Disturbances in feeling may be thought of as sensory deficits. This symptom is more correctly known as paresthesia. These sensory problems can include numbness, tingling or burning. They may also be perceived as increased sensitivity.
While multiple sclerosis is a neurological disease, it would seem obvious that sensations would be one of the first things to suffer when the central nervous system (CNS) comes under attack.
Sensory Problems in MS
Itching or pruritis may be perceived as an MS symptom. Despite the urge to do so, scratching the itchy areas should be avoided. Because the scratching may actually increase the itchiness and cause real damage to the skin.
When these paresthesias are caused by lesions in the central nervous system, they are called dysesthesias. The name comes from the Greek language and the literal translation is “bad sensation.”
Numbness and sensory deficits
The feeling of numbness is one of the most common sensory problems in MS. In Multiple Sclerosis the nerves that transmit sensory information have become demyelinated, preventing the correct transmission of the signals.
The paresthesia may be very localised, affecting only very small areas of the face or hands.
Or the numbness could cover entire areas of the face or limbs.
Most people will regard these symptoms as a mild annoyance but, in severe cases, they can cause far greater problems. For example, numbness in the face may allow the patient to bite their lips or tongues without knowing it. Numbness in the hands or forearm presents the danger of burns when cooking or handling hot implements.
Proprioception in MS
Another name for numbness is proprioception which is a loss of position sense. Sometimes called spatial awareness this is an important part of maintaining balance. If you cannot receive position sense, ou may walk drunkenly or be prone to falling.
Dysesthesias that cause uncomfortable sensations may be treated with anti-seizure medicines like gabapentin or pregabalin. Sometimes anti-depressants may help with the pain You could be prescribed amitriptyline, venlafaxine or duloxetine.
Sensory Deficits in MS
The sensory processing symptoms of Multiple Sclerosis are among the most troublesome and common symptoms of this debilitating disease.
While the sensory symptoms can be annoying, they are seldom debilitating. The presence of sensory symptoms does not predict a poor prognosis but, nevertheless, they should be taken seriously.
Many an MSer will experience blurred vision as one of the earliest symptoms of multiple sclerosis. This could be indicative of inflammation of the optic nerve or optic neuritis.
If the inflamed nerve is immediately behind the eye, the optic neuritis is called retrobulbar neuritis.
The optic nerve has a thick covering of myelin making it an easy target of the immune system in MS. Your medical specialist may use an ophthalmoscope to examine the rear of the eye to examine the optic nerve.
Double vision may result if the muscles in the eye are weakened after the demyelination of nerves in the brainstem. This double vision can produce severe nausea snd may require the wearing of an eye patch.
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Dizziness or Light-headedness
The feeling of dizziness is not a very specific symptom and is common to a number of dysfunctions. It is difficult for the clinician to diagnose because it involves eyes, ears, brain, metabolism, heart and other organs.
Diagnosing and rectifying balance problems can be complex. Problems with balance and coordination are motor abnormalities that involve the sensory system greatly.
Good balance requires input from the eyes, the vestibular part of the ears, sensation in the legs (position sense in the feet), and muscle strength.
Any disturbance in these proprioception pathways will impair standing, walking and running.
Some will feel a lightning-like sensation down the spine when the head is tilted forward.
Treating Sensory Deficits
Many GPs will want to treat your sensory problems with pharmaceutical interventions. This is a road I have travelled many times and seldom liked the destination.
When trying to appease your parasthesia, your doctor may prescribe one of the tricyclic antidepressants like Gabapentin or Pregbalin. I took Gabapentin for a few months will little perceptible benefit.
When suffering from chronic pain, you will take anything that offers some form of relief. I was first offered amitriptyline a long time ago. This is also a tricyclic antidepressant and I took fright and refused the treatment.
Subsequently, I was offered Temazepam as an alternative. This sounded like the lesser of the two evils but, I was wrong. I had been told that Temazepam was quite addictive. But, I was not informed that it should be used only for short periods of time.
I have now discovered that I should have been taking Temazepam for no more than 3 months. My GP happily left me taking this highly addictive drug for over two years.
I had to endure some dreadful withdrawal symptoms and I accepted the offer of amitriptyline to get me through this ordeal. Because Temazepam withdrawal is real and difficult and this is my record of the experience.
Assessment of Sensory Disorders
A paper published on PubMed introduces the subject by stating that balance disorders are frequently observed in subjects with multiple sclerosis. It then continues to explain that sensory disorders and integration deficits of sensory inputs lead to inadequate motor responses.
This takes us back to the topic of proprioception. We rely heavily on the feedback from our limbs and muscles to maintain balance, correct posture and an upright stance.
In MS, the demyelination of the nerves in our CNS disrupts this essential feedback and we fall over.
One aspect of this that I find infuriating, is that if my lack of proprioception causes me to fall. The same proprioception tells me that I am falling. It doesn’t stop me from losing my balance but, it is quick enough to tell me that I have lost my balance.