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MS information for health and social care professionals Symptoms - a multidisciplinary approach

Despite recent developments in drug therapies which impact on the course of MS rather than on its symptoms, sound symptom management is still the key to optimising quality of life for most people with MS. Because the lesions characteristic of MS can occur anywhere within the central nervous system, the symptoms can be extremely diverse, present in many different combinations and with variable severity. No two people with MS have exactly the same symptoms.

A list follows of the more common symptoms, though it cannot be overstressed that most people with MS will only experience a few of these, either at any one time or over the whole course of the disease.

  • Bladder dysfunction
  • Bowel dysfunction
  • Visual disturbances
  • Fatigue
  • Pain
  • Spasm
  • Cognitive dysfunction
  • Tremor
  • Muscle weakness
  • Balance
  • Vertigo
  • Mobility problems
  • Sexual dysfunction
  • Depression
  • Emotional problems

A distinction can be made between symptoms and effects, where, for example, pressure sores may be an effect of untreated continence problems rather than a symptom of MS. Less clear perhaps is pain, which may be either a primary symptom deriving from damage to the CNS or a secondary symptom, the effect of bad posture.

Symptoms can also be divided into visible and invisible. Those which are invisible - sexual dysfunction, fatigue, cognitive problems - are less likely to be identified by most health professionals yet there is evidence that these may impact as much on quality of life as those such as lack of mobility which are immediately apparent.

From the diversity and range of symptoms, it will be obvious that many health and social care professionals may be involved in the care of a person with MS. A study reported up to 60 workers from different sources visiting the home of a person with MS[1]. NICE guidelines[2] state that 'when several healthcare professionals are involved with a person with MS they should work together with the person and his or her family as a team towards common agreed goals and using an agreed common therapeutic approach.'

It would be hard to envisage a situation in which the need for a coordinated approach by health and social care professionals were greater. GP, neurologist, radiologist, rehabilitationist, physiotherapist, occupational therapist, psychologist, counsellor, orthotist, dietitian, nurse, continence adviser, speech and language therapist, pain specialist, social worker, complementary therapist - all can have a role to play in helping the person with MS manage their condition. For the successful management of one symptom, several different professionals may have useful input. However, treatment must never be of a symptom or collection of symptoms but of the person who experiences the symptoms.

Provision of specialist MS services is still patchy. In some areas, people with MS have access to a specialist multidisciplinary team, often with a specialist nurse or key worker to work with them and to coordinate an appropriate care programme. For others, it may be difficult to obtain the right advice at the right time, ignorant of what might be useful, and still more so of how to access it.

References

  1. Thompson A, Johnston S, Harrison J et al. Service delivery in multiple sclerosis: the need for co-ordinated community care. MS Management 1997;4(1):11-18.
  2. National Institute for Clinical Excellence. Multiple Sclerosis - Management of Multiple sclerosis in Primary and Secondary Care. NICE Clinical Guideline 8. London: NICE;2003 p9