Non-motor symptoms in multiple sclerosis
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AbstractMultiple Sclerosis is an immune-mediated chronic inflammatory disease of the central nervous system (CNS) in genetically susceptible individuals. Even if diseasemodifyingtreatment was introduced more than a decade ago, symptomatic treatment is as important as previously, as immunomodulatory medications are not curing.
Recent years focus on health-related quality of life (HRQoL) has demonstrated the importance of non-motor problems in MS, of which fatigue, depression, anxiety, and pain are amongst the most important.
This thesis shows that pain was underdiagnosed amongst patients with MS and that only one-third of the patients were treated for their pain. Pain was independent of demographic and clinical variables. Fourty percent of the patients reported pain as having an important influence on daily activities.
Thirty-one percent of the patients reported symptoms of depression, while 19 % reported anxiety; both figures being significantly higher than in the general population. Only 16 % of the depressed patients and only 11 % of those suffering from anxiety reported treatment. 18 % of the untreated patients with symptoms expressed the need of treatment.
A total of 60 patients with MS with moderate disability (Expanded Disability Status Scale, EDSS, 4.0-6.5), were included for four weeks of daily individualised physiotherapy based on the Bobath concept. Fatigue improved after four weeks with inpatient physiotherapy, but the patients’ perception of fatigue was not correlated with improvement in physical performance. After three months, fatigue scores worsened while physical performance was improved. Improvement of fatigue after inpatient physiotherapy may therefore be explained by other factors than physiotherapy treatment alone.
A 30-month follow-up of 318 secondary progressive MS (SPMS) patients showed the HRQoL to be lower than for controls, strongly influenced by physical disability, disease progression and fatigue. The HRQoL dimension of pain, sleep and emotional reactions were influenced by MS.
There is a need of optimizing symptomatic treatment and psychosocial patient care to improve patients’ function and HRQoL. There is also a need of clinical trials to evaluate interventions for symtopmatic treatment and care. Finally, the patients need regular follow-up evaluations with focus on non-motor problems and to be offered the best treatment momentary available.
List of papers
I. Beiske AG, Czujko B, Pedersen ED, Myhr KM. Pain and sensory complaints in multiple sclerosis. European Journal of Neurology 2004; 11: 479-482
II. Beiske AG, Svensson E, Sandanger I, Czujko B, Pedersen ED, Aarseth JH, Myhr KM. Depression and Anxiety amongst Multiple Sclerosis Patients. European Journal of Neurology 2008; 15: 239-245.
III. Smedal T*, Beiske AG*, Myhr KM, Aarseth JH, Svensson E, Gjelsvik B, Glad SB, Strand LI. Fatigue in multiple sclerosis is associated with self-perceived health, but less with physical performance. Submitted BMC Neurology 2008 *These authors contributed equally to this work.
IV. Beiske AG, Naess H, Aarseth JH, Andersen O, Elovaara I, Farkkila M, Hansen HJ, Mellgren SI, Sandberg-Wollheim M, Sorensen PS, Myhr KM. Health-related quality of life in secondary progressive multiple sclerosis. Multiple Sclerosis 2007; 13: 386-392
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