Patient management
Multiple sclerosis symptoms and patient management
Like the disease itself, the symptoms of MS are heterogeneous and unpredictable[1]
MS can be complex to manage due to the variability in symptoms between patients. Furthermore, many of the symptoms are ‘invisible’, that is, they are not 'visible' and therefore not necessarily fully appreciated by other people.[2][3] Although each patient living with MS can experience their disease in different ways, the prevalence of some of the most common symptoms experienced in the first year after diagnosis are shown[4]:
Prevalence of MS symptoms in first year after diagnosis[4]
Data taken from the NARCOMS* registry a large natural history registry, a database that collects information from patient volunteers on patient-perceived impairment in 11 domains commonly affected in MS (n = 25728). The number of unique patient records is recorded below each symptom. Pain, depression, vision and tremor/coordination were not included in the survey until 2002[4].
*NARCOMS = North American Research Committee on Multiple Sclerosis
‘Invisible’ MS symptoms and your patients[2][3]
The ‘invisible’ symptoms of MS (such as fatigue, cognitive impairment, pain, bladder and bowel dysfunction, blurred vision, sexual problems and sensory dysfunction) are just as important to a patient’s sense of well-being as the ‘visible’ symptoms.[3][5]
‘Invisibility’ of MS symptoms was found to have numerous impacts, including not feeling understood or validated by others, issues around the perceived legitimacy of the illness, and living with needs which are hidden.[3] By considering the ‘invisible’ MS symptoms it can help to avoid them being unidentified, mislabelled or left untreated.[2]
Mechanisms underlying MS symptoms
For certain MS symptoms, the primary cause is well known.
Approximately ~70% of patients living with MS will experience vision loss as a result of inflammation and demyelinating lesions in the optic nerve (leading to optic neuritis).[6]
However, the pathophysiology of other prevalent MS symptoms remains poorly understood and remains under investigation.[7][8]
For example, current hypotheses into the pathophysiological mechanisms underlying primary fatigue in MS include:[9]
Structural damage of white and grey matter
Inflammatory processes (within or outside of the CNS)
Maladaptive network recruitment due to distributed lesions or inflammation
Alterations in metacognition
MS symptoms can also arise as a result of other symptoms or factors relating to the disease or due to adverse effects of treatment.
Examples of a secondary cause of MS symptoms include urinary tract infections due to bladder dysfunction, or fatigue due to lack of sleep caused by MS symptoms like muscle spasms or bladder problems.[10][11]
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