Multiple Sclerosis

How can people with Multiple Sclerosis and their family cope with the emotional effects of the
disease?

Mariah Caradine
Mrs.Lindinger
Senior Seminar
April 15, 2015
According to the website Healthline there were More than 400,00 in the United States
and about 2.5 million people around the world have Multiple Sclerosis (2005). In order for
people with MS and their families to cope with the emotional effects of the disease, they need to
know how to keep everything together to deal with it. One of the things that will be discussed in
this paper is the mood swings of MS. Also, the symptoms and medication of the disease.
Another thing is how can they cope their emotion of the disease.

Leah Bland was diagnosed with MS at the age of 26. Before Leah Bland passed away, her
family and her were depressed all the time because they knew that her life was coming to an end.
The emotions between the family and Leah were never expressed; everyone just kept their
feelings to themselves. People with MS and their families need to talk about their feelings. The
family wanted the best treatment for Leah so they had her admitted to the Cleveland Clinic
Mellen Center. A medical institution devoted solely to the treatment, research, and cure for this
disease. After a lengthy stay it was determined, she should move to Philadelphia.
MS is one of the most common diseases of the nervous system. It affects people of all
ages in many parts of the world. MS was among the first disease to be described. In 1421, the
first case of MS was reported. In 1824, the first recognizable clinical description of MS in
medical literature. Robert Carswell provides the first pathological illustration of MS in 1838
(MSatruim, 2013).
Carl Rokitansky provides the first microscope description of an MS lesion in 1846
(MSatruim, 2013). In 1868, Multiple Sclerosis was named. Louis Ranvier discovered myelin of
MS in 1878. It was James Dawson who described the pathology of MS in 1916. The National
MS Society was formed in 1946. In the late 1950s, interferon was used for treatment of MS.
During the 1960s, the autoimmunity was postulated in MS. The first diagnostic of MS was
established (MSatruim, 2013).
According to the National Library Medicine Multiple Sclerosis (MS) is an autoimmune
disease that affects the brain and spinal cord and central nervous system (2014). Myelin is
protected coat around nerve fibers in the central nervous system. The immune system attacks the
myelin. The myelin of MS can damage disrupts communication between the brain and body. The
National Multiple Sclerosis Society stated The damage myelin forms scar tissue (sclerosis),

which gives the disease it is name (2015). The immune mediated disease is when the bodys
immune system mistakenly attacks the myelin in the central nervous system. The immune
system is the body's defense against infectious organisms and other invaders. Through a series of
steps called the immune response, the immune system attacks organisms and substances that
invade body systems and cause disease(KidsHealth, 2015, pg.1).
The Natalizumab (Tysabri) it is designed to block the movement of potentially damaging
immune cells from the bloodstream to the brain and spinal cord. The t-cells pass the bloodstream
that goes to the central nervous system to attack the myelin coating around nerve fibers.
( National Multiple Sclerosis Society, 2015)
Most people who are diagnosed with MS are between the ages of 20 to 40 years old.
Women are more likely to have MS. In the United Stated there are 400,000 cases of people with
MS and 2.5 million in the world. Two hundred people are diagnosed with MS each week in
United States (Pietrangelo, 2014, pg. 1). The following countries have the highest incidents of
MS, per 100,000 people:

Canada 291
U.K 164
Norway 160
Sweden 189
Denmark 227
Germany 149
Czech Republic 160
Hungary 176
San Marino 250
Cyprus 175 (Healthline, 2015, pg.1)

MS is most common in Southern Canada, Northern United States, New Zealand, Southern
Australia and Europe. (Mayo Clinic Staff, 2014, pg.1)
The cause for MS is unknown. The ratio of women with MS to men with the disease is
two to one (Healthline, 2005, pg.1). For people with MS who have children, their children have

a 1-3% chance of having MS. (Healthline, 2005, pg.1). The following percentages break down
the percent of women per race that have MS: African American 95%, Hispanic 68.1%, Caucasian
67.8% and Asians 69.2% are likely to get diagnosed with MS. (US National Library of Medicine
National Institutes of Health, 2013, pg.1)
Leah Bland had MS for 11 years; she passed away 5 years ago. She was African
American and she was 26 years old when she was diagnosed with MS. Bland was depressed but
she did not show it. Leahs disease continued to progress. She was hospitalized and sent to Moss
Rehabilitation Center in Elkins Park, Pennsylvania. There she received physical and
occupational, inpatient and outpatient, therapy. The therapists provided training and support to
the CNA and family for the assistive technological devices she used.
The symptoms that she had slowly progressing while she was in her twenties. She started
to have tremors with her hands and legs. Once she started losing her legs; she started having a
problem with people helping her. People with MS like to hide their emotions from their loved
ones. Leah would snap on people when she did not want their help and wanted to do things on
her own.
After a few years, her tremors became to worsen. The tremors started messing with her
head every time she would turn a certain way. The tremors would bother her ability to walk or
stand on her own. In her early 30s, she was unable to walk and to take care of herself. Leah had
to have nurses and doctors to visit her at home.
There are a lot of different treatments that people with MS have to take almost everyday.
The treatments focus on speed recovery from attacks and slow down the symptoms and the
disease. They help with managing the symptoms. Some patients with MS have mild symptoms

