MS spasticity worse at night


Why is MS spasticity worse at night?

  • Pain and infection should be treated directly

  • A good position when lying, sitting or standing will help you manage your spasms, spasticity and prevent discomfort.

    • Loosening tight garments may help to relieve spasticity.


    • Make sure you are in a comfortable sleeping position – look at your mattress; is it comfortable, how long have you had it for and do you need to replace it?

    • For those that sleep on their sides, ensuring that your pillow isn’t too high or too soft is very important, as this can put more strain on your neck and spine, often worsening muscle tightness and spasticity

    2. Medication for spasticity

    You may be offered medication to relax muscles or to aid sleep if spasticity is worse at night, think about the timing of your medication to make sure you get the best effect when you need it most.

    Medication can come in the form of:

    • Tablets which work on the entire body e.g. Baclofen, Tizanidine, Clonazepam

    • Baclofen (Lyflex). Baclofen is the most commonly prescribed medication to treat spasticity and spasms in MS. It is important to increase the dose slowly to get a balance between minimising spasticity but not making muscles weak. Baclofen should not be stopped suddenly as it can have lead to severe withdrawal symptoms.

    • Benzodiazepines. These muscle relaxants work through sedation, reduced anxiety and muscle relaxation. The sedative effect may reduce spasticity at night, permitting uninterrupted sleep. However, these drugs also produce tolerance and dependence, limiting their long-term use.

    • Injections which target the medication to a specific muscle or group of muscles e.g. Botulinum Toxin, Peripheral Nerve Block

    • Botox injections which temporarily help severe spasticity in a targeted area

    • An implantable device e.g. Baclofen Pump, this is generally used when symptoms are severe and oral medication is not effective. This medication is delivered at the spinal cord level. This allows you to vary drug doses depending on your activities, allowing more flexibility in self-care throughout the day, and it helps more effectively control night-time spasms

    • Sativex / Cannabinoids. Nabiximols (Sativex) is a cannabis based spray and can be used in addition to any current anti-spasticity medication. Its an equal mix of tetrahydrocannabinol (THC) and cannabidiol (CBD), and can help with spasticity symptoms.

    3. Stress relief

    Feeling negative or depressed has been reported to increase spasticity. Using stress reduction techniques could help with spasticity symptoms. Try meditation, relaxation techniques, deep breathing, and guided imagery.

    4. Temperature

    Some people find that cold and hot temperatures can make spasticity worse. This could also be a result of Uhthoff’s phenomenon (the worsening of multiple sclerosis symptoms that some people experience when exposed to heat).

    Make sure you maintain a comfortable temperature at night using air conditioning, a fan, bedding or heating when necessary.

    Other ways to avoid spasticity symptoms related to temperature:

    • Use cooling devices or ice packs after exercise to reduce spasticity.

    • Avoid temperature extremes.

    • Cold temperature may be helpful for those experiencing muscular contraction (clonus). Try using hand held fans while out or bigger fans for the bedroom while trying to sleep.

    5. Stretching and movement

    It is important to maintain flexibility with specific stretches, as spasticity can be aggravated by reduced movement. A physiotherapist will be able to help you with a program of suitable stretches.

    Studies have reported positive effects of exercise on reducing spasticity in persons with MS. These have included cycling , a group exercise intervention and locomotor training .

    Exercises to help your spasticity

    Spasticity can cause muscles to shorten and joints to stiffen which can then increase muscle overactivity. Exercises to increase flexibility and increase muscle tone may be useful. Prolonged stretching can make muscles longer, helping to decrease spasticity and prevent contracture.

    Aim to stretch daily to muscle’s full length. It is also important to do some ‘range of motion’ exercises, used to keep joints strong and flexible. Make sure you balance your movements – do the same number of reps on each side and combine ‘push’ and ‘pull’ exercises.

    Here are our top tips:

    • Do the correct type of exercise for you – strenuous or fast activities may increase tone and spasticity.

    • Always stretch before and after exercise

    • A physiotherapist may be able to help you with a full programme of stretches tailored to you

    • Your local MS centre might be able to help with classes or physiotherapy for people with MS

    • Try to exercise in a cool environment

    A thorough stretching program will include exercises in certain sitting or lying positions that allow gravity to aid in stretching specific muscles.

