring can help those with MS manage their symptoms. To continue to read this article in its entirety click the link for more: MS and Brain Fog

Listening to Your Body

Whether it’s progressing quickly or slowly, the unpredictability of multiple sclerosis can really lead you to question yourself. Am I fatigued or am I just tired? Did I fall because I’m clumsy or because I experienced foot drop? Is this a new symptom? Oh no, is this another relapse? When you’ve grown accustomed to a disease impacting your body and life the way MS does, it’s easy to start second-guessing every little sensation you encounter. Some of the top questions that I get are along the lines of, “Do you think this is because of MS?” where they mention something that’s happened to them. Often, I tell them what I am writing about here: listen to your body.

Causes for Concern

With MS being so unpredictable, it’s very easy to panic if you’re not feeling right. Many people who have the disease, me included, are accustomed to being fine one minute and not the next. I used to even worry about going to bed sometimes, in fear that I might wake up with some sort of new issue or full on relapse.

Am I having a relapse?

That’s what happened to me through my first several exacerbations; I was fine prior to sleeping and then woke up with parts of my body no longer functioning properly. So, I understand the fear and concern that comes when you start to suddenly not feel so good. The fact that starting steroids at the first sign of a relapse can be crucial in lessening its duration only increases the anxiety and importance of properly figuring out if MS is the problem.

Know your triggers

When asked if a symptom or sensation is cause for concern, at first, I usually tell folks not to panic (remember, stress makes everything worse). I then tell them to think back: has it happened before? I also tell them to think about what has triggered symptoms in the past. When you experience a MS symptom or sensation, your body is talking to you. It takes some time and experience to understand what it’s saying though.

Understanding how your body reacts to things

For example, I’ve learned over the years, that if my vision starts to blur, it’s not the start of an exacerbation, it just means I’m too warm. If I start tripping or even falling, chances are I was very active the day before and I simply need some rest. The longer you live with this disease, the more you can put two and two together when it comes to how you feel.

Go with your gut

The longer you live with MS, the better you can understand your own body. You begin to realize that any number of activities, emotions, or even environmental changes can have a big impact on how you feel. After some time though, you’ll realize that when something is really wrong, you’ll just know. After many years, as weird as it might sound, when I’ve experienced a full-on exacerbation, I just knew it. I could feel it happening. I knew by the way I felt that it was different. I knew that I needed more than some rest. It was almost a gut feeling that told me, “This is different, this is serious, you need to talk to your neurologist NOW.”

Learning to listen to your body

So, while it’s important to step back and look objectively at what triggers your body has been exposed to recently, it’s also important to listen to that gut feeling you have. If you take a second to calm down and not panic, your body will tell you how concerned you should be, and many times, that gut feeling is how it does it.

Through experience, you’ll learn to listen to your body. You’ll realize that not every sensation or symptom you experience is cause for concern. You’ll also learn that your body will tell you when you really need to be concerned, you simply must be ready to listen to it.

Early Signs and Symptoms of Multiple Sclerosis

Multiple sclerosis(MS) is defined as being an aggressive immune related disorder. What this basically means is that our immune system mistakenly labels a certain section of our body as a threat, which it attacks, similarly to how it would work to attack and eliminate viruses in the body. The problem with MS is that it leads the immune system to attack the organs as well as the protective layers (or myelin) of our nerve cells.

MS is described as unpredictable with an abundance of symptoms. However, there are several common symptoms of multiple sclerosis you should be aware of.

1. Weakness and fatigue
Statistics indicate that as many as 80% of all patients will experience extreme weakness and fatigue. This usually occurs if the condition has led to your immune system attacking the nerves around your spinal column. However, it’s important to note that weakness usually starts in your feet before it spreads to the rest of your body.

2. Spasms and pain
Another common symptom patients experience is involuntary muscle spasms as well as chronic pain. In fact, a study that was conducted by the National MS Society demonstrated that as much as 50% of all patients will experience muscle spasms or chronic pain. This occurs as a result of your immune system attacking the nerve cells in the body that’s responsible for transmitting information from the brain as to how a particular part of the body should move.

3. Vision loss
As the immune system mistakenly attacks various sections of our body, it can lead to inflammation within our optic nerves. This build up of inflammation essentially interferes with our optics nerve’s ability to transmit information which is crucial for our central vision. This leads to double vision, blurry vision and a gradual loss of vision.

4. Numbness and tingling
In some instances, the condition may attack the body’s message center, which consists of billions of nerves in your spinal cord and brain. By interfacing with the body’s messaging center, it essentially causes it to send mixed signals throughout the body such as a tingling sensation. In some instances, this disruption will cause signals to stop, which leads to numbness.

