Lectures: Treatment Options - General Considerations
Appropriate exercise program is very beneficial for the patients with Multiple Sclerosis. Simple exercises such as normal walking, swimming, using exercise bike may be of considerable value to the patients. All patients should be strongly advised against overheating (saunas, hot tubs, sunbathing, etc.) to prevent declines in neurologic function. Exercising in a cool, well aerated environment is strongly encouraged.
PT and occupational therapy are often invaluable to assist the patients in maintaining or even improving the neurologic functions. Examples include ankle braces and devices that provide assistance with walking, personalized exercise program and counseling on work and daily activities.
Multiple Sclerosis Society recommends the low fat, low cholesterol diet adopted by American Heart Association. There is no substantial data from controlled trials that any diet is especially beneficial for patients with MS. However, it is known that overweight patients with motor, sensory and/or coordination deficits are at particular risk of falls resulting at times in serious injuries and even fractures. Obese patients also appear to lose any reserve muscle strength that they may have left because of their weight. Another category of patients with MS tend to lose weight and may require dietary supplement. From this perspective, balanced diet is important in patients with MS. Some patients with medullary lesions and difficulty swallowing may require feeding tubes to prevent aspiration and resulting pneumonia.
The risk of exacerbation(s) during pregnancy itself is reduced due to increased immune tolerance. There is an increased risk of exacerbation(s) in the first several month postpartum due to return to normal "pre pregnancy" immune tolerance. According to numerous studies, overall long term disability does not appear to be changed by pregnancy. Female patients in childbearing age need to be aware of problems related to infant or child care due to potential disease-related disability. All of these issues should be addressed before the patient reaches her decision about pregnancy and motherhood.
Treatment of Infections and Elevated Body Temperatures
Increased body temperature may lead to transient increase in neurologic symptoms or even precipitate exacerbation. Heat exposures and elevated core temperatures need to be avoided.
If a fever is due to an infection, infection needs to be identified and treated, and antipyretics need to be administered. Urinary tract infections are very common in MS patients and sometimes do not manifest themselves clinically. If a patient is overheated due to increased heat exposure, he/she needs to rest in a cool environment.
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