question-icon

What causes inability to walk, constant irritation and MS?

default
Posted on Tue, 31 Mar 2015
Question: I'm unable to walk and I have to sit most of the day as you might Guess, I have ongoing.irritation. How can I treat this problem, have MS
doctor
Answered by Dr. Shafi Ullah Khan (3 hours later)
Brief Answer:
limb mobility management explained

Detailed Answer:
Thankyou for asking

I read your question and I understand your concern. Walking and mobility limitations are common sequelae of MS exacerbations. Here is what you can do.

Disease-modifying therapies may help preserve ambulation by reducing the frequency of MS exacerbations and/or by slowing disease progression. In addition, use of high-dose corticosteroids during an exacerbation of MS may hasten the recovery and thus have a positive effect on ambulation. However, based on published evidence, these treatments are not expected to significantly improve chronic walking limitations. Instead, functional improvement may be achieved through rehabilitation, symptomatic medications, and the use of assistive devices.

A mobility and ambulation treatment plan involves a combination of interventions and will be based on needs expressed by PwMS , examination findings, as well as published evidence and/or clinical experience. You should know about the importance of improving gait safety and efficiency, even if a "normal gait" cannot be achieved.

There is evidence showing that both inpatient and outpatient rehabilitation improves mobility in patients with MS. Rehabilitation programs often combine stretching, strengthening, aerobic exercise, and gait training. Neurodevelopmental therapy may also be used to help you improve your mobility.] A pilot study of walking exercise with rhythmic auditory stimulation (a technique of music therapy) showed promising results. In addition, body weight-supported treadmill training allows more intensive walking exercise without compromising safety and can be combined with robot-assisted training. Virtual reality has also been proposed as a tool for gait training.However, Some researchers have observed that the benefits of gait training are lost after several weeks, underscoring the need for an ongoing home exercise program after the end of the rehabilitation treatment. In addition, physical therapists often recommend assistive devices (see below) and train patients in their use., it is important to consult rehabilitation professionals with experience in MS rehabilitation, or at the very least in neurological rehabilitation. So get a consult and let them help you in this regard.

Walking aides such as canes, crutches, and walkers are commonly prescribed when walking independently has become too unsafe or too inefficient. Orthoses (braces) are used to correct abnormal limb posture (eg, equinovarus caused by spastic paresis) and/or to limit abnormal movement (eg, knee recurvatum). Ankle foot orthoses (AFOs) are the most commonly used because they are light and relatively easy to put on and take off. The main role of AFOs is to stabilize the foot and ankle during standing and walking, but they also have an impact on the dynamics of the knee. Many patients are reluctant to use walking aides and "passive" orthoses (such as AFOs) because they perceive them as objective evidence of disability and disease progression, are concerned that their use will promote more weakness, and feel that their effects do not meet their expectations. These ideas and thoughts should be negated by you.

Recently, "active" devices have been proposed as a mechanism to help patients improve their gait and mobility. The Hip Flexion Assist Device (HFAD) uses elastic bands to augment active flexion during the swing phase of gait, and thereby improves walking performance (eg, speed, endurance) and lower extremity strength.Functional electrical stimulation (FES) devices for foot drop improve toe clearance by stimulating the peroneal nerve and facilitating active ankle dorsiflexion. The stimulation is triggered during swing phase, either via a heel switch or via a tilt sensor. FES-assisted cycling is an example of how FES can also be used to facilitate exercise and improve a patient's physical conditioning. Although these devices are more attractive than AFOs, they should not be used in patients with ankle instability. In addition they are more costly, and data on their efficacy in MS is limited.

