How to manage sensory disturbances in MS?

Question

Hello doctor,

My brother, who is 40, was diagnosed with multiple sclerosis (MS) and is experiencing very strange phantom sensations. He is an electrician and sometimes feels like his arm is on fire or being pricked by needles, even when nothing is touching him. These sensations are so intense that he drops tools unexpectedly while working. Some days, the sensations are mild; on other days, they are completely overwhelming. He is worried that these neurological issues might force him to quit his job. Are these sensations a normal symptom of MS? How can he manage these disruptive sensory hallucinations in his professional life?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concerns.

Yes, the strange, intense phantom sensations your brother is experiencing are related to multiple sclerosis (MS). These are known as "sensory disturbances" and can manifest as feelings of burning, tingling, pricking, or numbness in various parts of the body. These symptoms occur because MS disrupts the normal communication between the brain and the nerves, leading to abnormal sensory perceptions.

A. Understanding these symptoms in MS:

Sensory hallucinations: These sensations, like feeling pain or prickling where there is no physical cause, are common in MS due to demyelination, the process by which the protective sheath around nerves is damaged. This disrupts the normal nerve signals, causing unusual sensations.
Trigger factors: Sometimes, heat, stress, fatigue, or even the physical activity required in his job can exacerbate these symptoms, making them feel more intense or causing them to appear unexpectedly.
Phantom sensations: These might also be linked to "paresthesia," which is a common MS symptom where nerves send incorrect signals to the brain. The brain interprets these abnormal signals as real sensations like burning, tingling, or pricking.

B. Managing these symptoms:

Medications: Anticonvulsants like Gabapentin or Pregabalin can help manage nerve pain and abnormal sensations. Antidepressants (like Amitriptyline) may be beneficial for managing pain and sleep disturbances associated with MS. Apart from this, Capsaicin cream can be applied directly to the affected areas to reduce pain.
Lifestyle adjustments: Avoid overheating, especially during physical activity or in hot environments. Cooling vests or fans can be helpful. Stress can exacerbate these sensations. Techniques like meditation, deep breathing exercises, or gentle physical activities like yoga can be beneficial. A physical therapist can provide exercises to improve muscle strength and reduce spasms, which can sometimes relieve abnormal sensations.
Workplace modifications: He should discuss accommodations with his employer, such as changes to his work tasks or equipment, to minimize the risk of dropping tools. Ergonomic tools or adaptations might be helpful in managing his physical symptoms while at work.
Pain management strategies: Techniques like biofeedback, relaxation exercises, or acupuncture may help in managing pain and abnormal sensations without medication.

C. Monitoring and medical follow-up:

Regular check-ins with his neurologist are crucial to adjust his treatment plan as his symptoms evolve. Keeping a symptom diary can help track the frequency and intensity of these sensations and any potential triggers.
Discuss the possibility of new or adjusted medications if the current treatments are not providing adequate relief.

These interventions can help him manage the disruptive sensory symptoms without significantly impacting his ability to work. It is important for him to feel supported in both his professional and personal life as he navigates these challenges.

I hope this answers your questions.

Thank you.