6 Common Complications of Multiple Sclerosis—and What to Do About Them
For people with multiple sclerosis (MS), the immune system attacks nerves in the brain and spinal cord by demyelinating axons—that is, by removing the insulation that surrounds the wiring of the neurons, much like the rubber insulation that surrounds the wires that deliver electricity in our homes. This leads to inflammation and altered electrical signals in the brain, which often result in physical symptoms like tingling, fatigue, numbness, weakness, and trouble walking.
However, multiple sclerosis can affect the body and mind in many other ways—issues caused by the disease or its treatment that are referred to as complications of MS.
As Jonathan Howard, M.D., a board-certified neurologist and associate professor of neurology at NYU Grossman School of Medicine, in New York City, explains, “MS can cause a wide variety of symptoms, both directly due to injury to the nervous system, and secondarily as a consequence of disability.”
Although "complications" and "symptoms" are often used interchangeably, there is a nuanced difference between them. In simple terms, a symptom is the direct result of damage to the nervous system. MS complications are those secondary symptoms that may develop over time and that, well, complicate the manifestations and course of the disease.
Every person with multiple sclerosis is unique, so you may not experience the same issues as someone else with the condition—but these are six of the most common MS complications.
1. Vision Problems
Optic neuritis, or inflammation of the optic nerve, is a common complication of MS that can cause blurred vision or vision loss in one eye. You may also experience double vision or involuntary movement of the eye.
These problems are often treated by a neurologist, or by an ophthalmologist if the person has not yet been diagnosed with MS, with a short course of steroids. The prognosis is usually good, with vision returning to normal after treatment. Problems may temporarily recur during pseudo-exacerbations (recurrence of old symptoms due to stress or inflammation rather than a new attack on the nervous system) or when you’re fatigued.
2. Depression or Anxiety
Just as the result of damage to the nervous system by rogue immune cells can cause physical complications of MS, such as numbness, weakness, or pain, it can also cause psychological and emotional complications, such as depression and anxiety. In fact, chronic inflammation from any condition—including COVID-19, rheumatoid arthritis, and inflammatory bowel disease—is associated with high rates of depression.
Because of the direct effect of MS on the brain, the rates of depression are higher in MS than in any other neurological or medical condition: 50% of people with MS will have a major depression at some time during the course of their disease, compared to 20% of people in the general population. If left untreated, depression can increase the risk of suicide, making depression one of the true potential emergencies among the possible complications of MS. Fortunately, depression also happens to be one of the most treatable complications of multiple sclerosis if diagnosed and addressed.
If you’re having feelings of depression, don’t be afraid to have discussions with your doctor about what you’re feeling. They can also refer you to other resources if needed, too.
“If people are having anxiety or depression related to their illness or as a result of their MS, a therapist or psychiatrist may be important,” says Dana Cooper, M.D., a board-certified neurologist in Los Angeles. Treatment with antidepressants may also help, improving mood issues while also easing underlying pain that could also be contributing to depression.
3. Cognitive Problems
Because MS affects the brain, up to 65% of people with the condition can have changes in their cognition, including problems with attention, reasoning, and memory, as well as slower processing of information. Less commonly, these difficulties may cause problems with speech and verbal recall as well. "Speech therapists may be able to do cognitive therapy to help with cognitive difficulties," Cooper says.
If you experience this MS complication, you may also want to see a neuropsychologist, who can work with you to develop a care plan for cognitive rehabilitation. The two approaches to treating cognitive impairment are restorative and compensatory therapies.
Restorative therapies are geared at improving cognitive performance, such as through computer-based learning programs. Restorative plans may involve exercise and self-management strategies such as doing puzzles, games, and other activities that challenge and stimulate your brain.
Compensatory therapies help to find workarounds for fixed cognitive deficits. As part of the treatment, your doctor may also suggest working with a physical therapist or occupational therapist on strategies that accommodate any cognitive issues, like using an organizer and a system of automated reminders.
Overall, cognitive rehabilitation has been shown to significantly improve memory and cognitive function.
4. Urinary Symptoms
Bladder problems affect at least 80% of people with MS. Bladder issues are often due to the condition's impact on the spine, which is connected to the bladder through nerves. Problems can include incontinence (urinating when you don’t want to) or retention (not being able to urinate enough to empty your bladder).
Most neurologists are able to help treat bladder dysfunction, Howard says. Treatment of this MS complication may involve medication that helps control different symptoms, such as by providing improved urinary retention, or your doctor may suggest behavioral approaches, like using the restroom on a given schedule. “However, patients who do not respond to basic treatments may need evaluation by a urologist,” Howard says.
5. Sexual Dysfunction
Multiple sclerosis can have an impact on not only the bladder but also the whole genitourinary tract, which includes the sexual organs and affects sexual function. In men, MS may cause issues like erectile dysfunction; women may experience painful intercourse or have trouble orgasming.
A neurologist, urologist, or gynecologist can typically help with sexual problems. These doctors can talk with women about strategies like using vibrators or extra lubricant, and with men about medical interventions, such as medication or penile implants.
6. Speech and Swallowing Problems
Speech problems can occur in 25% to 40% of people with MS, particularly as the condition advances. These issues can include “scanning speech” (pausing between words and syllables), slurring words, or speaking at an unintentionally low volume. People with speech problems may also experience difficulty swallowing.
A speech therapist may be able to help with these issues by working with you on exercises that can help strengthen and coordinate the muscles used in speech, like those in your vocal cords, jaw, and lips. This approach may be more effective for some people than others, depending on the extent of their lesions. A speech therapist can also work with you on breath control and ways to help simplify your sentences if you’re having difficulty.
Finding Help for the Complications of MS
Fortunately, treatments are available for many of these MS complications—and their success can often be easier to judge than that of disease-modifying therapies, which slow the progression of MS but don’t treat the symptoms that have already appeared.
“It is important to work with a neurologist you trust in order to get on an appropriate treatment regimen,” Cooper says.
Although many of the symptoms of these MS complications can be treated with medications, Howard cautions against taking too many at once. “It’s important to make sure that medications are doing more good than harm,” he says. “Sometimes, patients come to me on a dozen medications, and the side effects [of that] may outweigh the benefit.”
Your neurologist can also refer you to specialists who can help through means other than medication. “Physical and occupational therapy are key in terms of helping patients maximize their function and independence,” Howard says.
Ultimately, the key to success in managing the different complications that can arise from MS is to have a team of care providers who work together on an integrated care plan. You should feel empowered to oversee your own health and advocate for the best possible course of treatment for you.
Talk to your neurologist about your symptoms and complications. The doctor can help you address them and refer you to specialists if needed to help reduce their impact on your life.
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