5. Emotional issues
A vast majority of patients with this disorder report that they experience major depression. Because of the various processes of the body that this condition targets, it can also lead to severe depression as well as mood swings and irritability.

6. Balance problems
Patients with multiple sclerosis, commonly report symptoms of dizziness and lightheadedness. This is especially true when they try to stand up after sitting for an extended amount of time. This is because the condition interferes with your body’s ability to coordinate and balance itself, This eventually leads to a severe loss of mobility.

7. Bowel and bladder dysfunction
Statistics indicate that as much as 79% of all patients with multiple sclerosis will experience bowel and urinary related problems, such as:

  • Intense urge to urinate
  • Inability to go long periods without urinating
  • Diarrhea
  • Inability to control bowel movements
  • Constipation

5 Foods That Help Manage Multiple Sclerosis

Multiple sclerosis is a progressive inflammatory disease that affects the central nervous system. The condition does not have a cure yet, but researchers say that a healthy, balanced diet rich in anti-inflammatory foods can help prevent frequent flare-ups and may even slow disease progression. Here are five beneficial foods for multiple sclerosis patients.

 

  • Fatty fish
    Fatty fish may be one of the best foods to include in the diet for multiple sclerosis patients as they are packed with omega-3 fatty acids. These healthy fats help fight and reduce inflammation, and they are also good for balancing out omega-6 fatty acids, which are generally higher in the typical American diet. Salmon, mackerel, sardines, tuna, herring, and trout are among the best sources of omega-3 fats.
  • Vitamin D-rich foods
    Studies indicate that many multiple sclerosis patients have vitamin D deficiency. Additionally, relapses and aggressive disease progression are more common among people with low vitamin D levels. Although the best way to get vitamin D is from sunlight, one can also acquire it from foods like eggs, low-fat dairy products, salmon, and fortified cereals and orange juice.
  • Turmeric
    Turmeric is a spice that is well-known in many parts of the world for its powerful anti-inflammatory properties. It contains curcumin, which is known to fight off inflammation. Turmeric may ease symptoms and even slow disease progression in people with multiple sclerosis. You can add the versatile spice to your meals while cooking or use it in salad dressing.
  • Fresh fruits and veggies
    Fruits and vegetables are among the most nutrient-dense foods on the planet.  They are packed with essential nutrients that help reduce inflammation, like antioxidants and phytochemicals. Also, studies have found that a diet rich in fresh fruits and vegetables can lower the severity of Multiple Sclerosis (MS) symptoms like pain, fatigue, and cognitive impairment. Some of the best foods to add to the diet are leafy greens, berries, bananas, papaya, kiwi, and oranges.
  • Avocados
    Avocados are yet another excellent source of healthy fats and potent antioxidants. They are also packed with other nutrients that help fight inflammation, like lutein, glutathione, and vitamin E. Plus, health experts strongly recommend that MS patients include avocados in their regular diet as they boost brain and heart health.

6 Hand Exercises for Multiple Sclerosis

These simple, functional exercises can help you stretch and strengthen your hands in order to continue to independently perform everyday activities.

Numbness or tingling in the hands, arms, and legs is often the earliest symptom of multiple sclerosis (MS). But symptoms affecting the hands can also include pain, muscle weakness, tremors, and problems with hand-eye coordination, says Linda Walls, an occupational therapist and consultant for the Can Do MS center in Avon, Colorado, for over 25 years.

All of these symptoms are caused by a disruption in communication between the central nervous system (the brain and spinal cord) and the sensory nerves in the hands. When your hands are affected, everyday tasks — such as writing, typing, getting dressed, and grasping or picking up objects — can become more difficult.

Is there anything that can help? Yes. In a word, exercise. “I recommend exercise to keep muscles moving and stretched, and it also stimulates the nerves to help with sensation,” explains Walls. “The goal is maximizing range of motion and strength so you can maintain the best function of your hands and stay independent with everyday activities.”

Hand exercises can help you maintain or improve your hand function so you’re better able to perform activities that require hand strength and coordination. Plus, the exercises will help with stiffness that may develop from some muscles being tight.

The following hand exercises for MS can also improve your ability to grip and pinch with your hands. Perform the exercises slowly, and pay attention to how you feel. “Do the exercises to a count of 2 or 3 so your muscles have a chance to fully respond and go through the full range of motion”.  As your range of motion and strength improve, you can add resistance to increase your hand and forearm strength.

 

Finger Flexion and Extension

 

The goal of finger flexion and extension exercises is to slowly increase range of motion and strength.

