Multiple Sclerosis Surgery

People with multiple sclerosis (MS) who have severe tremor (shakiness) affecting movement may be helped by surgery. People with severe spasticity (muscle stiffness) may be helped by insertion of a spinal pump to deliver medicines when oral medicines fail.

Surgery Choices

Surgery options include:

Deep brain stimulation for tremor. Severe and disabling tremor that occurs with the slightest movement of the limbs may be helped by an implanted device that stimulates an area of the brain. A neurological surgeon performs the surgery to implant the device.
Implantation of a drug catheter or pump, for spasticity. People who have severe pain or spasticity may benefit from having a catheter or pump placed in the lower spinal area to deliver a constant flow of medicine, such as baclofen (Lioresal).

What To Think About
Deep brain stimulation usually is a last resort after all other options have been tried without success to treat MS symptoms. Only people with severe tremor are candidates.

Recognize Multiple Sclerosis Symptoms

People with multiple sclerosis (MS) tend to have their first symptoms between the ages of 20 and 40. Usually the symptoms get better, but then come back. Some may come and go, while others linger.

Keep track of your symptoms to help your doctor know whether MS or another condition is to blame.

Whether you have a diagnosis or are worried about symptoms, know that MS doesn’t have to control your life. You can work with your doctor to treat and manage your symptoms so you can stay healthy and continue to live the life you want.

Early Symptoms of MS

  • Blurred or double vision
  • Thinking problems
  • Clumsiness or a lack of coordination
  • Loss of balance
  • Numbness
  • Tingling
  • Weakness in an arm or leg

No two people have exactly the same symptoms of MS.

You may have a single symptom, and then go months or years without any others. A problem can also happen just one time, go away, and never return. For some people, the symptoms become worse within weeks or months.

Common Symptoms of MS

These are the most common changes to the mind and body in someone with MS:

Unusual sensations: People with MS often say they feel a “pins and needles” sensation. They may also have numbness, itching, burning, stabbing, or tearing pains. About half of people with MS have these uncomfortable symptoms. Fortunately, they can be managed or treated.

Bladder problems: About 8 in 10 people have bladder problems, which can be treated. You may need to pee often, urgently, need to go at night, or have trouble emptying your bladder fully. Bowel problems, especially constipation, are also common.

Trouble walking: MS can cause muscle weakness or spasms, which make it harder to walk. Balance problems, numb feet, and fatigue can also make walking hard.

Dizziness: It’s common to feel dizzy or lightheaded. You usually won’t have vertigo, or the feeling that the room is spinning.

Fatigue: About 8 in 10 people feel very tired. It often comes on in the afternoon and causes weak muscles, slowed thinking, or sleepiness. It’s usually not related to the amount of work you do. Some people with MS say they can feel tired even after a good night’s sleep.

Muscle spasms: They usually affect the leg muscles. For about 40% of people they are an early symptom of MS. In progressive MS, muscle spasms affect about 6 in 10 people. You might feel mild stiffness or strong, painful muscle spasms.

Sexual trouble: These include vaginal dryness in women and erection problems in men. Both men and women may be less responsive to touch, have a lower sex drive, or have trouble reaching orgasm.

Speech problems: Sometimes MS can cause people to pause a long time in between words and have slurred or nasal speech. Some people also develop swallowing problems in more advanced stages of MS.

Understanding the Different Types of Multiple Sclerosis

In some ways, each person with multiple sclerosis lives with a different illness. Although nerve damage is always involved, the pattern is unique for each individual with MS.

Specific experiences with MS may vary widely, but doctors and researchers have identified several major types of MS. The categories are important because they help predict disease severity and response to treatment.

Primary Progressive Multiple Sclerosis

In primary progressive multiple sclerosis, symptoms continually worsen from the time of diagnosis. There are no well-defined attacks, and there is little or no recovery. Between 10% and 15% of people with MS have primary progressive MS.

Several aspects of primary progressive MS distinguish it from other types of MS:

  • People with primary progressive MS are usually older at the time of diagnosis — an average age of 40.
  • Roughly equal numbers of men and women develop primary progressive MS. In other types of MS, women outnumber men three to one.
  • Primary progressive MS usually leads to disability earlier than relapsing-remitting MS (see below).
  • Perhaps the most upsetting difference in primary progressive MS is its poor response to treatment. So far, no treatments have been shown to help, although studies are ongoing.

Relapsing-Remitting Multiple Sclerosis

Most people with multiple sclerosis — around 90% — have the relapsing-remitting type. Most people with this type of MS first experience symptoms in their early 20s. After that, there are periodic attacks (relapses), followed by partial or complete recovery (remissions).

The pattern of nerves affected, severity of attacks, degree of recovery, and time between relapses all vary widely from person to person.

Eventually, most people with relapsing-remitting MS will enter a secondary progressive phase of MS.

Secondary Progressive Multiple Sclerosis

After living with relapsing-remitting MS for many years, most people will develop secondary progressive MS. In this type of MS, symptoms begin a steady march, without relapses or remissions. (In this way, secondary progressive MS is like primary progressive MS.) The transition typically occurs between 10 and 20 years after the diagnosis of relapsing-remitting MS.

It’s unclear why the disease makes the transformation from relapsing-remitting to secondary progressive MS. A few things are known about the process:

  • The older a person is at original diagnosis, the shorter the time for the disease to become secondary progressive.
  • People with incomplete recovery from initial relapses generally convert to secondary progressive MS sooner than those who recover completely.
  • The process of ongoing nerve damage changes. After the transformation, there’s less inflammation, and more slow degeneration of nerves.

Secondary progressive MS is challenging to treat — and to live with. Treatments are moderately effective at best. Progression occurs at a different rate in each person and generally leads to some disability.

Progressive Relapsing Multiple Sclerosis

Progressive relapsing multiple sclerosis is the least common form of the disease. Relapses or attacks occur periodically. However, symptoms continue and are progressive between relapses.

Progressive relapsing MS is rare enough that little is known about it. Probably around 5% of people with multiple sclerosis have this form. Progressive relapsing MS seems similar to primary progressive MS in many ways.