S Y M P T O M M A N A G E M E N T I N
M S
A M B E R P E S K I N , A G C N S - B C , M S C N
O C H S N E R M U L T I P L E S C L E R O S I S C E N T E R
M A R C H 1 5 , 2 0 1 9
DISCLOSURES
• AcordaTherapeutics Speakers Bureau--2015-2018
• Biogen Speakers Bureau--2019
FATIGUE• Most common and debilitating symptom of MS
• Can be primary or secondary
– Co-Q-10 500mg daily
– B12
– Amantadine 100mg once or twice a day
– Provigil/Nuvigil
– Adderal/Ritalin/Focalin/Vyvanse
– Exercise
– Energy conservation
SPASTICITY
• Affects 40% of MS patients
• What is spasticity?
– Tightness, cramping, stiffness in the muscles
– Painful muscle spasms/involuntary contractions
– Clonus
– Impairs mobility
– Usually worse at night
SPASTICITY• Muscle relaxers
• Stretching
• Intrathecal baclofen pump
• Physical therapy
• Botox
G AIT D ISTURBANCE
• Walking speed
– Ampyra
• Foot drop
– AFO, Walk-Aid/Bioness
• Imbalance—cane, crutch, walker (U-
step)
MOOD DISTURBANCE
• Causes:
– physical changes in the brain
– emotional response to the stress of dealing with MS.
• Depression/Anxiety
– Anti-depressants
– Anti-anxiety agents
– Counseling
– Support groups
– Yoga
COGNITIVE ISSUES
• Concentration, problem solving, decision making,
short-term memory, word finding
• Can create problems at home and at work
• Other causes?—fatigue, medications, depression
– Cognitive testing, using calendars, reminders, notes,
pacing, cognitive rehab, EXERCISE
• Failure of bladder to store
urine
– Urgency, Frequency,
Incontinence
• Failure of bladder to empty
– Frequency, Retention,
Hesitancy, Interrupted
Stream
• Urinary Tract Infections—UA,
culture, Abx if needed
BLADDER DYSFUNCTION
• What can we do about it?
– Bladder ultrasound
– Medications—Ditropan, Detrol,
Vesicare (decrease bladder
emptying); Tamsulosin, Doxazosin,
Terazosin (improve emptying)
– Botox—relaxes the muscle, reduces
incontinence, improves quality of life
– Timed Voiding
– Intermittent Catheterization
– Referral to Urology/Urogynecology
BOWEL DYSFUNCTION
• Incontinence
• Diarrhea
• Constipation
• Neurogenic bowel, medication, lack of activity
• Recommendations for Improvement:
• Increase water intake
• Eat more fiber and healthy oils!
• Laxatives—bulking agents, osmotic laxatives, stimulant laxatives, stool
softeners
• The right position—Squatty Potty
SLEEP ISSUES
• Insomnia
– Sleep aides
– Sleep hygiene
• Obstructive sleep apnea
– CPAP
• Restless legs/Spasms
• Nocturia
PAIN/SENSORY DISTURBANCE
• Spasms
– Baclofen/Tizanidine
• Numbness/tingling
• Neuropathic pain—burning, electrical
shocks, shooting pain, hot/cold
sensations, itching
– Gabapentin, Cymbalta
• Trigeminal neuralgia
– Carbamazepine
• L’hermitte’s sign
HEAT SENSITIVITY
• Cooling vests
• Cooling towels
• Lightweight clothing
• Adequate hydration
• Exercise in cooler parts of the day
• REST!
A FEW OTHERS…
• Tremor
– Propranolol, primidone
• Vertigo/dizziness
– meclizine, vestibular rehab
• Fine motor coordination—occupational therapy
• Pseudobulbar Affect
– Nuedexta
• Slurred/stuttered speech
– Speech therapy
• Trouble swallowing, choking
– Swallow evaluations
• Vision impairment
EDUCATE YOUR PATIENTS!
• MS symptoms CAN improve!
• Don’t smoke!!
– Tobacco use in MS patients results in worsening vision, urinary problems, depression, and anxiety.
– Patients who smoke have greater disability.
– Smoking can also lead to an increased progression and a lower quality of life.
• Exercise
• Eat well
THANK YOU!!QUESTIONS?