Speech And Swallowing Changes With Ms
Speech and swallowing changes can occur due to affected nerves being damaged. This may present as changes to the voice tone and quality, or coughing when eating.
These symptoms should be reported to your MS healthcare team for assistance from a speech therapist, who can advise on appropriate management.
Organise Your Living And Work Spaces
You might find there are practical changes that can be made to the places you work and live. Maybe re-organising desks or cupboards, or adjusting the temperature or lighting to suit you better.
Sometimes, the simplest of changes can make the workplace or home more energy efficient for you.
An occupational therapist can help you assess the spaces you use at work and at home – and may suggest adaptations or equipment that could help. For more information about the support that occupational therapists can offer, and how to find one, download or order our leaflet Occupational therapy and MS.
Maladaptive Network Recruitment During Task Performance
Functional imaging studies have demonstrated that patients with MS affected by fatigue, compared with patients with MS without fatigue and healthy controls, frequently show an increase of distributed brain activity during the performance of tasks. In the spinal cord, patients with MS with fatigue, despite smaller WM lesion load, show higher functional recruitment of the cervical cord than patients with MS without fatigue . Moreover, patients with MS with fatigue often fail to show physiological adaptation of brain activity during tasks . This may differ across disease stages and brain regions.
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Krupp’s Fatigue Severity Scale
Many studies of MS-related fatigue have used the Fatigue Severity Scale to identify fatigued patients. Initially designed to identify common features of fatigue in both MS and lupus patients, the Fatigue Severity Scale assesses the impact of fatigue on multiple outcomes, with a physical focus. Each of 9 responses is provided on a 7-point Likert scale. Prior studies have shown acceptable internal consistency and stability over time, and sensitivity to change afforded by clinical improvement. The Fatigue Severity Scale has been shown to differentiate between subgroups of patients with MS, chronic fatigue syndrome, and primary depression. Moreover, the scores correlate with other scales commonly used in MS, including the Modified Fatigue Impact Scale and Fatigue Descriptive Scale.
When To Seek Treatment
Because omicron symptoms can be mistaken for the common cold or flu, doctors urge anyone experiencing them to isolate until symptoms subside.
The Centers for Disease Control and Prevention provided a list of emergency warning signs that need immediate emergency medical care:
- Trouble breathing
- Persistent pain or pressure in the chest
- New confusion
- Inability to wake or stay awake
- Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
Anyone suffering from these symptoms is urged to call 911 or your local emergency facility.
Notify the operator that you are seeking care for someone who has or may have Covid, the CDC advised.
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Icipants And Study Design
Seventy-one patients with relapsing-remitting multiple sclerosis were recruited from the multiple sclerosis clinic of Brighton and Sussex Universities Hospitals Trust, UK, between April 2017 and May 2018 into a larger study on multiple sclerosis fatigue. At recruitment, exclusion criteria for patients were history of other neurological diseases, or the presence of psychiatric and other clinical conditions. The depression subscale of the Hospital Anxiety and Depression Scale and the Epworth Sleepiness Scale were used to exclude participants with evidence of depression and sleep disorders at the suggested cut-off of 11 and 10, respectively., Participants on treatment with hypnotics within the last 4weeks prior enrolment, on recreational drugs, or with a known alcohol abuse were excluded. Major abnormalities, such as anaemia, ongoing infections, thyroid dysfunction, vitamin deficiencies, sleep disturbances including obstructive sleep apnoea were excluded based on the blood tests performed for clinical purposes. The Brief International Cognitive Assessment for multiple sclerosis was used to screen for cognitive impairment. For this particular study, we also excluded patients on treatment with compounds acting on one or more of the molecular systems of interest . Ethical approval was obtained from the London-Surrey Borders Research Ethics Committee . Written informed consent was obtained from all participants according to the declaration of Helsinki.