How to Do It: Bend the fingers of one hand toward the palm to make a fist, then straighten your fingers and stretch out your hand. Start with one set of 10 reps a day, then progress to two sets in a row (or do one set twice a day). Repeat with the other hand.

If one hand is more affected by MS symptoms than the other, you might do two sets on that hand and only one set on the stronger hand. You can also use the less affected hand to stretch the more affected hand. But be careful not to overdo it. “Hand muscles easily fatigue”.

To focus more on strength, hold a rolled-up washcloth or ball of therapeutic putty in your hand as you squeeze and release. Place the washcloth or putty on a tabletop, squeeze it in your hand, then push or roll it back out with your fingers. These objects will provide some resistance. Theraputty, which is available on Amazon and often comes with some pictured exercises. “I recommend a soft to medium resistance, not a firm resistance,” says Walls. “The added benefit of using Theraputty or a washcloth is the sensory stimulation that helps with numbness.”

Hand exercises should always be done in groups, adds Walls. “I have seen too many who work on finger flexion and forget that finger extension is just as important.”

 

Finger Abduction and Adduction

 

Finger abduction and adduction exercises are important for improving range of motion.

How to Do It:  Straighten the thumb and fingers of one hand. Spread the fingers apart and then squeeze them together. Perform three to five repetitions to start; progress to 10 to 15 reps. Repeat with the other hand.

To add resistance, place a rubber band around your fingers when they’re in the closed position (it should fit snugly), and then spread them apart, pressing against the band. You can also use a small rubber band on two or three fingers at a time.

 

Finger Pinch

 

Finger pinch exercises are effective for picking up and holding small objects such as a button or a coin.

How to Do It: Roll a washcloth or putty into a tube shape. Using your thumb and index finger, pinch along the tube from one end to the other. You can also just do thumb to each finger for coordination and range of motion, says Walls. To strengthen your palm, use your thumb, index finger, and third finger to pinch a washcloth or putty or a Nerf ball. Perform the exercises three to five times with each hand, working up to 10 to 15 reps. Repeat with the other hand.

After working on pinch, take a minute to fully open the hand and stretch the muscles you just worked in the opposite direction to encourage strength and range of motion.

 

Rice Exercises

 

Rice exercises are effective for general strengthening and sensory stimulation to the hand.

How to Do It:  Place a large bag (or two) of rice in a big bucket. Place your hands in the bucket and open and close them in these various positions:

  • Palms facing each other
  • Palms facing away from each other
  • Palms facing your body
  • Palms facing away from your body

You might also rotate your hands in a clockwise direction, and then counterclockwise, in the rice.

 

Movement Therapy, or ‘Piano Hands’

 

“This is a good strength and coordination exercise,”

How to Do It: Sit up tall in a chair, facing a table or desk. Place your hands, palms down, on the edge of the table (your forearms should be hanging off). Lift your fingers up and down, one at a time, as if you were playing the piano. Then move them up and down the imaginary keyboard. You might even do this to real music — play for 20 to 30 seconds of a tune to start. “This can be similar to typing on a computer keyboard”.

 

Dexterity Exercises

 

You can also try some hand physical therapy or hand occupational therapy, such as playing cards or video games, doing crafts that require dexterity, typing at your computer keyboard, or organizing your desk or kitchen drawers. Doing these exercises helps you focus your attention on developing functional movements and coordination, which will keep you engaged in everyday activities. “Try to use your hands as much as possible for everyday tasks such as picking up coins from the table, writing a note, bathing, using lotion, dressing, and preparing a meal,” says Walls. Also playing board games, building models, and functional activities like sorting nuts and bolts and organizing “junk drawers” in your home. These activities won’t make hand pain go away, “but stretching helps get more blood flowing to your hands and can help you increase movement and manage tightness.

You’ve Just Been Diagnosed With MS. Now What?

We all respond differently to information about our health. After learning you have multiple sclerosis (MS), you might be stunned, scared, or even relieved to have answers that explain vision changes, dizziness, or tingling. No matter what you’re feeling, you’re not alone.

You can’t figure out everything about MS at once, and you don’t need to. Taking small steps to adjust to your new reality can be empowering in a time of major change. According to the American Psychological Association, active coping strategies like getting organized and making a plan for managing your health can improve mental and emotional well-being.

 

Create Space for Multiple Sclerosis

It’s normal to feel out of control when you first learn you have MS. You may have a pile of pamphlets crowding your kitchen table and a head full of questions that you forget the moment you set foot in a doctor’s office. You can begin to tame the chaos by implementing very simple organizational techniques that will help you create space for this new aspect of your life.