and they usually do not need the treatments. This damage slows or disrupts the transmission of
nerve impulses and causes the symptoms of MS National Society of MS, 2014, pg.1).
The treatment for attacks are corticosteroids and plasmapheresis. Most people with MS
have to take Aubagio, Avonex, Betaseron, Copaxone, Extavia, Gilenya, Lemtrada, Novantrone,
Plegridy, Rebif, Tecfidera and Tysabri. (National Society of MS, 2014, pg.1).
Symptom

Medication

Fatigue

Amantadine, Provigil (modafinil), Prozac

Bladder Problem

Botox (onabotulinumtoxinA), DDAVP Nasal Spray (desmopressin),

Detrol (tolterodine), Ditropan (oxybutynin),Ditropan XL,Enablex
(darifenacin), Flomax (tamsulosin), Hytrin(terazosin), Minipress
(prazosin), Oxytrol (oxybutynin), Pro-Banthine (propantheline),
Sanctura (trospium chloride), Tofranil (imipramine),Vesicare
(solifenacin succinate)

Walking (gaits) Difficulty

Ampyra (dalfampridine)

Tremors

Laniazid- Nydrazid (isoniazid), Klonopin- Rivotril-Syn-Clonazepam

(clonazepam). Spasticity medications are Dantrium (dantrolene),
Gablofen (baclofen [intrathecal]), Klonopin (clonazepam), Lioresal
(baclofen), Valium (diazepam), Zanaflex (tizanidine)

Bowel Dysfunction

Colace (docusate), Dulcolax (bisacodyl), Enemeez (docusate stool

softener laxative), Fleet Enema (sodium phosphate), Mineral oil,
Metamucil (psyllium hydrophilic mucilloid)
Nuedexta (dextromethorphan+ quinidine)

Emotional Changes
Depression

Cymbalta (duloxetine hydrochloride), Effexor (velafaxine), Paxil

(paroxetine), Proxac (fluoxetine), Wellbutrin (bupopion), Zoloft
(sertraline)

Dizziness and Vertigo

Antivert (meclizine)

(National Society of MS, 2014, pg.1).

The corticosteroids it is a prescribed to reduce the nerve inflammation. The side effects
are mood swings; increase blood pressure and fluid retention. The plasmapheresis helps with the
blood cells. Beta Interferons is things that people have to injected under the skin it reduces the

frequency and severity of relapses. The Glatiramer acetate (Copaxone) is a medication that helps
with the immune system that attacks the myelin. (Mayo Clinic Staff, 2014, pg.8)
The most common symptoms of MS are fatigue, walking difficulties, numbness, tingling,
spasticity, weakness, vision problem, dizziness, vertigo, bladder problem, sexual problems,
bowel problem, pain, cognitive change, emotional changes, and depression. The less common
symptoms were speech problems, swallowing, tremor, seizures, breathing problems, itching,
headache, hearing loss. (National Society of MS, pg. 1) The symptoms of MS get worse over
time. According to the article Worsening of Symptoms is associated with lower Physical activity
levels in individuals with Multiple Sclerosis by RW Motl, in a study done, it was noted that
individuals with MS reported that their worsened over a 3-5 year period of time.(2008, pg.1)
Dimethyl fumarate (Tecfidera) is something that has to be taken twice daily to reduce
relapses. The side effects is flushing, diarrhea, nausea and blood cell count. The Fingolimod
(Gilenya) is a medication at has to be taken once daily it helps with the heart rate. The side
effects are high blood pressure and blurred vision. Teriflunomide (Aubagio) it is a medication
that can cause liver damage and hair loss. It is known to be harmful of developing fetus.
Glatiramer acetate (Copaxone)This medication may help block your immune system's attack on
myelin(Mayo Clinic, 2014, pg. 8). Mitoxantrone (Novantrone) is a drug that affects the heart
and can development of blood cancer. It is only good to treat severe (Mayo Clinic, 2014, pg. 8).
They should going to support groups and therapy with their family and for themselves
will help them process with MS. Some medications can slow down the process of the symptoms.
Some medications makes the depression and mood swings worse. The symptoms are also a
reason for a person to have depression. A person with MS also has fears. People with MS are
scared to talk with their family about their disease so they become depress. According to the