    Exercise ideas:

    • Massage the calves, Achilles tendon area and outside of thighs.

    • Next, flex the feet as far as you can and hold, then point your toes to stretch in the opposite direction. Repeat for each leg.

    • Rotate the ankles first outwards, then inwards and repeat on the other leg

    • Bend and extend the legs several times and then hold the extended pose for a short while (1 min). Repeat.

    If you are having spasticity symptoms at night, try some moves in bed e.g. drawing knees up to the chest and letting one knee fall to the side, then repeat on the other side. Otherwise, get up and try some moves slowly and mindfully.

    Types of exercise you can try to improve spasticity symptoms:

    Yoga / adaptive yoga

    Yoga is a flexible practise and there are lots of types which you can choose from to suit you – it is also something you can do at home. You can use props such as a chair, bolster or the wall.

    Yoga and pilates can also help improve posture and positioning. Yoga has also been found to decrease fatigue. Other studies have reported improvement in anxiety, depression, fatigue, bladder function, pain, spasticity, weakness and walking.

    Here is an example yoga relaxation sequence you can use. This can also help you to relax.

    Pilates / MS pilates

    Pilates stretching exercises can also be very helpful. Pilates is a series of exercises based on whole-body movement and are low impact, building strength and control.

    This can also help with other MS symptoms such as cognitive symptoms and like all exercise, it can reduce fatigue levels, as well as improve things like strength, mobility and bowel and bladder function.

    Passive range of motion exercise

    Passive exercise is when something or someone is moving your joints for you.

    • Motorized physical therapy exercise cycles – these allow you to get exercise regardless of endurance or strength levels

    • Active treadmill exercise – assisted by a training partner or training equipment such as elastic bands.

    • Locomotor training – where you are suspended in a harness over a treadmill

    • A passive stretch – where you assume a position and hold it with some other part of your body, or with the assistance of a partner or some other apparatus.

    • Proprioceptive Neuromuscular Facilitation (PNF) – a more advanced form of flexibility training, which involves both the stretching and contracting of the muscle group being targeted.

    To improve spasms, try strengthening exercise to keep your muscles strong. This could be using light weights or exercise bands. This will depend on the intensity of spasms and the individual.

    To help manage spasticity at night, a combination of factors can help reduce the symptoms. A combination of medication, improving sleep positioning and gentle exercise can help manage the symptoms effectively.

    Further Reading

    Have you ever experienced muscle stiffness or a heavy feeling in your muscles which makes them difficult to move? Or perhaps one of your muscles has suddenly stiffened causing your arm or leg to kick out or jerk towards your body? These symptoms are known as spasticity and spasms – they’re a common symptom of MS and can have a big impact on your daily life.

    To find out how spasticity and spasms can be successfully treated and managed, we put some of your questions to physiotherapist, Katrina Buchanan.

    Are there any exercises or stretches that I can do to ease spasticity in my legs?

    Katrina says: The majority of individuals with spasticity and spasms report that exercises can be very helpful in relieving their symptoms. It’s really important to maintain as much muscle mobility and strength as you can and to try and maintain flexibility of muscles, joints and ligaments. Moving each joint and limb through its range of motion each day can be very helpful and also stretching specific areas of tightness or restricted mobility can also be useful.

    A physiotherapist can help to guide you with a specific programme that meets your needs and you can then hopefully fit this into your daily routine, either carrying out exercise at home or perhaps incorporating it into some fitness regimes at the gym or during a sport that you enjoy.

    Stiffness in my legs seems to be worse in the morning and it can be quite painful. Is this normal and is there anything I can do to minimise it?

    Katrina says: Stiffness is often worse in the mornings because you’ve spent a prolonged period of time fairly inactive in bed at night. It is quite a common phenomenon that many people with MS spasticity report. Some people with spasticity find that some gentle exercise whilst still in bed in the morning can help, for example bending and straightening your legs at the hips and knees, and rotating your trunk. This can help you to get moving more easily in the morning.

    For people taking medication, sometimes we suggest that you take your medication as soon as you wake up. It is safe to take any of the anti-spasticity medications on an empty stomach, so often people will keep a glass of water and their medication beside their bed and on waking they’ll take their first dose. If you then wait 10–20 minutes before getting up, it can help that initial stiffness in the morning.

