MS Strength

The second most common region for multiple sclerosis attacks is the brain stem-cerebellar area, making up approximately 38% of all relapses. There is a term called “Charcot’s Triad”, named after neurologist Jean-Martin Charcot, which describes the most prevalent symptoms resulting from these attacks: speech difficulties, compromised balance, and double vision. Brain stem-cerebellar attacks can cause any of the following symptoms in an MS patient:

Loss of Balance and Coordination

These problems can involve walking, rising to a standing position, using the legs, and/or using the arms and hands. MSers can have difficulties with walking and may sway to one side, or possibly experience vertigo or dizziness (along with nausea.) Loss of coordination, also referred to as ataxia, can affect the fine movements of the hands and make writing, combing one’s hair, and tying shoe laces very difficult. Another manifestation of this damage is an intention tremor, where the hand or hands shake. Patients also describe problems with clumsiness and the coordination of limbs.

Eye and Vision Abnormalities

There are two types of eye problems associated with brain stem and cerebellar attacks. The first is eye muscle jerking, or nystagmus, which causes vision to be “jumpy’” or moving. The second type is eye muscle weakness, or gaze palsy, which can cause double vision.

Speech and Swallowing Disturbances

Problems with speech, also known as dysarthria, can affect the rhythm or pronunciation of words. The slurring of words is one disorder, where a person might appear to be intoxicated. Rhythm can be affected too, and a patient may find herself “scanning” or speaking in a jerky or stuttering fashion. Problems with swallowing, or dysphagia, may also occur.

Trouble with Facial Muscles and Nerves

Weakness, muscle spasms, numbness, and pain may occur in facial muscles. A particular facial nerve that may be affected is the trigeminal nerve, which runs along both sides of the face. This can cause severe pain blasts or dull, achy pain along the cheeks and jawlines.

Tinnitus (Ear Pain and Ringing)

This is a less common problem. In severe cases, a loss of hearing may result. This is generally limited to one ear.

Emotional Disturbances

Inappropriate laughing, crying (emotional lability), and euphoria (exaggerated sense of wellbeing) can be noted with brain stem and cerebellar attacks. These symptoms are considered separate from multiple sclerosis depression, which appears to originate from damage to the cerebrum.

Reference:

Rosner, Louis J., MD and Shelley Ross. Multiple Sclerosis: New Hope and Practical Advice for People with MS and their Families. Simon & Schuster: New York, NY, 2008.

Doctors have identified specific areas of multiple sclerosis damage that correlate with specific MS symptoms and impairments. Depending on the location of a lesion (MS nerve demyelination), the resulting damage will affect sensory perceptions, motor skills, vision, balance, swallowing, and so on.

Spinal cord attacks— those that occur anywhere on the spinal cord from the cervical region (the neck) down to the thoracic region (mid-back)— are the most common form of MS relapses (approximately 42%) and can result in the following impairments:

Sensory Functions

paresthesia: unpleasant sensations in the limbs and torso such as pins-and-needles or tingling, buzzing, hot and cold sensations, wetness, banding or tightening around the mid or upper torso (the “MS hug”), or vibrating sensations

Lhermitte’s sign: a very common sensation of tingling or electrical impulses that radiate from the neck down into the arms and legs when the head is bent forward

numbness: this can be mild, with a slight impairment of feeling, or more pronounced, with the inability to sense one’s limbs or trunk, causing problems with sitting and movements (clumsiness)

Motor Functions

spasticity: muscle spasms that cause rigidity and involuntary jerking in the limbs and trunk. The legs are the most common area for this to happen. Spasticity can increase at night or with fatigue, and a common complaint is “restless leg syndrome”, where leg muscles will alternate between jerking and cramping. Muscle stiffness is another problem.

weakness: heaviness and/or tiredness in the limbs. Often noted at “walking through cement” or “having lead limbs.” This can cause problems with walking, standing, and dexterity (including problems with writing and properly using the hands.) Sometimes rest can help limb weakness.

Bodily Functions

bladder and bowel problems: these can include emptying and/or holding the bladder or bowel. The muscles that control these are compromised and problems with bladder infections and constipation can result. Also, urgency can be increased and holding becomes an issue.

sexual dysfunctions: men and women can have numbness and tingling in the genital regions, and problems with erections and arousal

Reference :

• Rosner, Louis J, MD, and Shelley Ross. Multiple Sclerosis: New Hope and Practical Advice for People with MS and their Families. Simon & Schuster: New York, NY, 2008.