website Depression is negatively affecting your life-- causing difficulties with relationships,
work issues, or family disputes -- and there isnt a clear solution to these problems (WebMD,
pg. 2).
A lack of knowledge of the disease can add anxieties commonly experienced by people
who are just diagnosed with MS. If there is damage to the nerve fiber in the brain it can also
result in emotional changes. Corticosteroids and steroids is a medication that can also have affect
on the emotions. The emotion disorder is common in MS. People with MS and all those closely
associated with them should be aware that depression in its various forms of common during the
course of MS (National Society of MS, pg.2). Depression is not something that a person can
control or prevent by will power or determination.
Most common moods of MS are major depression, anxiety, adjustment and bipolar. MS
can involve various types of emotional instability such as uncontrollable laughing and crying.
There is a part that the brain involved in emotion, the part relates to the emotional responses that
allows the person to control them. MS mood swings will happen out of nowhere without
warning. The mood swings can be managed with treatment, therapy and frank communication.
One- third to one-half of people with MS will have a major depressive episode in their
lifetimes (American Academy of Neurology, 2013, pg. 1).
Anxiety is not caused by medical problems. Anxiety is an mental health disease. It can be
caused by some of the physical problems with MS. More people with MS have an anxiety. A
study of 7786 adults with MS showed that 54.1% had excessive symptoms of anxiety, while
46.9% had excessive symptoms of depression (MS Connection, 2015,pg. 1). It is brings and
attention to depression that becomes an disorder. Many Multiple Sclerosis symptoms can cause

anxiety. MS anxiety is caused in the brain itself. It is a sign of danger and MS can make the
anxiety warranted, it is hard to control it. (Mental Illness, 2015, pg.1)
The anxiety affects more than one-third of people who has MS. The adjustment disorder
is nearly one-fourth and bipolar disorder is 13% with people who has MS. The studies shows
three types of treatments for the emotional disorder of MS; type counseling called cognitive
behavioral therapy, antidepressant drugs treating depression and anxiety and dextromethorphan
with quinidine for treating PBA (American Academy of Neurology, 2013, pg. 2).(Mental Illness,

2015, pg.1)
Depression is common with people who have MS. It is exactly one of the symptoms of
MS. Depression can also be a side effect from some of the medications used to treat MS.
Depression is an episode of sadness or other symptoms, it is not a sign of weakness. Everyone
sometimes feels depressed but people with MS sometimes can not get out of depression. This is
depression, mental illness that, if left untreated, can worsen, lasting for year and causing untold
suffering, and possibly even resulting in suicide ( Cleveland Clinic, 2014 pg.1). It can also

cause difficulties with relationships, work issues and family disputes. ( Cleveland Clinic, 2014
pg.1)
Symptoms of Depression

Sadness
Loss of energy
Feelings of hopelessness or worthlessness
Loss of enjoyment from things that were once pleasurable
Difficulty concentrating
Uncontrollable crying
Difficulty making decisions
Irritability
Increased need for sleep
Inability to fall or stay asleep at night (insomnia)
Unexplained aches and pains
Stomachache and digestive problems
Decreased sex drive
Sexual problems
Headache
A change in appetite causing weight loss or gain
Thoughts of death or suicide
Attempting suicide (WebMD, 2015)

Leahs family didnt know what to do or where to turn for help. A friend told the family to
contact Liberty Resources, which is an agency dedicated to providing services to enhance the
quality of life for disabled persons. People with MS also has grief about their symptoms. They
grieve about losing their ability to work, walk, and do other activities. Grief does not have a
time limit. People who are grieving need to resolve it on their own. It can be beneficial to the
person to talk about their feelings. If they can not, then they may need treatment or supportive
counseling and/or support groups.
Living with any chronic illness can be difficult. To manage the stress of living with MS,
consider these suggestions:

Maintain normal daily activities as best you can.

Stay connected to friends and family.
Continue to pursue hobbies that you enjoy and are able to do.
Contact a support group, for yourself or for family members.
Discuss your feelings and concerns about living with MS with your doctor

or a counselor (Mayo Clinic, 2015)

Family remember who knows someone with MS, it can be hard for them to wrap their mind
around the whole thing. Some families can not image a remember being handicap. It will be a
challenge for the family about they have to pull everything together.
In conclusion, in order for people with MS and their families to cope with the emotional
effects of the disease, they can join support programs and therapy. Multiple Sclerosis can take a
toll on a person who has MS and also the family for each other. The only thing the family and
person with MS can do is to be there for the people who are having emotional problems and
encourage them to go to counseling. People can be depressed, even from their symptoms and
medications.

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