Multiple Sclerosis

Multiple Sclerosis

A Speech and Language Therapist (SLT) can work with a person with MS in relation to any difficulties with communication and/or swallowing. If needed, working with an SLT is a positive step towards helping manage a person’s symptoms of MS, and maximise confidence, well-being and quality of life.

What is Multiple Sclerosis?

Multiple sclerosis (MS) affects the central nervous system (CNS). In MS, the body's immune system (or infection-fighting system) attacks its own cells. This response is known as an "autoimmune” response.

On average, people are diagnosed with MS between the ages of 20 and 50 years. Women are much more likely to get MS than men.  The cause of MS remains unclear, although research shows that both environmental and genetic factors may play a part in a person developing MS.

Questions about Multiple sclerosis (MS)

Multiple sclerosis (MS) is an unpredictable disease, and can be different for everyone. Difficulties vary from person to person, and can change, worsen, or remain stable over time. Symptoms of MS range from very mild to severe.

As mentioned above MS can vary from person to person and it is important to link with your medical team if you have any concerns.

Most Common Symptoms of MS

  • Fatigue or tiredness
  • Numbness, tingling, or “pins and needles”
  • Muscle weakness, spasms, or stiffness
  • Visual problems, unusual eye movement, eye pain/discomfort
  • Dizziness and balance problems

Less Common Symptoms of MS

  • Speech and/or voice changes
  • Swallowing difficulties
  • Cognitive changes, memory problems, and difficulty “thinking clearly”
  • Walking difficulties
  • Bladder and bowel control problems
  • Pain, itching, over-sensitivity to heat
  • Emotional changes, depression
  • Sexual problems
  • Hearing problems

The different types of MS are diagnosed based on how a person’s symptoms progress over time. The four main subtypes of MS are;

  • Relapsing-Remitting MS (RRMS). This is the most common type of MS. In RRMS a person will experience periods of symptom “flare-up”. These periods are known as "attacks" or "relapses." These attacks may last for days or weeks at a time. In between attacks the person with MS usually returns to their usual level of functioning, in a period known as a “remission”.

  • Primary Progressive MS (PPMS). In PPMS the person’s symptoms gradually worsen over time. There are no defined periods of MS “attacks” or “remissions”.

  • Secondary progressive MS (SPMS). Some people who start out with a diagnosis of RRMS reach a point where their symptoms no longer resolve after the “attacks”. MS symptoms gradually worsen over time, and they receive a new diagnosis of SPMS.

  • Clinically isolated syndrome (CIS). This is a person’s first episode of MS symptoms, usually lasting at least 24 hours. CIS can be the first sign of a person who will later develop MS. However, some people with CIS never experience any further symptoms. An MRI scan can help identify those people most at risk of developing the disease. Research shows that early drug treatment following CIS may delay a second episode.

 

Unfortunately, diagnosing MS is complicated as there is no single test to diagnose the condition. In many cases, doctors can only diagnose MS after waiting to see how a person’s symptoms and test results change over time, and so a diagnosis may take months or even years.


There are a number of tests that your doctor can do to help in the diagnosis of MS, and also to rule out other conditions that may have symptoms similar to MS. These include;

  • A neurological examination: Your doctor will look for weakness or changes in your limb coordination, eye movements, balance, gait, speech and reflexes. These results indicate if there has been any damage to your nerves and nerve pathways
  • A MRI scan: A magnetic resonance imaging (MRI) scan takes a detailed image of your brain and spinal cord. The scan is painless and takes around 10-30 minutes. MRI scans can show nerve damage or scarring in your central nervous system. Over 90% of people with MS are diagnosed using an MRI scan.
  • An evoked potentials test: This quick and painless test involves placing small electrodes on your head to monitor how your brain waves react and respond to sounds and sights around you.
  • Lumbar puncture (or a spinal tap): A thin needle is inserted into your lower back to take a sample of the fluid that surrounds your brain and spinal cord (cerebrospinal fluid). This is normally done under local anaesthetic, which means that the area will be numbed. The fluid is then tested for antibodies.
  • Blood tests: These test are usually used to rule out other causes of your symptoms, and to test for the presence of antibodies in your blood.
    Optical coherence tomography: In this test a special light is used to examine the inside of your eyes for signs of MS.
  • Optical coherence tomography: In this test a special light is used to examine the inside of your eyes for signs of MS.

Treating and Managing the Symptoms of MS

Treating and Managing the Symptoms of MS

The management of MS varies greatly depending on the person, the course of their MS, and their symptoms. MS is most commonly managed with a mix of both medical and non-medical treatments, as well as making healthy lifestyle choices including; eating a balanced diet, reducing stress levels, working to maintain good mental health, and exercising regularly. It is very important to seek advice from a doctor before starting any treatment.

A Speech and Language Therapist (SLT) can work with a person with MS in relation to any difficulties with communication and/or swallowing.

Medical Treatments for MS

  • Managing symptoms- this may include medications, access to therapies, rehabilitation, visual and mobility aids, etc.
  • Steroids- used to reduce inflammation during relapses, or “attacks”
  • Disease modifying therapies (DMTs)- medications used to reduce the frequency and severity of MS “attacks” or relapses, and slow down progression of the condition. They are not a cure and are generally only used in relapsing-remitting MS (RRMS).

If I have Multiple Sclerosis, how can an SLT help?

A Speech and Language Therapist (SLT) can work with a person with MS in relation to any difficulties with communication and/or swallowing. If needed, working with an SLT is a positive step towards helping manage a person’s symptoms of MS, and maximise confidence, well-being and quality of life. SLTs can help people with MS who are having; 

The MS Society of Ireland have a wide range of other online supports and informational documents available from their website

Read more

MS Ireland Booklet

MS Explained - Read Here

What to expect from SLT if you have MS

An SLT will work collaboratively with the person with MS, their family, and with other healthcare professionals to ensure effective management of their communication and/or swallowing problem. SLT may include;

  • Assessment and review of a person’s communication and swallowing function
  • Direct intervention, including therapy programmes for speech, voice and swallowing
  • Support, advice and education relating to MS and its symptoms

 

A referral to an SLT is usually made by a GP, public health nurse, or other medical team, such as a Neurologist. SLTs work in a variety of settings, including community clinics, people's homes, and in hospitals. If you have concerns about any of the symptoms mentioned above please don’t hesitate to contact your GP / medical doctor about a referral to SLT.

Other useful resources

Advance Health Care Planning

An Advance Healthcare Plan is an outline of a person's general wishes & preferences for their future healthcare & end of life care.

Read more

Supporting eating, drinking and swallowing difficulties (Dysphagia).

Swallowing disorders, known as dysphagia ( pronounced dis-fay-dya) affects a person’s ability to safely swallow drinks, food and medication. It can impact people across the lifespan.

Find out More