    The only time we need to be careful with this is if there’s a situation where you use your stiffness to help you get in and out of the bed, or to help you stand. In those situations you may find it more effective to just do the exercise before getting up and then take your medication once you’re out of bed.

    I’ve heard other MS symptoms can trigger spasticity – why is this? Are there any other triggers I should be aware of?

    Katrina says: Trigger factors are sometimes known as aggravating factors for spasticity and spasm. These include things like pain, changes in temperature, fatigue, uncomfortable clothing or ill-fitting splints, and bladder and bowel problems. The reason these symptoms trigger an increase in stiffness and spasms is that they provide a sensory stimulus that is fed into the central nervous system. This ongoing, frequent sensory stimuli in turn leads to an output of increased muscle contraction and spasm. If we can help to reduce the trigger factors, this will help to relieve some of the symptoms of spasticity and spasm.

    Is there anything I can do myself to help with spasticity?

    Katrina says: Being very vigilant to any potential trigger factors is really important. Keep an eye out for any potential infections, keep your bladder and bowel well managed if you can (with use of medication to ease constipation if necessary) and make sure any infections are treated promptly. Watch out for any areas of sore skin, pressure ulcers and keep your nails well-trimmed to avoid any ingrowing toenails. This will all help with the management of spasticity and spasms.

    Regular movement is also really beneficial as we often stiffen up when we stay still for a period of time. If you can, try and incorporate some movement, whether it be by yourself or assisted by someone else, regularly during the day and by changing your position at night when you’re in bed.

    A good posture is really important and being comfortable in the position that you are either sitting or lying in. An occupational therapist or physiotherapist can help review how you’re sitting or lying – perhaps in your office chair, a wheelchair or in your armchair at home – and help to improve and then maintain your posture and thereby reduce the likelihood of fatigue, pain or discomfort, and the onset of spasticity and spasm.

    Do you have any tips for people whose spasticity is affecting their sleep?

    Katrina says: It’s quite common for people to report an increase in stiffness and spasms overnight. There are several things you can try if spasticity and spasms are affecting your sleep.

    • It’s really important to have a comfortable sleeping position and it may be worth looking at your mattress and thinking about whether it’s comfortable, how long you’ve had it for and whether a different mattress or bed may be better for you. If you’re comfortable in bed, you’re less likely to trigger the spasticity and spasm.
    • If the spasms want to stretch out your legs in extension, sometimes resting with your legs in a degree of bend – for example, with a pillow or t-cushion under your knees or, if you have a profiling bed, using the profiling mechanism – may be helpful in reducing the number of spasms.
    • If you have spasms that pull your legs up towards your body, you may find that lying on your side, keeping one leg straight and one leg bent, is helpful in reducing those spasms.
    • If you take medication to help stiffness and spasms at night, it may be helpful to think about the timing of your medication. Think about taking it about 30 minutes before you go to sleep so by the time you’re ready to sleep, it’s having its greatest effect.

    What drug treatments are available to help with spasticity and the pain it can cause?

    Katrina says: There are several drug treatments licensed for the management of spasticity and spasm. The MS NICE guidelines recommend that the first-line treatment that we use is either baclofen or gabapentin. We would normally choose one of these drug treatments and start it on a low dose and gradually increase. The aim of the treatment is to get a balance with management of the stiffness and spasms whilst preserving and maintaining as much muscle function and mobility as possible.

    If these treatments aren’t helpful individually, sometimes we’ll combine them and some people get good effect from two different types of medication used at the same time. If baclofen or gabapentin don’t prove to be effective, or have side effects, the second-line treatments that we progress to are tizanidine, dantrolene or pregablin.

    In some situations, where perhaps night time spasms may be impacting on comfort and sleep, we can use benzodiazepines such as clonazepam. These can provide effective relief of spasms overnight and aid sleep.

    Sometimes the treatments mentioned above are not effective for managing all the symptoms of spasticity and spasms. In those situations we may choose to use other treatments such as botulinum toxin, better known as Botox. This is an injection which is administered into a muscle which is stiff and is usually used for focal or specific areas of muscle stiffness, for example a hand, a foot or a toe. Following the injections, a physiotherapist will help to set up a programme of exercises and stretches in order to maximise the effect of the treatment.