How Ms Fatigue Is Different To Other Types Of Fatigue
Ordinary fatigue is described as a sensation of muscular tiredness and weakness. It is the tired feeling everyone experiences after an excessively busy day or a lack of sleep. It is the type of fatigue that is usually managed by rest and a good nights sleep. Ordinary fatigue is quite different to the fatigue experienced in MS.
Fatigue associated with MS is described as an overwhelming sense of tiredness that can occur at any time of the day without warning. MS-fatigue usually occurs more rapidly, lasts longer and takes more time to recover from than ordinary fatigue.
MS-fatigue can occur for no apparent reason or after relatively mild exertion, such as a short period of walking, writing or reading, with an immediate need to rest.
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Changes To Bladder And Bowel Function With Ms
Issues with bladder and bowel function can be a common problem for people with MS at some stage in their life. These issues may be related to other conditions, so it is important to report any changes, so the right assessments can be made.
Issues with bladder and bowel function may include:
- Incontinence an accidental or involuntary loss of urine from the bladder or bowel motion, faeces or wind from the bowel . It is a widespread condition affecting many Australians, so you should not feel alone.
- Bladder dysfunction symptoms including greater or less frequency of passing of urine, urgency, incontinence, urinary tract infections and the need to urinate frequently overnight.
- Bowel issues including severe constipation, faecal incontinence and diarrhoea.
With the right advice, you can manage these symptoms and prevent complications or associated illnesses.
You can also make small changes that could make a big difference, including:
Fatigue Ms And Depression
People who have depression both those who have MS and those who do not frequently experience fatigue as a symptom of their mood disorder. Some of the fatigue experienced by those with MS may be due to undiagnosed depression. Treating depression can also help treat fatigue that is caused by the condition. Anyone who is experiencing symptoms of depression, including consistently sad or low mood, a lack of enjoyment in previously enjoyable activities, difficulty sleeping, irritability, or a sense of hopelessness, should talk to their doctor about their symptoms.4
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What Are The Authors Proposing To Change
The proposal is to introduce new classifications and a framework to define and assess MS fatigue in a better way. Presently, there is difficulty in defining and assessing different types of fatigue, such as motor fatigue , tiredness, cognitive fatigue , central fatigue and performance fatigue , as well as differences in the way a healthcare professional and patient report and communicate about fatigue. It has been suggested that renaming this diagnostic term to reflect the cause and breadth of the fatigue experience, might be helpful and assist to drive more effective research and management into the condition. The authors are recommending an international MS initiative is set up to progress this further and present the renaming criteria to the World Health Organisation for consideration. Potential early suggestions to rename MS fatigue include:
- Central neurophysiological dysnervation/denervation
- Transitory multifocal central nervous system denervation
- Cyclic lesion inflammation
The process to rename a recognised symptom is a rigorous and challenging process and will require multidisciplinary engagement, using expertise from all specialities of MS healthcare.
Axonal Loss And Altered Cerebral Activation
As conventional measures of T2 lesion volume and atrophy have fallen short in providing a basis for fatigue in MS, many investigators have relied on non-conventional neuroimaging techniques to shed further insight. The demonstration on positron emission tomography of decreased regional glucose metabolism in the frontal cortex and basal ganglia of fatigued MS patients has suggested that neuronal dysfunction in these regions may play a role. Magnetic resonance spectroscopy studies have shown significant reductions in N-acetylaspartate/creatine ratios in multiple brain regions among fatigued MS patients in comparison to non-fatigued MS patients, suggesting axonal loss as a contributing factor., MS-related fatigue also may arise at least in part from compensatory reorganization and increased brain recruitment, as functional MRI studies that have demonstrated increased volumes and patterns of activation in the cingulate gyri and left primary sensory cortex in fatigued MS patients compared to non-fatigued patients.
Fuel Your Body With High
Theres no specific diet for MS, but the NMSS recommends following a healthy diet thats low in fat and high in fiber. According to the NMSS, the foods you choose to eat affect your energy levels.
