Spasticity in MS

Multiple Sclerosis (MS)

Multiple Sclerosis (MS) is one of the most common diseases of the central nervous system (brain and spinal cord). Myelin is a fatty material that insulates nerves, acting like the covering of an electrical wire. It allows the nerve to transmit its impulses rapidly, for smooth, coordinated movements. In MS, the loss of myelin interferes with messages between the brain and other parts of the body. This produces the various symptoms of MS1.

The zones where myelin is lost (plaques or lesions) appear as hardened areas or scars. In MS, these scars appear at different times and in different areas of the brain and spinal cord. The term ‘multiple sclerosis' means, literally, ‘many scars' 1.

For most people, the condition involves an unpredictable, lifelong progression of complex symptoms.

Facts about MS

  • In the European Union, over 700,000 people have Multiple Sclerosis (MS)1.
  • MS affects people in the prime of their life, when families and careers are developing. People are usually diagnosed between the ages of 20 and 40.
  • It is the most common cause of disability affecting young adults and is more common in women than men, with a ratio 3 to 2.
  • MS disease is the result of the autoimmune damage to the brain and spinal cord. This interferes with messages between the brain and other parts of the body.
  • The most common form of MS is where symptoms come and go, named Relapsing-Remitting MS. For some people, MS means gradually increasing disability, being called then Progressive MS.
  • Common MS symptoms include: blurred vision, extreme fatigue, pain, numbness in legs and hands, spasticity, loss of movement and speech problems1, 2.
  • Increasing disability, added to a lack of expertise in MS among some professionals, can mean that basic health problems such as depression, cognitive impairments, continence issues and sexual health all go unnoticed.
  • Palliative care skills are not always available to people whose MS is advanced, and have complex physical and psychological needs.
  • Despite all research efforts, MS is not yet curable. It is therefore essential to conduct much more research on the causes and potential cure of MS1.
  • People with MS typically are keen to remain in employment for as long as possible. However, the progressive, degenerative, or fluctuating nature of their condition means that they need to reduce/ adapt their hours and/or adapt their working environment to accommodate changing needs.
  • It is vital, particularly if they are faced with increasing disability, that they can access coordinated care from all the professionals in a skilled, multi-disciplinary team that is expert in MS.

There are very significant country and regional discrepancies with regards to the provision and quality of services and support for people affected by MS across the European Union. However, there is growing recognition that people affected by MS have much to offer to professionals working with them through their own experience and knowledge of their disease.

 

MS in Europe. According to the Organization for Economic Co-operation and Developtment (https://www.oecd.org)

 

MS is more common than you think

MS affects more than 700,000 in Europe1.

  •   > 100,000
  •   50,000 - 100,000
  •   < 50,000

According to the Organization for Economic Co-operation and Developtment (https://www.oecd.org)

 

Symptoms of MS

 

74%
Visual problems3
 

68%
Abnormal speech3
 

96%
Fatigue3
 

82%
Spasticity3
 

92%
Balance and coordination problems3
 

81%
Muscle pain3
 

 

88%
Altered sensations such as tingling and "pins and needles"3
 

 

 

What is Spasticity?

The muscles of the body maintain what is called 'normal muscle tone' - a level of muscle tension that allows us to hold ourselves up. When the tension in these muscles increases, they become rigid and are said to be 'spastic'. When muscles become spastic, their range of motion decreases and movement of these muscles can be painful4.

Spasticity is one of the most common symptoms of MS. It is defined as muscle stiffness that is often generalized and continuous. Sometimes, there are periods of worsening, in the form of involuntary muscle spasms, as muscle function is progressively lost4.

Spasticity is one of the main reasons for disability in MS. This is because it tends to be associated with pain (continuous or due to spasms), changes in bladder function and in sleep, the inability to walk and perform other movements, including those required for personal hygiene4.

Spasms are involuntary muscular movements in the limbs and torso. There are three kinds of spasms4:

  • Flexors: make the limbs bend at the joints.
  • Extensors: make the limbs extend themselves.
  • Adductors: make the limbs close tightly to the body's midline (arms pulled toward trunk, legs close together, etc).