    There may be some individuals who find, despite the use of several medications, that spasticity and spasms continue to be very problematic for them. In those situations we may consider more invasive treatments such as intrathecal baclofen where we implant a small pump into the abdomen of the patient which delivers a drug into the fluid around the spinal cord and delivers baclofen directly to the place where it’s needed. This can be a very effective treatment for spasticity but does require an operation.

    The last treatment that we sometimes use for individuals with severe spasticity can be injections of intrathecal phenol which are given into the space and fluid around the spinal cord. They cause damage to the nerves and stop the transmission of nerve signals from the spinal cord out to the legs and can produce an effective relief of severe spasticity and spasm. They do however affect bladder and bowel function, sexual function, and can affect sensation, so we would expect to undertake these more invasive procedures with careful consideration and joint teamwork with a spasticity management service and the person with MS.

    Katrina Buchanan is a consultant physiotherapist at the National Hospital for Neurology and Neurosurgery, London, where she works within the Spasticity Management Service.

    Signs and symptoms of MS in women

    The symptoms of MS in women are similar to those in men, but they can include additional issues due to hormonal changes.

    MS can also affect female sexual health and bladder function differently.

    MS symptoms in women include:

    1. Vision problems

    For many people, a vision problem is the first noticeable symptom of MS.

    MS can cause various vision problems, which include:

    • blurred vision
    • poor color vision or contrast vision
    • painful eye movement
    • blindness in one eye
    • a dark spot in the field of vision

    People with MS develop vision problems either because their optic nerves become inflamed or because they have nerve damage in the pathways that control visual coordination and eye movement.

    While vision problems due to MS can be scary, most either resolve without treatment or are highly treatable.

    2. Numbness

    Numbness in the face, body, arms, or legs is another common symptom of MS, and it is often one of the earliest symptoms of the condition.

    The numbness can range from mild and barely noticeable to severe enough that it interferes with everyday activities, such as holding objects and walking.

    Most periods of numbness from MS resolve without medication and do not become permanently disabling.

    3. Fatigue

    Share on PinterestFatigue is a common symptom of MS.

    About 80 percent of people with MS experience fatigue or unexplained exhaustion.

    Sometimes, the cause of fatigue relates to another symptom of MS. For example, people with bladder dysfunction may sleep poorly because they have to wake throughout the night to go to the bathroom.

    People with MS who have nocturnal muscle spasms may not sleep well, leaving them feeling tired during the day. MS can also increase the risk of depression, which can cause fatigue.

    Another type of fatigue that seems to be unique to MS is called lassitude. A person’s fatigue may be lassitude if it:

    • occurs daily
    • worsens as the day goes on
    • happens in the morning, even after a good sleep
    • worsens with heat or humidity
    • interferes with daily activity
    • is unrelated to physical impairments or depression

    4. Bladder problems

    Bladder problems affect at least 80 percent of people with MS. These issues occur when scars on the nerves impair nerve signaling that is necessary for the function of the urinary sphincters and bladder.

    MS can make it difficult for the bladder to hold urine and may reduce the amount that it can store, causing symptoms such as:

    • more frequent or urgent urination
    • hesitancy starting urination
    • frequent overnight urination
    • being unable to empty the bladder
    • being unable to hold urine or having urine leaks

    5. Bowel problems

    Many people with MS experience bowel problems, such as:

    • constipation
    • diarrhea
    • loss of bowel control

    Bowel problems can make other MS symptoms worse, especially bladder problems, muscle stiffness, and involuntary muscle spasms.

    Researchers think that people with MS have problems controlling their bowels because of the neurological damage that the condition causes. Some people with MS may also have trouble controlling their bowels when they are constipated.

    6. Pain

    Some research suggests that 55 percent of people with MS experience clinically significant pain, while 48 percent live with chronic pain. Women with MS may be more likely than men to experience pain as a symptom of this condition.

    Acute MS pain seems to be due to problems with the nerves that help transmit sensations in the central nervous system.

    Some of the acute pain symptoms that have an association with MS include:

    • Trigeminal neuralgia, a stabbing pain in the face that people may confuse with dental pain.
    • Lhermitte’s sign, a short sensation resembling an electric shock that moves from the back of the head down the neck and spine, usually after bending forward.
    • The MS hug, a stabbing, squeezing, painful, or burning sensation around the torso or in the legs, feet, or arms.

