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Prevalence
Ataxia and tremor are present to some degree in about one third of
patients who have MS. About 5% of patients have it as their only or
most significant symptom. In these patients the level of disability
is particularly high, resulting in loss of independence in even the
basic activities of daily life.
Of all the varied symptoms that may occur in MS, ataxia is one of the
most disabling. It has an effect on many aspects of daily life such
as walking, feeding, eating and dressing. Patients with severe ataxia
are often forced to use a wheelchair even though they have sufficient
strength in their muscles for walking.
Studies have shown that the degree of ataxia directly relates to the
amount of disability the patient has and to their level of dependence:-
the greater the level of ataxia, the more disabled the patient and the
more dependent the patient is on others for support.
Problems Caused
Ataxic symptoms may be due to lesions affecting sensory pathways leading
to loss or inappropriate sensory feedback for movement control or as
a result of damage to parts of the brain that control movemenet (cerebellar
pathways). It may impair upper limb function leading to a loss of co-ordination
and dexterity, and a difficulty in reaching out and grasping accurately.
The sufferer will have difficulty managing everyday activities such
as writing, dressing, handling money and shopping and caring for their
own dependants. Lower limb and truncal ataxia are also common causing
difficulty in balance and walking. Some patients have a constant tremor
of the head and their speech is affected causing it to be slow and difficult.
MS sufferers who have the problems described often feel socially isolated.
They are reluctant to integrate in public as every day activities such
as eating, talking and shopping ( handling money, writing cheques )
accentuate their symptoms.
Current practice
Assessments of upper limb spasticity (Ashworth Scale), range of movement
and muscle strength (MRC Scale) were carried out to see whether other
symptoms may have an effect on the results. In addition the subjects
completed a questionnaire looking at general health, level of function
and problems caused by ataxia. We have analysed and written up the results
and it would seem that some of the tests used are sensitive to changes
in ataxia in patients with MS. Even small changes can be detected and
the tests were not affected by muscle weakness.
In view of the serious disability caused by ataxia we plan to continue
to develop the assessment and then to use it to measure the efficacy
of various treatments aimed at improving ataxia in the hope that further
effective strategies may be developed.
Assessment of Tremor
TREMOR. EU TIDE Project No 3216
Description of the project for people with MS or those with an interest
in MS.
This programme of work, carried out under the Technology for the Disabled
and Elderly (TIDE) programme of the EU has the stated aim: "to
improve the treatment of disability caused by tremor through the development
of new assistive devices"
Tremor and ataxia (uncoordinated movement) are symptoms of MS, which
although not common, can, when they are present, cause considerable
difficulties in every-day life. One of the problems in managing tremor
is that few drugs that can help, and most of these have unwanted side
effects which, although not serious, can give rise to other problems.
The European Union (EU) encourages projects that, if successful, can
significantly improve the quality of life for people with disabling
conditions, and the seriousness of some disabling problems in MS is
well recognised. The strength of EU projects is that they bring together
the expertise of people from all over Europe so that the greatest possible
effort can be applied to solving a problem. The TREMOR project brings
together people who have expertise in measurement, treatment and research
into MS and tremor. This includes research and development departments
of manufacturers who have expertise in developing medical devices.
The project is arranged so that there are groups involved in developing
the devices and clinical centres for testing them. The devices themselves-
a "jacket" to measure and control arm movement and a joy-stick
based device that can be attached to any number of other household or
communication devices such as computers, wheelchairs or methods for
the remote control of household items etc.-are intended to be affordable
easy-to-use systems making the best use of modern electronic expertise.
The MS Research Unit in Bristol is one of the centres involved in representing
the views of people with MS as possible users of such a system, and
in testing the devices.
In conjunction with other MS organisations across Europe we will be
trying to gather the views of as many people with MS as possible about
the sort of things that would help them most in their daily lives. We
will let you have more news of this and of the trials in due course,
but in the meantime, if you have any queries, or would like to complete
the TREMOR questionnaire please contact us.