Dizziness is a lightheaded sensation that may be caused by any one of several other difficulties aside from MS. If possible, an exact reason for the dizziness needs to be identified in order to receive the best treatment. Certain medications, such as tricyclic antidepressants, may cause lightheadedness with sudden changes in position.
Dizziness may often be experienced when flu symptoms are present. As the flu is cared for and related symptoms abate, so will the dizziness. While dizziness may result from other physical problems, changes in nerve impulse flow can also cause dizziness and treatment for this may require medication.
Vertigo is a condition that is more severe than dizziness, adding the feeling of movement when none is taking place. A person with vertigo may describe this symptom as a "spinning" or "floating" sensation. This can be quite uncomfortable at times; often causing difficulty with standing or walking. Some individuals may experience nausea and vomiting with vertigo.
People with MS who are experiencing vertigo may have difficulties with the nerve impulses originating from the inner ear, an area involved with dizziness and vertigo. Afflictions aside from MS may also result in vertigo, but for many people with MS, inflammation in the brainstem area is at fault. Along with autonomic functions, the brainstem controls the coordination of the eyes, limbs, and trunk, all of which assist with balance.
Occasionally, a physical therapist is able to help alleviate dizziness by teaching certain exercises. These exercises tend to work for the type of dizziness that worsens when changing position. In most cases of dizziness and vertigo, however, a drug program is necessary to manage these symptoms.
Antihistamines are often prescribed to treat less severe cases of dizziness and vertigo. The most commonly recommended drug, well known for the treatment of motion sickness, is dimenhydrinate (Dramamine®). Other frequently used antihistamines include meclizine (Bonine®, Antivert®), diphenhydramine (Benadryl®), and cyclizine (Marezine®). Dro
wsiness is a common side effect of most antihistamines.
Another drug often used for motion sickness that may be successful in treating vertigo is scopolamine (hyoscine, Transderm-Scop®). Although scopolamine is available in tablets or capsules, it is typically prescribed for motion sickness or vertigo in the form of a skin disc that is placed behind the ear.
The medicine from the disc is absorbed into the body over a three-day period. Dry mouth is a common side effect, and drowsiness only occurs in 15 percent of those taking the drug. Care must be taken to wash hands after handling, as this drug can cause temporary visual damage if it gets into the eyes.
A group of tranquilizers known as benzodiazepines offers drugs which are able to suppress the inner ear. Such drugs include diazepam (Valium®), clonazepam (Klonopin®), and oxazepam (Serax®). These strong medications frequently provide some relief, however, they must be carefully monitored as they may cause dependence. If someone has been taking any of these drugs regularly for a period of time, discontinuing the drug will need to be done gradually.
Occasionally a person with MS may experience vertigo to an extent that he or she is vomiting and is unable to take medication orally. In such instances, a physician may recommend the patient be given a high dose of cortisone intravenously along with other fluids. This serves to reduce inflammation at the affected area, typically at the brainstem.
By doing so, normal nerve flow may be restored and vertigo symptoms diminished or eliminated.
MS fatigue is perhaps the most common and disabling symptom for people with MS. Demyelination, causing a slowing of the nerve impulses, is largely to blame. Other factors may play a role in the loss of energy, and different types of fatigue have been identified.
Although a cure for MS fatigue has yet to be found, a number of strategies, therapies, and medications may be employed to help alleviate the effects of MS fatigue. Depending upon the exact cause or causes of the fatigue, an appropriate treatment plan may be developed.
Fatigue can often impact daily routine. It tends to become worse when an individual is experiencing stress, exposed to heat, or participating in physical activities. One may feel frustrated with the tiredness and find the ability to cope with situations to be reduced. Even one's level of motivation may be affected.
Fatigue is especially difficult for others to understand, because this is a symptom no one else can readily see. Rest, sleep, changes in lifestyle, positive experiences, alternative health care, and drug therapy are all ways in which MS fatigue may be approached.
As mentioned earlier, fatigue may have different causes and one should not just assume his or her exhaustion is attributable to MS. In addition to demyelination, fatigue may be caused by sleep deprivation, infection, anemia, kidney disease, medications, depression, or fractures. If fatigue becomes a significant problem, a doctor should be consulted and the patient may be seen for an evaluation – which in most cases will include laboratory studies.
Lifestyle, symptoms, general health, and overall attitude need to be examined once unrelated factors have been eliminated. Sometimes fatigue is caused by a full day of activities. This type of fatigue is normal, even for those without MS, and good sleeping habits often solve the problem.
Daytime fatigue is certainly to be expected if someone is not getting enough sleep at night. The ability to sleep may be affected by spasticity and muscle spasms as well as medication, pain, anxiety, depression, excessive inactivity, taking recurrent naps, or not adhering to a healthy sleep schedule.
If the problem relates to medicine or pain, a doctor may be able to alter the present treatment. This is often accomplished by adjusting dosages, switching or adding medications, changing the time of day to take the medicine, or even adding alternative treatments – such as relaxation techniques or massage – to enable the individual to sleep better.