    Some of the symptoms that people with chronic MS pain may report include:

    • burning
    • aching
    • pins and needles
    • prickling

    Many people with MS also experience chronic pain as a secondary effect of the condition. For example, it could be due to:

    • compensating for gait changes
    • muscle stiffness, cramps, and spasms
    • incorrect use of mobility aids
    • muscle changes from mobility loss

    7. Cognitive changes

    More than 50 percent of people with MS experience changes in cognition, which means that they may sometimes have trouble:

    • processing new information
    • learning and remembering new information
    • organizing information and problem-solving
    • focusing and maintaining attention
    • properly perceiving the environment around them
    • understanding and using language
    • doing calculations

    The cognitive symptoms of MS are typically mild to moderate and only affect a few aspects of cognition.

    In rare cases, people with MS may experience disabling cognitive problems.

    8. Depression

    Share on PinterestFor people with MS, clinical depression is a common symptom.

    Clinical depression is one of the most common symptoms of MS. Depression is more common in people with MS than in people with other chronic health conditions.

    While almost everyone experiences periods of sadness or grief, clinical depression refers to depressive symptoms that last for a minimum of 2 weeks.

    Some of the symptoms of clinical depression include:

    • loss of interest in everyday activities
    • increase in appetite or appetite loss
    • sadness
    • irritability
    • insomnia or excessive sleep
    • fatigue
    • feelings of guilt and worthlessness
    • difficulty thinking or concentrating
    • behavioral changes
    • thoughts of death or suicide

    Clinical depression can also worsen other MS symptoms, including:

    • fatigue
    • pain
    • cognitive changes

    9. Muscle weakness

    Many people with MS experience muscle weakness. This symptom is due to damage to the nerve fibers that help control muscles.

    People with MS may also experience muscle weakness because a lack of use has led their muscles to become deconditioned over time.

    MS-related muscle weakness can affect any part of the body. It can be especially challenging for people with MS to walk and stay mobile when muscle weakness affects their legs, ankles, and feet.

    10. Muscle stiffness and spasms

    MS can cause spasticity, which is muscle stiffness and involuntary muscle spasms in the extremities, especially the legs.

    Some of the signs and symptoms of spasticity include:

    • tightness in or around the joints
    • painful, uncontrollable spasms in the arms and legs
    • lower back pain
    • hips and knees that bend and become difficult to straighten
    • hips and knees that stiffen while close together or crossed

    11. Dizziness and vertigo

    Some people with MS experience dizziness and the sensation of being lightheaded, woozy, weak, or faint.

    Less commonly, they experience vertigo, which makes it feel as though a person or their surroundings are spinning.

    MS may cause vertigo by damaging the pathways that coordinate the spatial, visual, and sensory input that the brain needs to maintain balance in the body.

    The symptoms of vertigo include:

    • balance problems
    • motion sickness
    • nausea and vomiting
    • being lightheaded
    • a spinning sensation

    12. Sexual problems

    People with MS often experience sexual problems and may find it difficult to get aroused or have an orgasm.

    MS may reduce natural vaginal lubrication, potentially making sexual intercourse painful for women.

    The disease can also cause sexual problems by damaging nerves in the sexual response pathways that connect the brain and the sexual organs.

    People with MS can also experience issues with sex as a result of other MS symptoms, such as:

    • muscle spasms and stiffness
    • mood or self-esteem changes
    • fatigue

    13. Emotional changes

    MS can cause a wide range of emotional symptoms and changes, including:

    • mood swings
    • periods of uncontrollable laughter or crying
    • irritability
    • grief
    • worry, fear, and anxiety
    • distress, anger, or frustration

    The condition is unpredictable, often has fluctuating symptoms, and can become disabling, all of which can be scary for someone.

    MS can also cause emotional changes by damaging the nerve fibers in the brain. Some of the medications that people take to manage MS can cause mood changes too.

    For example, corticosteroids can have many emotional side effects, including:

    • anxiety
    • irritability
    • agitation
    • tearfulness
    • restlessness
    • fear

    14. Difficulty walking

    People with MS can develop problems with gait, or how they walk, because of several factors. MS symptoms that affect how a person walks include:

    • muscle stiffness and spasms
    • numbness or other sensory problems in the hips, legs, ankles, or feet
    • fatigue
    • muscle weakness
    • loss of balance

    15. Hormonal effects

    There is some evidence to suggest that MS can affect women differently than men due to hormonal changes, including those that occur during:


    More research is necessary to draw firm conclusions, but the NMSS state that some studies have found that women with MS have worse symptoms within a week of starting their period.

