Multiple sclerosis is the disease with a thousand faces. Not every patient is affected by every symptom. However, far too many sufferers often take the limitations for granted. For example, MS-induced spasticity occurs in most patients during the course of the disease. But in many cases, multimodal therapy management can provide relief and support participation in life.
Multiple sclerosis (MS) is a very complex disease that manifests itself differently in each patient. However, there are symptoms that occur over time in almost all people with MS – for example, MS-induced spasticity. It is found in more than 80% of all patients [1]. Increased muscle tension is caused by damage to the brain or spinal cord. This not only significantly limits mobility, but can also further worsen the fatigue that is often present.
In spasticity, the part of the brain that is most affected is the part that constantly sends calming impulses to the muscle to regulate tone and intrinsic reflexes. Since the calming impulses are missing, cramping occurs. Most patients suffer from muscle stretch reflexes, muscle stiffness, and muscle spasms. However, bladder dysfunction or insomnia may also occur. Many also suffer from severe pain, which further reduces quality of life [2]. The impact on everyday life can be stressful. In about 70% of MS patients, the ability to walk is limited as a result of spasticity, and one in six people with MS requires assistance [3].
Targeted questioning by the physician
The problem, however, is that many patients take the complaints for granted and do not even inform the doctor about their symptoms and limitations. As a result, some of the spasticity goes untreated. However, there are effective concepts to alleviate the symptoms. First and foremost, treatment should be based on the intensity of symptoms and manifestations. As a rule, a multimodal therapy regime is effective. It is often essential to ask MS patients specifically about potential problems that may be caused by spasticity.
Better quality of life through comprehensive therapy
The goal of treatment is to maintain or restore mobility, increase well-being, maintain independence, and preserve quality of life. Non-drug treatment measures primarily include physiotherapy. Muscle and stretching exercises (active, passive), flexibility, coordination, strength and endurance training as well as standing and gait exercises come into play here. Aids such as splints or orthoses can support motor skills. Occupational therapy complements physiotherapy treatment by practicing activities that are practical for everyday life. The focus is on independent dressing and undressing, personal hygiene, preparing food and eating. Patients learn techniques to better manage daily life [4]. In addition, there are other therapeutic options, such as physical treatment with e.g. transcutaneous electrophysiological nerve stimulation (TENS) or electromagnetic therapy. Hippotherapy or alternative methods such as acupuncture can also help.
Effective pharmacotherapy for significant discomfort
In severe cases, concomitant drug treatment may be useful. This is based on the severity and manifestation of spasticity as well as the drug’s efficacy and side effect profile. A combination of different approaches is also common. Among oral antispasticity agents, baclofen and tizanidine are considered the most important. Dantrolene is one of the muscle relaxants. Botulinum toxin can also be used – but only if a few circumscribed muscle groups are affected. Good experience has also been gained with nabiximols, an approved cannabinoid.
Literature:
- Rizzo MA, Hadjimichael OC, Preiningerova J, Vollmer TL: Prevalence and treatment of spasticity reported by multiple sclerosis patients. Mult Scler 2004; 10: 589-595.
- www.gelbe-liste.de/neurologie/pharmakotherapie-bei-ms-spastik/ms-induzierte-spastik-symptome (last accessed on 15.01.2022)
- Oreja-Guevara C, et al. Spasticity in multiple sclerosis: results of a patient survey. Int J Neurosci. 2013; 123(6): 400-408.
- www.gelbe-liste.de/neurologie/pharmakotherapie-bei-ms-spastik/ms-induzierte-spastik-therapie (last accessed on 15.01.2022)
InFo NEUROLOGY & PSYCHIATRY 2022; 20(1): 34.
