Hi Rebecca I’m good but I’m a little bit stressed. I have a test on monday with Ms. Rocher and there are many things I just don’t understand at all so it really scares me. I don’t know what to do…
Oh, ok I get it, maybe you need some help? What is your exam about?
It is about multiple sclerosis… I don’t understand this disease. I did some research on the internet but I think I need an example with a real patient to represent the disease, you know.
OOOOOHHH I can easily talk about it if you want! Last year I was doing my internship in a functional rehabilitation center so I’ve seen many patients with multiple sclerosis!
Oh great! Do you have a little bit of time now, to explain some things to me please?
Yeah of course I need to be back only for the afternoon so we have the time, tell me! What do you know about multiple sclerosis and what is the most difficult to understand for you?
Ok thank you very much! So, I know that multiple sclerosis is a chronic inflammatory disease of the central nervous system (so it concerns the brain, the spinal cord and the optic nerves). I also learned that it has an autoimmune origin but I don’t know what it means…
In fact, this illness is due to a deregulation of cellular immunity which leads to a demyelination and axonal loss in the central nervous system as you said. In other words, the myelin sheath that surrounds the axon is mistakenly attacked by the patient’s own immune system.
Oh, Ok it makes sense! I remember Ms. Rocher was talking about demyelination plaques that can appear in various locations of the central nervous system. And I think it explains the diversity of clinical signs from one patient to another. However, I don’t understand some of these manifestations and how it happened.
Ok, so multiple sclerosis is mainly characterized by motor, sensory, emotional and cognitive symptoms.
Yes, I already know motor and sensory symptoms but I am not very sure about emotional and cognitive symptoms. It’s confusing in my head.
So, tell me what you already know and I will complete it.
Ok. For the motor symptoms, we are mainly talking about abnormal movements and a muscular weakness which can sometimes lead to a partial paralysis. In fact, it is an evolutive disease so at first patients can easily walk and run but progressively it becomes more difficult and they will need a cane or a wheelchair. Unfortunately, they can also finish their lifetime in a bed. Motor troubles are more frequent if the onset age was early.
Yes, generally an early age of onset is not a good predictor for the evolution of this disease. Knowing that the age of onset is on average between 20 and 40 years. I remember a 17-year-old patient who was diagnosed with this disease during my internship… He already encountered some difficulties when he was running. He was more tired and he lived it badly because his passion was football. I felt sad and powerless for him. Fortunately, it is not the same for all the patients with multiple sclerosis.
Ok it is a sad story…
Yes… please continue.
Ok. In my memories those patients can suffer from impared balance and visual disabilities (especially a decreased vision and a diplopia so they have a double vision of objects).
Yes exactly.
They can also have sensitivity disorders such as tingling, numbness, loss of sensitivity and pain. More surprisingly, we can find abnormal sensations of electric shocks, imaginary flows, and so on.
Yes, it is very varied from one person to another. Do you remember anything else ?
Aren’t those patients who also have urinary and sexual disorders?
Yes, absolutely but those disorders appear in many pathologies so it is not the most revealing for a multiple sclerosis even if it exists.
Ok, can you now explain to me the main emotional and cognitive troubles in multiple sclerosis, please?
Of course! So, as you can imagine all the patients don’t have cognitive troubles. From memory it concerns between 40 and 60% of the patients. It is mostly the processing speed, the working memory, the attention and executive functions. In other words, these patients can be slowed down when they are processing information. They also can have difficulties to manipulate information in memory for example for mental arithmetic or in a dual-task situation. It can be difficult for them to concentrate over a long period of time or in a situation with a lot of information, for example in a group conversation. They also can encounter some difficulties adapting to new situations. Maybe you know the neuropsychological tests we can use to assess those functions?
Maybe the Stroop Neuropsychological Test, the D2, the Digit Span and the Digit Substitution Test from WAIS IV, the Wisconsin Card Sorting Test, and so on.
Yes, why not, good choice. However, we must not forget to evaluate all the other functions.
Yes, of course. I didn’t think there could be so many cognitive troubles!! But I don’t understand, do patients with cognitive troubles have all of them?
No, not necessarily. Most of the time, patients only have few. For example, in my internship, I have seen a man suffering since several years from multiple sclerosis. He had an excellent working memory with the maximal span on the Digit Span from the WAIS IV (it was very impressive) but he had very important difficulties to concentrate over a long period of time. In his daily life it bothered him a lot because he was a very intellectual man. He liked to play chess, to read a lot of scientific books, to watch documentaries… It was the first patient with multiple sclerosis that I saw. It’s important to know that the symptoms get worse with time, it’s not a stable disease so those difficulties to concentrate were new for him and he suffered a lot from that.
Oh, it seems to not be easy for daily activities… After that it is easy to understand that some patients with multiple sclerosis suffer from depression.
Yes, especially when we know that this disease can lead to social isolation. For example, at the beginning of his disease, he was not paralyzed but now he could only move his head and one arm and he was shaking a lot so his movements were reduced. He moved in a wheelchair.
Ok and so, what treatments exist to help those patients?
Doctors can prescribe a drug treatment to reduce the duration and intensity of sensitive and motor symptoms. These treatments are adapted depending on the type of multiple sclerosis. Other treatments target pain, tiredness, sexual disorders… There is also functional rehabilitation to maintain autonomy as long as possible and to limit the complications due to patient’s immobilization.
Yes, I know but my question was more related to the role of the psychologist.
Oh! First the psychologist evaluates the intensity of cognitive disorders, if there is any. Then, it’s important to suggest a therapeutic education program in order to help the patient understand his symptoms, how his disease works and the interests of care. Finally, the psychologist can propose a cognitive reeducation.
I imagine it is also important to have psychological treatment because, like you said before, patients with multiple sclerosis can suffer from depression because of the difficulty of being dependent and sometimes isolated.
Exactly. It is very important to have multidisciplinary care for those patients.
Ok! It’s good to know that there are possibilities for patients to feel better and to live their life as normally as possible and as long as possible. Thank you very much for your help, I understand better now and I find it’s really fascinating.
No problem you’re welcome, if you want to know more about this illness and carry-on learning, you can read the book from Bruno Brochet and colaborators. You can also find many reports on the internet like for example a report with JK Rowling talking about her mother who was suffering from these illnesses. There are many other things to know about multiple sclerosis but I don’t have time to explain to you, I have to go back to school. I hope it will help you, have a good afternoon bye!!
Thank you very much for your help. I will look at that this evening! Good afternoon too good bye!!!