Put Everything in One Place

Storing all of your printed doctors’ visit summaries, pamphlets about MS, and other resources in a designated spot can help create some order and help you find information when you need it. You don’t need a fancy filing system — a kitchen drawer, an old binder, or simply an orderly stack on your bedside table can make a big difference. In addition to helping you keep track of important papers, there is evidence that controlling clutter is associated with better moods.

Remember Your Questions

Keep a list of questions about MS for your health care provider in a dedicated notebook or on your smartphone. Jot down your questions as you think of them, and bring your list to your appointments so you can remember your questions and write down the answers.

Manage Your Appointments

If you already rely on a digital calendar or paper planner to manage work and family obligations, stick with that method for managing your new doctors’ visits. If keeping a calendar is new to you, consider using what you’ve already got at home, such as a grocery list notepad or a piece of paper and a magnet on the fridge. You can also ask your doctor’s office about phone call or text message reminders that can help you keep on top of appointments.

Track Your Medications

Using an old-fashioned pill organizer is a great way to keep track of an oral medication regimen. You can also use a paper medication tracker. If you’re comfortable using a smartphone, consider downloading a medication tracking app to manage your treatment schedule.

Reach Out for Support

It can feel overwhelming to reach out after receiving an MS diagnosis, but you don’t have to face your diagnosis alone. Support from loved ones, your medical team, and other people with MS is crucial as you embark on a treatment plan and adjust to your new normal. There are a few basic steps you can take to start building your network of support.

Multiple Sclerosis Communities

You may not be ready to talk about your diagnosis with your loved ones right away. You may also not have time or feel comfortable joining an in-person support group. That’s OK. Your local MS Support Group can provide an ongoing emotional boost whenever you feel worried or overwhelmed about life with MS or want to celebrate a victory.

Health Care Providers

Many hospitals and medical practices offer resources that extend beyond your medical appointments. These may include chaplaincy services, health education classes, patient liaisons or nurse navigators, on-site support groups, and referrals to other services.

Friends and Family

Sharing your MS diagnosis with friends and family can be hard. They may be afraid and struggle to react in a helpful way. Try to remember that everyone is doing their best with difficult news. If you’re able, let your loved ones know how they can be most helpful to you during this time, whether that’s helping with household chores or offering a listening ear.

Learn More About Multiple Sclerosis

You might not have known much about MS before your diagnosis, but now you probably want to learn more. Your health care provider is a great resource for information, but you may also want to do your own research. Remember to be cautious of what you read online, especially if someone is offering a quick fix or selling a cure. You can always reach out to your health care provider or patient liaison if you have questions about something you’ve read.

Can Turmeric Help Manage Multiple Sclerosis?

Curcumin, a key ingredient of the spice, may reduce inflammation, but questions remain about its usefulness for MS.

Our stories are medically reviewed by board-certified specialists to ensure that all factual statements about medical conditions, symptoms, treatments, procedures and tests, standards of care, and typical protocols are accurate and reflect current guidelines as well as the latest research.

 

Can-Turmeric-Help-Manage-My-Multiple-Sclerosis-722x406
Much more research is needed before turmeric can be recommended as a supplement for people with MS.Per Swantesson/Stocksy

Variety may be the spice of life, but is turmeric the spice for people with multiple sclerosis (MS)?

More and more people with MS are using complementary and alternative approaches like herbs and supplements to augment prescription medication treatments for symptoms like pain, spasticity, memory loss, and fatigue — even though scientific evidence supporting their use is limited. One of the most popular herbal remedies is turmeric, a spice that is used commonly in cooking, particularly in Asian cuisines.

Turmeric has properties similar to ginger, another popular flavoring ingredient.

Although turmeric has been used to treat the symptoms of a variety of health conditions — including everything from Alzheimer’s disease, rheumatoid arthritis, and prostate and colon cancer to heart disease and type 2 diabetes — its use in MS hasn’t been well studied, at least to date. Still, what’s known about its possible benefits is promising.

“I’m from India originally, and we’ve used turmeric for centuries, both for cooking as well as for medicinal uses,” says Vijayshree Yadav, MD, a neurologist and Tykeson Family Term Professor in wellness research, as well as MS Center director at Oregon Health & Science University in Portland.

“It’s an antioxidant with multiple chemical ingredients, including curcumin, that may have beneficial effects for people with a number of conditions, but there’s still a lot we don’t know,” Dr. Yadav says.