    Studies that used an MRI have also shown that MS disease activity may change according to the different hormonal levels during menstruation.


    Pregnancy can reduce the risk of MS symptom flare-ups, especially during the second and third trimesters.

    Researchers think that pregnancy has a protective effect against MS by raising the levels of compounds that help reduce inflammation and the effects of the disease.

    Women who are pregnant also have naturally higher levels of circulating corticosteroids, another type of immunosuppressant.

    Although pregnancy can temporarily reduce some MS symptoms, flare-ups tend to return in the first 3 to 6 months postpartum. However, in the long term, there is no proven link between pregnancy and a higher risk of disability.

    While being pregnant can temporarily reduce the risk of flare-ups, pregnancy also puts a lot of physical stress on the body, which can make certain symptoms of MS worse.

    In addition, some of the medications that people use for MS are not safe to take during pregnancy and can worsen symptoms.

    Anyone with MS who is pregnant or planning to become pregnant should discuss their medications with their doctor.

    Some MS symptoms that pregnancy often exacerbates include:

    • fatigue
    • gait problems
    • bladder and bowel problems


    MS symptoms may worsen after menopause, possibly because declining estrogen levels adversely affect disease progression.

    However, it is difficult to tell whether MS symptoms worsen because of menopause or just as a natural result of aging or the progression of the condition.

    Much more research is necessary to understand the relationship between menopause and MS symptoms.

    How to Get a Good Night’s Sleep When You Have MS

    The Basics of Good Sleep Hygiene

    No matter what’s at the heart of your sleep problems, failing to maintain good “sleep hygiene” can make it worse. Here are some things you can do to prepare for a good night’s sleep:

    Have a Pre-Bedtime Routine

    “Create a ‘buffer zone,’ or a nightly evening routine before bedtime that lasts between 30 and 60 minutes and helps you unwind for the day and prepare for sleep,” says Drerup.

    In addition to powering down all electronics, an evening routine can include doing some yoga or gentle stretching, reading in a dim light, meditating, or writing in a gratitude journal, says Drerup.

    Create a Dark, Comfortable Environment

    Make your bedroom environment quiet, dark, and cool so it’s conducive to sleeping.

    “As much as possible, you want the bedroom to be reserved for sleep and intimacy,” says Costello. Take out the TV, and put in room-darkening curtains. Turn your mattress if it feels worn, and invest in comfortable pillows. Adjust the thermostat so that you’re neither too cool nor too hot.

    Establish a Sleeping Pattern

    Go to bed at the same time every night. Wake up at the same time every morning. Programming your body to expect a certain schedule can help regulate your sleeping pattern.

    To prevent problems falling asleep or disrupted sleep, avoid eating a large meal right before bed, using any kind of nicotine, or drinking alcohol or caffeinated beverages close to bedtime.

    “Alcohol may make you feel drowsy, but it is a depressant, and after the initial drowsiness wears off, the nervous system rebounds and can be disruptive later on during the sleep cycle,” explains Costello.

    Don’t Take Long Daytime Naps

    Don’t take long naps in the afternoon. Settle for a catnap if you’re feeling fatigued — just long enough to feel rested, but not so long that you aren’t able to fall asleep at bedtime.

    Try a Relaxation App

    Consider trying a relaxation app to help put you to sleep. Pzizz, for example, plays a combination of music and voice for any length of time you choose to help put you to sleep. Relax Melodies also plays soothing music and other sounds, with optional meditation and movement modules to induce sleep. And White Noise plays sounds of ocean waves, thunder, rain, and similar noises. The basic versions of these apps are free and available for both iOS and Android devices.

    Additional reporting by Susan Jara.

    Multiple Sclerosis (MS) is a disorder in which the body’s immune system attacks and destroys myelin, a membrane that covers axons in the brain and spinal cord. Myelin serves both to protect axons and to speed the conduction of electrical impulses along nerve fibers. The destruction of myelin results in scarring and loss of nerve cells and can lead to a whole host of symptoms for MS patients, including paralysis, depression, loss of memory, fatigue and problems with vision, balance, bladder and bowel control. However, because it is a disease that progresses slowly, MS can be very mild for some patients and many people with MS are able to lead full and active lives.