Consuming simple carbohydrates such as sugary foods and highly refined foods such as white bread, white rice, or pasta can cause blood sugar levels to spike and crash. The crash can exacerbate preexisting fatigue in persons with MS, explains Barbara Giesser, MD, neurologist and MS specialist at Pacific Neuroscience Institute at Providence Saint Johns Health Center in Santa Monica, California.
How can you avoid this? Regularly choosing high-quality foods can help, says Dr. Giesser. Good options include:
- Protein-packed options, like beans, nuts, and lean animal proteins
- Fiber-rich foods, like oatmeal, brown rice, and high-fiber breakfast cereals
- Fresh fruit and leafy green vegetables
- Fat-free or low-fat yogurt
What Are The Symptoms Of Ppms
People with primary progressive multiple sclerosis tend to experience a greater impact on their motor functions than those with other forms of MS. This is because PPMS causes more spinal cord lesions than it does brain lesions.
PPMS has many symptoms that present differently from person to person. Not all people with PPMS will experience all of the symptoms below. While some symptoms of PPMS are caused directly by the disease itself, others may develop as a result of other symptoms.
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Heterogeneous Concepts Of Fatigue
Concepts of fatigue vary remarkably in the literature. For example, fatigue has been described as a feeling arising from difficulty in initiation of or sustaining voluntary effort, an overwhelming sense of tiredness that is out of proportion or as a feeling that relates to the lack of motivation to deploy resources and engage in high effort performance to cope with their situation.
In an attempt towards standardisation, a recent taxonomy distinguishes two major dimensions of fatigue: perception of fatigue and performance fatigability. The latter refers to objectively measurable aspects of fatigue, for example, the observable decrease in performance during a cognitive or motor task. By contrast, the perceptual dimension is inherently subjective and cannot be assessed directly by an external observer. From a pathomechanistic perspective, these two dimensions are distinct: explanations of fatigability can, in principle, be derived from physiological and biochemical principles. By contrast, understanding the subjective perception of fatigue requires a cognitive perspective, in particular, concepts of interoception and metacognition.
Work Closely With Your Ms Healthcare Providers
Make and keep regular appointments with your doctor to assess whether your disease is under the best control possible and youre receiving optimal MS treatment.
In many cases, when MS is well-controlled, it can help in terms of fatigue levels, says Devon Conway, MD, a neurologist at Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research in Ohio.
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Demographic And Clinical Characteristics
We measured demographic and clinical characteristics for describing the sample and examining these variables as possible confounders of the association among fatigue and devicemeasured LPA, MVPA, and sedentary behavior.12 Demographic and clinical characteristics included age, gender, race, years of education, marital status, number of children, income, MS type, disease duration, and disability status based on Patient Determined Disease Steps scale scores. The PDDS scale contains a single item for measuring self-reported disability status.29 PDDS scores range between 0 and 8 , and the scores have been validated as a measure of disability status in persons with MS based on the linear and strong correlation with physician-rated Expanded Disability Status Scale scores.29 The PDDS further contains fewer questions and is less cumbersome than self-report versions of the EDSS. Race, marital status, number of children, income, and MS type were all dichotomizednamely, the race was categorized into either Caucasian or non-Caucasian, marital status was divorced/other or married, children were either 0 or 1 or more, income was either less than $40 000/year or greater than or equal to $40 000/year, and MS type was either relapsing-remitting MS or progressive MS. This is consistent with previous research12 and the notion that these variables as measured likely represent a categorical structure.30
What Are Symptoms Of Fatigue
There are two major types of fatigue in MS. These two types of fatigue are probably separate problems related to the MS.
The first type is a general feeling of tiredness. It may feel as if one has not slept the night before. This feeling may be worse in the afternoons or after activity. People may feel that they are unable to do as many tasks without getting tired as they did before.
A second type of fatigue is muscular. In this type, there is increased weakness after repeated activity. Often, this occurs with walking. People may find that they are dragging one leg or are more unsteady.