Symptomatic medications could, in theory, improve ambulation by alleviating underlying impairments. However, in most cases, their efficacy in the management of ambulation has not been demonstrated. For example, fatigue is the symptom most frequently reported by PwMS, with an impact on physical, cognitive, and psychosocial dimensions.Fatigue is usually defined as a subjective lack of energy limiting a person's ability to perform usual activities.For this reason, fatigue is assessed via questionnaires such as the Fatigue Severity Scale or the Modified Fatigue Impact Scale. It should be noted, however, that motor fatigue (a decreased ability to generate force during exercise) can be objectively assessed. There is evidence of motor fatigue with walking in MS.Although there are no drugs approved for the treatment of subjective MS fatigue in the United States, off-label medications, including amantadine and modafinil, are routinely used. However, none of these treatments was shown to improve walking performance.Part of the reason for this is the lack of systematic evaluation of ambulation in published clinical trials; however, it is also possible that these medications have no significant impact on walking because poor correlations between subjective fatigue and walking performance have been reported.

Spasticity, defined as a velocity-dependent increase in stretch reflexes, causes hypertonia, decreased range of motion, and involuntary movements such as spasms and clonus. Spasticity dynamically interferes with voluntary movement through co-contraction of agonist and antagonist muscle groups around a joint. The prevalence of spasticity in MS is high and has been associated with disability.Therefore, one can hope that controlling spasticity will promote active function in patients with MS. However, spasticity is usually associated with other components of the upper motor neuron syndrome, particularly decreased motor control (spastic paresis). This may explain why functional improvement has not been demonstrated in MS with oral medications for spasticity (mainly baclofen and tizanidine), botulinum toxin therapy, intrathecal baclofen therapy, or orthopaedic surgery (to correct deformities and contractures).

Dalfampridine, an extended-release formulation of 4-aminopyridine (4-AP), was recently approved by the US Food and Drug Administration to improve walking in patients with MS, based on an improvement in walking speed.4-AP is a potassium channel blocker that was shown to facilitate action potential conduction along demyelinated axons. Dalfampridine is administered orally, at the dose of 10 mg twice daily, 12 hours apart. In a phase 3 double-blind, placebo-controlled trial, there was a significantly higher proportion of responders in the active treatment group compared with the placebo group (34.8% vs 8.3%).Responders were defined as subjects whose walking speed on at least 3 out of 4 "on drug" visits, exceeded the maximum speed observed during 5 "off drug" visits. Walking speed was assessed with the T25FW. The average gain in walking speed in the treatment group was 25.2% (vs 4.7% in the placebo group). The change in MS Walking Scale-12 scores was significantly higher in responders (independent of group assignment) than in nonresponders.

Dalfampridine is contraindicated in patients with a known history of seizures and in those with moderate or severe renal impairment (defined as a creatinine clearance at or below 50 mL/min).The most common side effects included urinary tract infection, insomnia, dizziness, headache, nausea, asthenia, back pain, balance disorder, MS relapse, paresthesia, nasopharyngitis, constipation, dyspepsia, and pharyngolaryngeal pain.A phase 2 dose-ranging study demonstrated no additional benefit at higher doses, but did show a dose-dependent increase in side effects (including seizures).Since dalfampridine has been available for less than a year, it is not known yet whether the efficacy and safety findings from the clinical trials will be replicated in clinical use. Further studies will be needed to explore the effects of dalfampridine on gait and to assess whether its efficacy can be enhanced by adding other interventions such as rehabilitation.
Conclusion

Walking limitations are frequent in PwMS and have a significant impact on their lives. There is a growing array of interventions to improve walking and an increasing body of evidence to guide clinical practice. Thus, walking performance should be monitored routinely in the management of patients with MS because simple tests and questionnaires are available. Improving walking performance in those with MS often requires a combination of interventions and thorough patient education.

I hope it helps. Consult your doctor. Take good care of yourself and don't forget to close the discussion please.

Regards XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Shafi Ullah Khan (10 hours later)
The answer does not apply, diagnose/primary progressive. Incapable of standing!
Need alternative answer!
doctor
Answered by Dr. Shafi Ullah Khan (26 minutes later)
Brief Answer:
All explained

Detailed Answer:
Thank you for getting back

These are the immobility issues secondary to Ms and I have provided all the possible solutions and alternatives.

I am afraid I won't be able to help any more in this regard. If you did not understand any of the above mentioned approaches for mobility support I can explain further.

