Complications
Patients with urinary tract infections may present only with neurologic worsening. Therefore, the threshold for screening for urinary tract infection should be low.
Urinary tract infections should be treated appropriately and preventive measures considered, such as increased hydration, control of constipation, and prophylactic antibiotics.
Multifactorial causes include inactivity, smoking, low intake of calcium and vitamin D, and use of corticosteroids.
There may also be an underlying process in the pathophysiology of MS that increases the likelihood of osteopenia and osteoporosis.
Patients should be screened for osteoporosis and treated appropriately. Prophylaxis with calcium and vitamin D should be considered in all patients.
Multifactorial causes such as sleep disturbance and situational response.
The incidence of depression is quite high in MS and may cause difficulty with sleep as well as exacerbating fatigue.
Treatment of MS-related depression is similar to that for other types of depression, including pharmacotherapy and psychological therapy, although further research on the management of depression in MS is needed.[205]
A proprietary formulation containing a mixture of dextromethorphan and quinidine can be used for pseudobulbar affect. It may also be used as an adjunct treatment for depression in patients with MS. The evidence for improvement in quality of life and functional and cognitive outcomes is inconclusive.[206]
Exercise has been reported to significantly improve depressive symptoms among people with MS, with a greater effect noted when exercise reduced fatigue.[207]
Consultation with a mental healthcare provider may be helpful.
Visual complications of MS are protean and are a primary manifestation of the disease. Disease-modifying therapy is directed at preventing recurrence or occurrence of these manifestations, which include optic neuritis, intranuclear ophthalmoplegia, nystagmus, and diplopia caused by various types of extraocular movement abnormalities.
Patients should be seen by an experienced ophthalmologist, preferably a neuro-ophthalmologist, to make sure that symptoms are truly MS related, and not related to difficulties from medications (e.g., cystic macular edema caused by fingolimod, corneal difficulties caused by amantadine, or glaucoma or cataract formation as a result of corticosteroid use). Most ocular manifestations of MS do not have specific treatments apart from primary prevention of the disease, although some clinicians use gabapentin to reduce motility disturbance from nystagmus.
Common in MS. ED is characterized by the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. The exact cause of ED after MS is still unclear. Sildenafil citrate is an effective treatment for ED, but there is limited evidence to support its use in patients with MS.[213]
Cognitive training and psychological interventions may offer some benefit, particularly regarding quality of life outcomes; however, the evidence for these interventions is inconclusive.[48][50][208]
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Low-certainty evidence suggests that memory rehabilitation may be effective in improving memory function in patients with MS.[209][210]
Some patients will benefit from improving sleep and/or increasing their level of general physical activity.[211][212] Treatment of depression may also be of benefit.
Although full cognitive assessment is costly and resource intensive, a brief cognitive assessment (involving the Symbol Digit Modalities Test and California Verbal Learning Test) has been recommended for MS.[46]
Disease-modifying therapy is directed at preventing progression, with variable effectiveness.
Patients should be seen by an experienced physical therapist who can assist with the prescription of appropriate devices including ankle foot orthosis (AFO) and 4-wheeled walkers with hand brakes, which are preferred for patients with MS due to stability issues.
Progressive resistance training (PRT) is a rehabilitation tool that has been shown to improve muscle strength in patients with MS.[134] However, there is uncertainty as to whether it can improve functional capacity.
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