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Special senses
Involvement of the visual pathways usually occurs and most commonly affects the optic nerve. The patient complains of blurring of vision in one eye. The symptoms progress, usually over hours or days. The visual disturbance varies according to the severity and extent of the lesion, often being patchy (scotomata) and sometimes so subtle as to impair only color discrimination, although total blindness can occur. Pain is a common accompaniment. Recovery occurs, typically within one or two months. Deafness occurs in multiple sclerosis, occasionally at presentation. Feelings of unsteadiness are common; and acute brainstem demyelination cause diplopia, vertigo, facial numbness and/or weakness or dysphagia. A typical picture is sudden diplopia and vertigo with nystagmus, but without tinnitus or deafness. This lasts for some weeks before recovery.
Motor symptoms
Impaired mobility affects the majority of patients with multiple sclerosis, usually as a result of spinal disease; movements are slow, with weakness differentially affects extensors in the arms and flexors in the legs. Spasticity may be more problematic than weakness and all aspects of immobility are frequently complicated by fatigue. Cerebellar involvement causes incoordination of speech and eye movements.
Sensory symptoms
Altered sensation occurs at some stage in nearly every patient with multiple sclerosis. A common presentation is numbness, in various locations. This disturbing symptom seldom leads to loss of function. Damage to the cervical cord produces tight, burning, twisting, tearing, or pulling sensations, which are usually painful.
Autonomic involvement
Autonomic symptoms occur in many patients with multiple sclerosis. Bladder symptoms (e.g. urgency and frequency with incontinence) are most common in women whereas impotence occurs frequently in males.
Unusual Presentations
Epilepsy occurs more commonly in multiple sclerosis patients than in the general population. So, too, does trigeminal neuralgia. Tonic spasms of a limb are another unusual symptom of this disease. Dementia or organic psychosis is occasionally a feature of early multiple sclerosis.
End-stage multiple sclerosis
In the later stages of the disease the patient is severely disabled with a combination of spastic tetraparesis, ataxia, optic atrophy, nystagmus, and incontinence of urine. Dementia is common. Death follows from uraemia and/or bronchopneumonia.
Clinical course and prognosis
80% of patients present with relapsing/remitting disease, episodes occurring at random frequency and for an unpredictable period, but averaging about one per year and decreasing with time. Later, a high proportion of patients enter a slowly progressive phase of the disease, but in 20% the illness is progressive from onset. Life expectancy is at least 25 years, and a high proportion of patients die from unrelated causes. Recovery from each attack is invariably slower than the onset, and may be incomplete.
About 25% of patients have multiple sclerosis in a form that is not disabling. In about 5% of patients, a latent period of over 20 years occurs between the presenting and the next episode. Benign disease usually occurs in young females who mainly have sensory symptoms and complete recovery from individual episodes. Conversely, in 5% relapses occur frequently and do not recover, leading rapidly to disability and early death; and up to 15% become severely disabled within a short time. Occasionally, patients die acutely from respiratory failure. |
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According to the location of lesions in the brain and spinal column, multiple sclerosis can present in various ways. The neural symptoms include difficulty speaking, blurred vision, double vision, weakness and heaviness of one or both legs, jerking of the legs, numbness or tingling and incoordination. Some individuals may only show vague signs like vertigo, incontinence, urinary urgency or frequency, vomiting, diarrhea and impotence. If the nervous system keeps on degenerating, symptoms will progressively worsen.
TCM practitioners usually begin with a full investigation of the individual and then categorize his or her symptoms under syndrome groups known as "disharmony patterns." In addition to the symptoms discussed above, TCM practitioners also focus on associated symptoms for syndrome differentiation. The disharmony patterns, which present at different stages of the disease, generally indicate the degree of disharmony of the body and the involved organs as well as the progress of the disease.
Meridian obstruction by phlegm and heat
After onset of fever, individuals develop sudden limb weakness, numbness or paralysis. Associated symptoms include distended headache, irritability, chest tightness, ear ringing or blurred vision. In some cases, there may be sudden blindness, thirst without the desire to quench it, speaking difficulties, yellow sticky secretions in the throat, and even urinary difficulty.
Damp-heat dissemination
This leads to a gradual development of limb weakness which is obvious in the lower limbs as well as numbness and a slight puffiness in the limbs. Other symptoms include tightness in the forehead, generalized heaviness, sallow complexion, abdominal distention, depression, decreased vision, diarrhea and yellowish urine.
Blood stasis accumulated in meridian
This leads to limb weakness with numbness, tingling or contracting pain; other symptoms are dizziness, ear ringing, sallow complexion, muscular atrophy, urinary difficulty or dribbling after voiding, double vision or even blindness.
Deficiencies in lung and spleen
This leads to slow and progressive development of limb weakness, unsteadiness, tremor and muscular atrophy in the lower limbs. Other associated symptoms include pale complexion, poor appetite, abdominal distention, diarrhea, and aversion to wind; there is also a tendency to catch cold or flu, dizziness, inability to void urine, blurred version or even blindness.
Deficiencies in liver and kidney
Individuals present with general paralysis, weight loss, unsteadiness, clumsiness, facial distortion, soreness in lumbar and knee regions. Associated symptoms include dizziness, vertigo, blurred version, throat dryness, constipation, ear ringing, fatigue, depression, speaking difficulty, urinary difficulty, as well as hot sensations in the palms, soles and chest.
Depletion of kidney yang
Individuals present with general paralysis, numbness, muscular atrophy, clumsiness, unsteady steps, blurred version or dropping of upper eyelids, declined hearing, difficulties in swallowing and speaking. Other accompanying symptoms include dizziness, limbs coldness, fatigue and sleepiness, sensitivity to cold temperatures, poor appetite, urinary frequency and diarrhea.
Illustration of TCM organs |
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