    According to the National Institute of Neurological Disorders and Stroke at the National Institutes of Health, MS is more common in women than men and is more than twice as likely to affect white people than people of other races. Also, the prevalence of MS among people in the more northerly climate zone is five times higher than for people in the tropics. The cause of MS is unknown but environmental, viral and genetic causes may play a role. MS is not fatal or contagious, although severe symptoms may lead to a shortened or decreased quality of life for some people.

    Fatigue, one of the most common symptoms of MS, can be profoundly disabling. The cause of fatigue in MS is not well understood but some researchers believe that the degree of fatigue felt by MS patients is an indication of how far along the disease has progressed. However, a recent study conducted by researchers from Pennsylvania State University found that depression and sleep disturbance were stronger predictors of fatigue in MS patients than disease severity. Specifically, the results of this study showed that all three contribute to fatigue in MS, but that sleep disturbance is the biggest contributor.

    MS is also associated with a number of sleep disorders. According to a study led by W. Elon Fleming, MD, at the Sleep Disorders Center at Island Hospital in Anacortes, Washington, the most common sleep disorders in MS patients are insomnia, nocturnal leg spasms, narcolepsy, REM sleep behavior disorder, and sleep disordered breathing. Restless legs syndrome (RLS) is also highly prevalent among MS patients. One study revealed that among 156 MS patients, 51% met the criteria for RLS based on neurological examination and medical interview and that RLS was associated with higher MS-related disability. Medications used to treat MS may also cause or worsen these problems. The study also showed that pain, medications and frequent nighttime urination influenced sleep among MS patients.

    Reducing fatigue and improving sleep is critical to improving the lives of people with MS. There are many options for improving sleep, including both behavioral and pharmaceutical remedies. It is very important that physicians screen for sleep problems among their MS patients and that they are aware of the options to treat them.


    Initial symptoms of MS may be brief and mild and usually first occur in people between the ages of 20 and 40. Each MS patient has a unique set of symptoms, depending on where in the brain the destruction of myelin occurs. Some patients are most affected by severe fatigue while others complain of blurred vision and loss of balance. Still others may suffer most profoundly due to loss of bladder and bowel control. MS patients might experience any of these and other symptoms either fully or partially while others go for months or years with no symptoms whatsoever. Another feature of the disease is unpredictability; MS patients may have severe symptoms one day and be symptom-free the next.

    Many of the body’s essential functions depend on the brain and spinal cord, at least as a relay station, and damage to it in people with MS results in a wide variety of symptoms. Here are some of the most common:

    • Visual impairments – eye twitching, blurred vision, double vision, loss of color vision, blindness
    • Muscular effects – weakness, loss of muscle tone, slurred speech, muscle contractions, foot drop, paralysis
    • Sensory symptoms – numbness, tingling, pain, burning, itching, loss of awareness of location of body parts
    • Coordination and balance – loss of coordination or balance, shaking, over or undershooting limb movements, nausea, vomiting, stuttering, loss of ability to move to a rhythm
    • Bowel, bladder and sexual dysfunction – urinary incontinence, bowel incontinence, impotence, lack of ability to achieve orgasm
    • Cognitive abnormalities – short and long-term memory problems, speech impairments
    • Mood disorders – mood swings, anxiety, depression
    • Sleep disorders – insomnia, nocturnal movements, sleep disordered breathing, narcolepsy, and REM sleep behavior disorder
    • Other – epileptic seizures, problems breathing, acid reflux, impaired taste and smell, difficulty swallowing, problems regulating heat and cold, fatigue

    There is no single test for MS. When a person seeks treatment for MS-related symptoms, a doctor will consider neurological exams, laboratory tests and the patient’s medical history to confirm the diagnosis. The clinical diagnosis is usually confirmed by an MRI examination of the brain.


    There is no cure for MS at the present time. The goal in treating MS is to limit the destruction of myelin, which typically requires suppression of the body’s immune system. If you are diagnosed with MS, your doctor may prescribe pharmaceutical therapies that achieve this and address your related symptoms. However, some people with MS lead healthy lives without any treatment at all.