When someone suffers from anxiety and/or depression, he or she may find that not only is sleep being disturbed, but appetite may be affected as well. Energy levels are associated with good nutrition; without a healthy diet, the body cannot keep functioning at its full potential. While proper eating and sleeping habits need to be followed, difficulties are not solved without treating the primary cause. For problems such as anxiety or depression, counseling or therapy is strongly recommended. Medications such as antidepressants may possibly be prescribed.
Excessive inactivity, recurrent naps, and an inconsistent or improper sleep schedule can all lead to sleep problems and resultant daytime fatigue. Optimal sleep habits include always getting between six and nine hours of sleep each night. The ideal number of hours depends on what works best for the individual. Going to bed and getting up at the same times each day allows the body to adjust to a regular sleep schedule which encourages sound and uninterrupted rest.
A nap is a good idea for those who find it helps to get them through the day and doesn't dramatically affect their evening sleep. Any day sleep that keeps one from sleeping at night, however, should be avoided.
Doctors sometimes prescribe flurazepam (Dalmane®) to assist someone with developing a consistent sleep cycle should natural methods prove unsuccessful. A common dosage is 15mg each night before going to bed. Dalmane® should only be taken for short intervals because over time, the response to this medication decreases, and the patient will need to take increasingly larger doses to derive the same effect. Tricyclic antidepressants and zolpidem (Ambien®) are often useful.
Fatigue may quickly increase when a person is involved in a physical activity. This type of MS fatigue is seen often, and one does not need to stop all activity to avoid this exhaustion. Continuing with exercise and recreation, as well as social, household, and work duties, is important to everyone's mental and physical well-being.
The best way of dealing with this type of fatigue is to alter the person's lifestyle, saving steps and allowing one to become more efficient in terms of energy spent. Exercise, under the direction of a physician, may be continued to just below the threshold of significant fatigue.
Scheduling and planning ahead can be very helpful with saving energy. Listing activities in their order of importance enables a person to see clearly what needs to done first and what can wait until another day – should all energy be used up before reaching the end of the list.
Those with limited energy can learn to accept that not everything will necessarily be completed when and how one prefers them to be done. In most cases, an unfinished job or activity will still be there the next day. By waiting, more energy and enjoyment will be found in accomplishing the task at a later time.
Scheduling sufficient periods for rest and alternating them with periods of physical exertion can be helpful, thereby preventing one from becoming too tired too quickly. Should a person take on a project that is too much to handle at one time, it should be divided into smaller parts and scheduled accordingly. If this is not possible, he or she may want to have someone lend a hand to accomplish the task and avoid overexertion.
Efficiency and energy-saving techniques are very useful in combating fatigue while tackling household duties. Whenever possible – such as when cooking or cleaning – supplies should be arranged in advance so the person may be sitting for most of the activity.
For instance, collecting all the ingredients at one time for a recipe enables the cook to prepare the food while sitting, using minimal effort. The same is true for cleaning, keeping supplies in one carrier and putting them in a safe place near the site of the next job.
If the washer and dryer are not convenient to other rooms in the home, things to do should be brought along so he or she may sit nearby until the clothes are finished. Washing only one or two loads of laundry daily will spread them over the full week. This is far less stressful than doing several loads over the course of one day.
Quickly removing clothes from the dryer and immediately folding or hanging them will help to keep clothes from wrinkling. When ironing is necessary, the clothes and board should be arranged so the ironing may be done while sitting.
Adaptive equipment with long or easy-to-grip handles can be very helpful. Frequently used items should be organized and hung or stored in easy-to-reach places, using pegboards, sliding drawers, lazy Susans, and lightweight storage boxes.
Trays and wheeled carts are indispensable for transporting food, dishes, laundry, and other bulky or heavy things around the house. When something heavy needs to be moved without a tray or cart, do so by sliding versus carrying. If lifting a heavy object cannot be avoided, one should keep his or her back straight, stand with feet apart, and keep from straining muscles.
Another way to be protected is to ensure that the chairs used are supportive for a person's back. When applicable, check that these are in the proper position with the desk, table, or countertop. Using a shoulder-phone device (a plastic piece which sits between the phone receiver and the shoulder) helps to avoid neck strain while talking on the phone. A speakerphone is especially useful if upper limbs are weak.
Enough cannot be said about good planning. With respect to meals, selecting menus in advance with easy recipes can save both time and money. Before shopping for food, a list of all necessary ingredients for the week's meals may be written. Becoming familiar with the local store and the aisles on which individual items are located assists with saving energy as well.
Better yet, if available and affordable, the food order can be delivered. Whenever possible, double portions of a meal may be prepared and the leftovers frozen for another day. This provides extra meals that require little time to prepare. Selecting easier methods of preparation, such as baking instead of frying, or using a microwave or crockpot, can really help to reduce the workload as well.
