The most common cause of impairment in MS is some form of disturbance of gait. This
can be due to weakness, spasticity, incoordination, imbalance, tremor, or any combination
of these signs. Similar involvement may occur in the arms at times with or without
gait disturbance, but usually some form of gait disturbance is present. The degree
to which the gait disturbance impairs function must be established. Other factors
such as speech, fatigue, paresthesias, or dysesthesias may also be present in different
areas of the body.
Certain mental changes in patients with MS are well-recognized, and most frequently
noted is euphoria, but not infrequently there also is emotional depression. It is
important to consider emotional depression when related to fatigue since when fatigue
is based primarily on emotional depression, it can usually be treated with appropriate
psychotherapeutic drugs. Depending on where the abnormal demyelinating plaque lesions
might lie anatomically, there can be other types of behavorial aberrations associated
with MS. These can be, in most cases, adequately treated either with psychotherapy
and/or with some of the psychotherapeutic drugs which help to control these abnormalities.
However, in certain cases of MS, there is evidence of mild to marked signs of organic
dementia which cannot be adequately treated.