Consequences of Spasticity for MS Patients

 

66%
Muscle pain5
 

70%
Pass water several times in the night5
 

70%
Difficulty walking5
 

40%
Restricted movements5
 

51%
Poor sleep5
 

17%
Require further help with washing and dressing5
 

 

People suffering from spasticity associated with MS may present a variety of symptoms, including4:

  • Hypertonicity (increased muscle tone), which can lead to muscle stiffness, rigid joints and bladder dysfunction.
  • Spontaneous muscle activity, in the form of uncontrollable muscle spasms either isolated or as a series of rapid muscle contractions (called 'clonus').

  • Exaggerated tendon reflexes.
     

    These are associated with4:

    • Pain that can range from slight (tense muscles) to severe (painful spasms in the limbs).
    • Nocturnal awakening, due to pain and/or bladder dysfunction.
    • Deterioration of muscle function that may affect walking and all other types of movement and speech.

These symptoms of spasticity can result in functional disabilities, including changes in posture caused by an increased muscle tone (muscle tension or activity state). Muscles must normally sustain an adequate level of muscle tone in order to keep the body upright and allow for movement, while at the same time permitting flexibility and speed during movement. Spasticity is the result of increased muscle tone, which results in a loss of muscle response. These effects can notably increase fatigue and make performing daily activities very challenging4.

 

Fatigue

Fatigue is a common symptom that seriously impacts the lives of people with MS. It can aggravate other MS symptoms, like visual disturbances, difficulty in concentrating and memory loss, hindering the ability to carry out daily activities. Fatigue can also negatively affect activities that are important to the patient, as well as affect those of their family members, friends and social circle6.

Sexual Dysfunction

Sexual dysfunction (sexual problems) is a disorder that is frequently associated with MS for several reasons. The emotional burden of MS can be so great that the patient may not feel any sexual desire. Pain and fatigue can also make sexual activity a problem. Frequently, both factors are involved. Some patients worry that their sexual activity will require too great of an effort, that their MS will worsen or that they will suffer a new episode of the disease. This concern is completely unfounded7.

Pain

Approximately 86% of MS patients are affected by pain with varying intensities at any given time. It is correlated with age, the duration of the disease, degree of disability, fatigue and depression. Neuropathic (or neurogenic) pain is the result of the progressive loss of the myelin sheath. Muscle pain is the result of musculoskeletal changes – including spasticity rigidity and spasms – that are caused by MS. The cause of headaches in MS patients is not clearly understood, although an association does exist with changes in brain functional circuits and damage caused by the disease. Also, the risk of having headaches seems to increase in patients with more damage8.

If you need any support of guidance, you can turn to your MS center or local patient's association:

References

1. European Multiple Sclerosis Platform (EMSP). MS Facts [Internet]. [Cited 2020 Feb]. Available at: http://www.emsp.org/about-emsp/

2. Kister l, et al. Natural history of multiple sclerosis symptoms. Int J MS Care [Internet]. 2013 Fall; 15(3):146-58. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24453777. doi: 10.7224/1537-2073.2012-053.

3. Hemmet L, et al. What drives quality of life in multiple sclerosis. Q J Med [Internet]. 2004 Oct; 97(10):671-676. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15367738. doi: 10.1093/qjmed/hch105.

4. Almirall. All about spasticity [Internet]. 2017. Available at: https://www.almirall.com/documents/4257831/4259970/Spasticity.pdf/645847cb-828d-eda4-aeb7-eb313be0ac27?t=1585063148823

5. Oreja-Guevara, et al. Multiple sclerosis spasticity in Spain: the 6E patients' survey. Poster. Presented at: 5th Joint triennial Congress of the European and American Committees for Treatment and Research in Multiple Sclerosis. Multiple Sclerosis Journal [Internet]. 2013; 17:580. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23297730. doi: 10.3109 / 00207454.2012.762364.

6. Almirall. All about fatigue [Internet]. 2017. Available at: https://www.almirall.com/documents/4257831/4259184/Fatigue.pdf/ee835fd9-cd2b-4c11-8052-c21226c4f8b0?t=1385486503000

7. Almirall. All about sexual problems [Internet]. 2017. Available at: https://www.almirall.com/documents/4257831/4259184/Sexual+disfuncton.pdf/71d750b1-6d9c-4488-b940-1f47ff6f1883?t=1385486427000

8. Almirall. All about pain [Internet]. 2017. Available at: https://www.almirall.com/documents/4257831/4259184/Pain.pdf/48be6d96-adf7-44bb-8b09-05b52c249e47?t=1385486580000