You reserve the right to cancel the consult and claim a refund.

Regards
Khan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Shafi Ullah Khan (48 minutes later)
How do I get a refund? Question not really addressed.
doctor
Answered by Dr. Shafi Ullah Khan (5 minutes later)
Brief Answer:
ask for a refund

Detailed Answer:
You can easily ask for refund. Staff will help you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Shafi Ullah Khan (9 minutes later)
I'm asking for a refund. XXXXXXX XXXXXXX
doctor
Answered by Dr. Shafi Ullah Khan (2 hours later)
Brief Answer:
Consult hcm team

Detailed Answer:
Please contact the hcm team. They will process your request.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Shafi Ullah Khan

General & Family Physician

Practicing since :2012

Answered : 3613 Questions

premium_optimized

The User accepted the expert's answer

Share on
What causes inability to walk, constant irritation and MS?

Brief Answer: limb mobility management explained Detailed Answer: Thankyou for asking I read your question and I understand your concern. Walking and mobility limitations are common sequelae of MS exacerbations. Here is what you can do. Disease-modifying therapies may help preserve ambulation by reducing the frequency of MS exacerbations and/or by slowing disease progression. In addition, use of high-dose corticosteroids during an exacerbation of MS may hasten the recovery and thus have a positive effect on ambulation. However, based on published evidence, these treatments are not expected to significantly improve chronic walking limitations. Instead, functional improvement may be achieved through rehabilitation, symptomatic medications, and the use of assistive devices. A mobility and ambulation treatment plan involves a combination of interventions and will be based on needs expressed by PwMS , examination findings, as well as published evidence and/or clinical experience. You should know about the importance of improving gait safety and efficiency, even if a "normal gait" cannot be achieved. There is evidence showing that both inpatient and outpatient rehabilitation improves mobility in patients with MS. Rehabilitation programs often combine stretching, strengthening, aerobic exercise, and gait training. Neurodevelopmental therapy may also be used to help you improve your mobility.] A pilot study of walking exercise with rhythmic auditory stimulation (a technique of music therapy) showed promising results. In addition, body weight-supported treadmill training allows more intensive walking exercise without compromising safety and can be combined with robot-assisted training. Virtual reality has also been proposed as a tool for gait training.However, Some researchers have observed that the benefits of gait training are lost after several weeks, underscoring the need for an ongoing home exercise program after the end of the rehabilitation treatment. In addition, physical therapists often recommend assistive devices (see below) and train patients in their use., it is important to consult rehabilitation professionals with experience in MS rehabilitation, or at the very least in neurological rehabilitation. So get a consult and let them help you in this regard. Walking aides such as canes, crutches, and walkers are commonly prescribed when walking independently has become too unsafe or too inefficient. Orthoses (braces) are used to correct abnormal limb posture (eg, equinovarus caused by spastic paresis) and/or to limit abnormal movement (eg, knee recurvatum). Ankle foot orthoses (AFOs) are the most commonly used because they are light and relatively easy to put on and take off. The main role of AFOs is to stabilize the foot and ankle during standing and walking, but they also have an impact on the dynamics of the knee. Many patients are reluctant to use walking aides and "passive" orthoses (such as AFOs) because they perceive them as objective evidence of disability and disease progression, are concerned that their use will promote more weakness, and feel that their effects do not meet their expectations. These ideas and thoughts should be negated by you. Recently, "active" devices have been proposed as a mechanism to help patients improve their gait and mobility. The Hip Flexion Assist Device (HFAD) uses elastic bands to augment active flexion during the swing phase of gait, and thereby improves walking performance (eg, speed, endurance) and lower extremity strength.Functional electrical stimulation (FES) devices for foot drop improve toe clearance by stimulating the peroneal nerve and facilitating active ankle dorsiflexion. The stimulation is triggered during swing phase, either via a heel switch or via a tilt sensor. FES-assisted cycling is an example of how FES can also be used to facilitate exercise and improve a patient's physical conditioning. Although these devices are more attractive than AFOs, they should not be used in patients with