So can turmeric help manage your MS symptoms? read more on this subject by clicking this link Can Turmeric help manage MS

Breast Cancer and MS: New Data Shed Light on Survival

MS was associated with a 28% increased hazard for all-cause mortality (HR 1.28, 95% CI 1.08-1.53), but not with cancer-specific survival (HR 0.98, 95% CI 0.65-1.46), reported Ruth Ann Marrie, MD, PhD, of the University of Manitoba in Winnipeg, and colleagues in Neurology.

“Although multiple sclerosis and its complications remain the most common cause of death in people with MS, cancer is the second or third most common cause of death,” Marrie said in a statement. “Our study looked at whether survival rates for women after a breast cancer diagnosis were different for those with MS and those without it.”

Earlier Canadian research showed the incidence of breast and colorectal cancers was similar between people with and without MS. Breast cancer incidence is of particular interest since several cases of breast cancer had been reported in ocrelizumab (Ocrevus) phase III clinical trials. The drug, which was approved for MS in 2017 in the U.S., carries a breast cancer warning.

In their study, Marrie and colleagues identified female MS patients in population-based administrative data in Manitoba and Ontario from 1994 through 2016, linking the MS cohorts to cancer registries. For each woman with MS and breast cancer, the researchers selected four breast cancer controls without MS, matched on birth year, cancer diagnosis year, and region.

The analysis included 779 MS cases (691 from Ontario and 88 from Manitoba) and 3,116 controls with a mean age of 58 at diagnosis. Most women were diagnosed with stage I or II breast cancer. About half of the study group was diagnosed in 2010 or later, and most lived in urban areas. To read this aerticle in its entireity click here: Breast Cancer and MS

Why MS Can Affect Your Breathing — and What You Can Do About It

Among the many possible complications of multiple sclerosis (MS) is a reduction in your ability to exhale fully and to cough effectively enough to clear secretions or food from your airway, says Anthony Reder, MD, a multiple sclerosis specialist and professor of neurology at the University of Chicago. A serious consequence of these changes is a higher risk of respiratory infections like pneumonia. Changes in breathing function can also cause fatigue, as you work harder to breathe and supply your body with the oxygen it needs.

How MS Can Affect Your Breathing

There are a number of ways that MS can lead to breathing problems, including the following:

Lesions in the Brain

As multiple sclerosis progresses, lesions in your brain and spine can affect almost every aspect of your physical functioning. It’s possible that brain lesions could change your respiratory function, says Zulma Hernandez-Peraza, MD, a neurologist at the University of Illinois Hospital and Health Sciences System in Chicago.
Lesions that disrupt the signals from the brain to the lungs can result in a condition known as central sleep apnea, in which breathing stops and restarts repeatedly during sleep, notes Dr. Reder. Symptoms of central sleep apnea include waking up abruptly with shortness of breath, having shortness of breath that improves with sitting up, insomnia, daytime sleepiness, and chest pain at night.
A more common form of sleep apnea, where the upper airway becomes intermittently obstructed, can also occur in people with MS if the muscles that normally keep the airway open become slack due to lesions in the brain, adds Reder. Obstructive sleep apnea is associated with snoring and obesity.

Spinal Lesions

These can cause weakness of the breathing muscles and also restrict your ability to get air in and out of the lungs, says neurologist Staley Brod, MD, professor of neurology at the Medical College of Wisconsin in Milwaukee. “Weakness can affect breathing,” says Dr. Brod. Spasticity in the muscles that help with inhaling and exhaling could also contribute to the problem.
“A lesion in the cervical spine creates the ‘MS hug‘ sensation, which can cause the feeling of shortness of breath,” adds Dr. Hernandez-Peraza. “This is usually just an unpleasant perception. When tested, the oxygen levels in your blood should be normal.”

Medication

One of the side effects of the MS disease-modifying drug Gilenya (fingolimod) is a reduction in some measures of breathing function, says Reder. Some types of medication, such as tranquilizers, muscle relaxants, and opioids, can also slow or reduce breathing.
In 2019, the U.S. Food and Drug Administration (FDA) issued a warning that serious breathing difficulties may occur in people who have respiratory risk factors who are taking gabapentin (Neurontin, Gralise, Horizant) or pregabalin (Lyrica, Lyrica CR). According to the National Multiple Sclerosis Society, these pain medications (known as gabapentinoids) are sometimes prescribed for people who have multiple sclerosis. Talk to your doctor if you have respiratory risk factors including (but not limited to) chronic obstructive pulmonary disease (COPD) or older age and you have been prescribed these medications, especially at high doses, notes Reder. To read this article in its entirty click link Breathing issues with MS