Planning also applies to personal tasks. When bathing, having a grab bar, supplies, and tub seat in place or within easy reach will save extra work. Clothing may be set out the night before it is needed. When dressing the following morning, clothes should go on the weak side first. When undressing, begin with the strong side.
If caring for a baby, working above the waist level to bathe, change, and dress the infant will be less strenuous. With toddlers, having them stand on a stool for dressing or washing reduces physical strain. Disposable diapers require the least amount of work, while velcro or other fasteners on clothes are easier to manage than buttons. These types of fasteners also work well on clothing for individuals with limited movement or energy.
Most energy-saving techniques are little more than common sense and one may be surprised at how much physical strength is conserved by simply employing these strategies. During all activities, good light and ventilation should be available so valuable energy is not used up straining to see clearly or to take a fresh breath. Spreading out activities while taking care not to put
tiring tasks on consecutive days will also prove to be beneficial.
Research has shown that nerves with damaged myelin are sensitive to changes in temperature. A rise in temperature may cause nerve signals to fail, whereas a reduction in temperature may allow more signals to be transmitted across a damaged nerve.
The idea of cooling people with MS to alleviate symptoms has been researched and practiced for many years, but practical methods of cooling an individual had not been perfected until recent years, after MSAA and NASA joined forces to develop and test a "cool suit."
Cooling someone too quickly – such as taking cold baths or sitting close to the air conditioner – can cause shivering and vasoconstriction. This reaction does not help to alleviate MS symptoms.
By slowly cooling an MS patient to a maximum of two degrees from the person's baseline temperature, an individual with MS may experience improvement in areas of physical performance, cognitive processing, and motor function. Cooling also significantly alleviates fatigue, helping to give a person with MS the energy needed to perform their daily activities.
Controlled cooling is now achieved through the use of active cool suits or passive cooling garments. Active cool suits use a vest with small tubes that circulate cool liquid from a cooling unit or battery pack. These are portable and allow the wearer to enjoy symptom relief indoors or out. Passive cooling garments, such as a cap, vest, or bandana for the neck, use ice or gel packs to give people with MS immediate and simple relief from heat and some MS symptoms. Other passive garments are dampened and chilled before use.
Cooling often provides temporary drug-free relief from fatigue and heat intolerance, as well as other MS symptoms. Cooling suits and garments may be available for use at no charge through MSAA. (Interested people may contact MSAA by calling the number listed on the back page of this publication.)
One of the most promising drugs to be studied and used for MS fatigue is modafinil (Provigil®). A recent clinical trial conducted at Ohio State University showed that treatment at 200 mg per day for two weeks significantly reduced fatigue as compared to placebo. The most common side effects included headache, nausea, and aesthenia.
Amantadine (Symmetrel®) has been used for a number of years and is considered by many to be the drug of first choice for fighting fatigue. Often given to those with Parkinson's Disease, it facilitates the release of "dopamine" from CNS nerve endings. Dopamine is a chemical that naturally occurs in the brain and controls communication between cells. In addition to helping to relieve MS fatigue, amantadine is also an antiviral drug used to prevent influenza infections.
Since a portion of exacerbations are brought on by viruses, this drug may have a second advantage of reducing the frequency of exacerbations by preventing influenza infections. A two-year study of amantadine, begun in 1987, resulted in people with MS having far fewer exacerbations compared to those taking the placebo.
The effects of this drug tend to diminish after a few months of use, so intermittent therapies may be the best approach with amantadine. Side effects, which include allergic reactions, insomnia, mood disturbances, confusion, hallucinations, and urinary retention, are rare, occurring most often in elderly patients.
Amantadine can prove toxic for some, particularly at high doses or for patients with kidney disease. Normally, this drug is well tolerated and is commonly given in doses of up to 200 mg daily (100 mg twice a day).
Some studies have shown positive results using amantadine in conjunction with pemoline (Cylert®), a stimulant. Cylert® is not used often because of possible liver toxicity and the requirement to undergo frequent blood tests to check for liver problems. Cylert®, as well as the stimulant methylphenidate (Ritalin®), may help to relieve fatigue symptoms, but all too often interfere with sleep – which only serves to worsen the problem overall.
Two other medications, 4-aminopyridine (4-AP) and 3-4 diaminopyridine, are still under investigation for the treatment of MS fatigue. Side effects of these agents, however, include seizures.
Fluoxetine hydrochloride (Prozac®) appears to have excellent antifatigue properties. This medication is traditionally used as an antidepressant and usually displays no significant side effects for those who can tolerate this drug. Other antidepressants that may be useful in treating fatigue include paroxetine (Paxil®) and sertraline (Zoloft®).
Stimulants such as amphetamines (Dexedrine®, "speed") or even caffeine and Dexatrim®, are to be avoided, as they put extra strain on the CNS and may cause additional difficulties for the patient. Cocaine, an illegal substance in the U.S., may well be "cut or laced" (diluted, contaminated) with other substances and could be quite dangerous or even fatal for anyone with MS taking this drug.