ankle instability. In addition they are more costly, and data on their efficacy in MS is limited. Symptomatic medications could, in theory, improve ambulation by alleviating underlying impairments. However, in most cases, their efficacy in the management of ambulation has not been demonstrated. For example, fatigue is the symptom most frequently reported by PwMS, with an impact on physical, cognitive, and psychosocial dimensions.Fatigue is usually defined as a subjective lack of energy limiting a person's ability to perform usual activities.For this reason, fatigue is assessed via questionnaires such as the Fatigue Severity Scale or the Modified Fatigue Impact Scale. It should be noted, however, that motor fatigue (a decreased ability to generate force during exercise) can be objectively assessed. There is evidence of motor fatigue with walking in MS.Although there are no drugs approved for the treatment of subjective MS fatigue in the United States, off-label medications, including amantadine and modafinil, are routinely used. However, none of these treatments was shown to improve walking performance.Part of the reason for this is the lack of systematic evaluation of ambulation in published clinical trials; however, it is also possible that these medications have no significant impact on walking because poor correlations between subjective fatigue and walking performance have been reported. Spasticity, defined as a velocity-dependent increase in stretch reflexes, causes hypertonia, decreased range of motion, and involuntary movements such as spasms and clonus. Spasticity dynamically interferes with voluntary movement through co-contraction of agonist and antagonist muscle groups around a joint. The prevalence of spasticity in MS is high and has been associated with disability.Therefore, one can hope that controlling spasticity will promote active function in patients with MS. However, spasticity is usually associated with other components of the upper motor neuron syndrome, particularly decreased motor control (spastic paresis). This may explain why functional improvement has not been demonstrated in MS with oral medications for spasticity (mainly baclofen and tizanidine), botulinum toxin therapy, intrathecal baclofen therapy, or orthopaedic surgery (to correct deformities and contractures). Dalfampridine, an extended-release formulation of 4-aminopyridine (4-AP), was recently approved by the US Food and Drug Administration to improve walking in patients with MS, based on an improvement in walking speed.4-AP is a potassium channel blocker that was shown to facilitate action potential conduction along demyelinated axons. Dalfampridine is administered orally, at the dose of 10 mg twice daily, 12 hours apart. In a phase 3 double-blind, placebo-controlled trial, there was a significantly higher proportion of responders in the active treatment group compared with the placebo group (34.8% vs 8.3%).Responders were defined as subjects whose walking speed on at least 3 out of 4 "on drug" visits, exceeded the maximum speed observed during 5 "off drug" visits. Walking speed was assessed with the T25FW. The average gain in walking speed in the treatment group was 25.2% (vs 4.7% in the placebo group). The change in MS Walking Scale-12 scores was significantly higher in responders (independent of group assignment) than in nonresponders. Dalfampridine is contraindicated in patients with a known history of seizures and in those with moderate or severe renal impairment (defined as a creatinine clearance at or below 50 mL/min).The most common side effects included urinary tract infection, insomnia, dizziness, headache, nausea, asthenia, back pain, balance disorder, MS relapse, paresthesia, nasopharyngitis, constipation, dyspepsia, and pharyngolaryngeal pain.A phase 2 dose-ranging study demonstrated no additional benefit at higher doses, but did show a dose-dependent increase in side effects (including seizures).Since dalfampridine has been available for less than a year, it is not known yet whether the efficacy and safety findings from the clinical trials will be replicated in clinical use. Further studies will be needed to explore the effects of dalfampridine on gait and to assess whether its efficacy can be enhanced by adding other interventions such as rehabilitation. Conclusion Walking limitations are frequent in PwMS and have a significant impact on their lives. There is a growing array of interventions to improve walking and an increasing body of evidence to guide clinical practice. Thus, walking performance should be monitored routinely in the management of patients with MS because simple tests and questionnaires are available. Improving walking performance in those with MS often requires a combination of interventions and thorough patient education. I hope it helps. Consult your doctor. Take good care of yourself and don't forget to close the discussion please. Regards XXXXXXX