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How Can This Process Help People With Ms
Although many things about living with MS have improved in recent times, the prognosis of living with the daily onset of MS fatigue has not. It has been suggested that maintaining this inappropriate label hinders clinical research primarily because if it is hard to measure and describe, it is difficult to then assess whether treatments and interventions have made a difference. If we can break the cycle and offer changes which reflect a better understanding of the whole fatigue condition, this could potentially lead to research which provides a deeper understanding of the neuroprocesses involved in fatigue. This, in turn, would support changes to how we treat and manage MS fatigue.
MS Australia has funded previous fatigue research , and together with the International Progressive MS Alliance, supports the call to action to advance fatigue research in MS. Addressing the needs of people living with MS struggling with fatigue, could lead to an improved quality of life, improved communication of symptoms with healthcare professionals, enhanced relationships with family, friends and employers and less social isolation. Importantly, we would be addressing a major gap in understanding MS that has remained for over 200 years.
Get Help For Depression
If you are feeling down and hopeless, or if things that used to be enjoyable dont interest you anymore, you may be depressed. Depression is one of the most common symptoms of MS, and left untreated, it can make your fatigue worse.
Depression is treatable, so if you think you might be depressed, tell your healthcare provider right away.
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Engage In Regular Physical Activity
I encourage exercise for my patients, says Conway. In my experience, it can make fatigue worse at first, but if a person can get over the initial hump, it can actually improve fatigue, he says.
If youre not sure how to get started with exercise or need some help identifying exercises that will improve your fitness without wearing you out, trying working with a physical therapist or a personal trainer who is knowledgeable about MS.
Motor Symptoms And Ms
Difficulty with walking or a change in walking style can be one of the first MS symptoms noticeable to others, for example beginning to stumble or trip.
Nerve demyelination can cause damage to the nerves that direct the affected muscles, causing incoordination. In some people, balance may also be affected, if special areas of the brain are demyelinated, and can lead to feeling off-balanced and leaning to one side, or difficulties in perception of where the body is in space .
Balance and walking problems vary considerably from one person with MS to another and may include:
- tripping, stumbling or falling
- unsteadiness when walking or turning
- needing support from walls, furniture or other people
- a heavy feeling in the legs when stepping forward
- leg weakness when weight bearing
- difficulty placing the foot squarely on the ground
- taking slower, shorter steps
- loss of confidence when walking.
Spasticity is a symptom of MS that causes your muscles to feel stiff, heavy and difficult to move. A spasm is a sudden stiffening of a muscle which may cause a limb to kick out or jerk towards your body and can also cause pain.
Not all motor problems are caused by MS, so it is important to seek professional advice. A health professional, such as a neurologist, an MS nurse, GP or physiotherapist can work with you to determine the cause of your walking and balance problems and advise on management.
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What Is Ms Fatigue
MS fatigue is very different from the feeling of being tired or exhausted that people without MS may experience following heavy exercise or a busy day at work. It involves a sudden loss of energy and not being able to continue an activity. Fatigue can be either physical or mental fatigue or both at the same time.
Fatigue feels as if I am an inflatable, and someone has pulled the airstopper out! My brain goes fuzzy, I cant think clearly, my speech slurs and my eyesight goes. Swallowing becomes more difficult, my balance gets worse and my legs feel heavy and clumsy.
Unlike the limits of normal, everyday tiredness, which may give a little when pushed against, MS fatigue can feel like a barrier. It can be difficult to recognise what your limits are until youve overstepped them.
Whilst recovery from everyday tiredness is relatively swift, you may find that it takes much longer to build your energy levels back up again after an episode of fatigue.
Fatigue feels like being weighed down, as if youre trying to walk up to your neck in a deep, muddy river in heavy, wet clothes carrying shopping bags full of rocks.
As an ‘invisible’ symptom of MS, fatigue is sometimes not properly understood by family, friends or colleagues. Until it is experienced, it is hard to understand the impact of fatigue and how debilitating it can be. Fatigue is a major cause of stopping working or reducing working hours.