    Because of its connection to symptom severity, sleep problems should be given special consideration in MS patients. There are many options for improving sleep, including both behavioral and pharmaceutical remedies. If you have MS and are suffering from sleep problems, talk to your doctor about diagnosing and treating them.


    Getting a good night’s sleep helps to alleviate many common symptoms of MS, including chronic fatigue, mood and memory problems. Daytime naps can also help, but only if napping does not interfere with night-time sleep.

    Evidence suggests that exercise can reduce fatigue symptoms as well as muscle control and balance problems. Some MS patients report a worsening of symptoms caused by warm weather or body heat that results from heavy exercise. If this occurs, try taking a cold bath or going swimming.

    Some people report that alternative therapies have helped with MS symptoms, though there is no scientific data to support such claims.

    When a person is diagnosed with MS, his or her life may be disrupted. His or her career or education may be jeopardized by the onset of MS symptoms at a time when treatment costs are at their highest. This can be a difficult situation to cope with.

    Nocturnal leg cramps can ruin your sleep!

    If your nocturnal leg cramps are MS-related

    Your doctor will likely offer treatment options which include drugs, supplements, or physical therapy.

    Meanwhile, more research is being done to help evaluate new drugs that could help with treating the leg cramps and spasticity that are a hallmark of MS.

    The pharmaceutical company, Flex Pharma, recently announced a Phase 1 clinical trial which will evaluate its product, FLX-787, for its effectiveness in modulating pain receptors through a therapy known as topical chemical neuro stimulation. They believe this new agent could provide relief from intense spasms and cramping in people with MS.

    Their researchers say they have found FLX-787 to reduce cramp intensity in a way that is dose responsive, meaning that the more of it you take, the better the relief.

    Flex Pharma’s chief medical officer, Thomas Wessell MD PhD, recently said in a press release, “By prioritizing our clinical programs to severe neurological diseases ahead of nocturnal leg cramps, we can focus on those patients with the greatest unmet need and accelerate our research efforts for cramps and spasticity.”

    Rod MacKinnon, MD, Flex Pharma co-founder and a Nobel Prize winner, added, “Our approach has a broad range of applications that we believe will ultimately benefit the millions of people that suffer from frequent painful muscle cramps.”

    For occasional leg cramps at night

    You cannot fix chronic problems with nocturnal leg cramps by using over-the-counter treatments or tried-and-true home remedies. That is for a doctor to help you manage.

    However, if you only have occasional nocturnal leg cramps, these approaches can offer some relief:

    • Stretch the muscles in your feet, ankles, calves, and upper legs during the day and right before bed.
    • Where shoes that have good heel support.
    • Drink more water to avoid dehydration; for the same reason, avoid caffeine products and alcohol, which have a diuretic effect on the body.
    • Make sure your diet has adequate amounts of calcium, magnesium, iron, and other minerals to ensure your electrolytes are in a working balance.

    Remember, anything that chronically disrupts your sleep can have a negative long-term impact on your disease course. Your brain needs sleep to fight multiple sclerosis. If your sleep’s constantly being interrupted (for whatever reason), you’re destined to never get enough deep sleep, opening the door to future chronic health problems.

    Editor’s note: “Need to Know” is a series inspired by common forum questions and comments from readers. Have a comment or question about MS? Visit our forum.

    This week’s question is inspired by the forum topic “Leg spasticity: How do you manage it?“, from April 30, 2018.

    What is leg spasticity?

    Muscle spasticity is a common MS symptom. It can occur anywhere, but generally, it occurs in the muscles that we use to stand and balance. That means the legs are a common, if not the most common, target.

    Lesions in the brain and spinal cord that damage the nerves controlling muscle movement are the chief cause of this unpleasant, sometimes disabling symptom.

    Types of leg spasms

    Extensor spasticity refers to muscle spasms on the front of the leg (the quadriceps) and the inside leg (the adductor muscles).

    Flexor spasticity refers to spasms in the muscles on the back of the leg (the hamstrings) and the muscles that connect the upper thighs to the hips (the hip flexors).

    Clonus is a general term that means “rhythmic, repeating spasms.” That weird twitching and jerking in your legs? That’s clonus.

    Stiffness is generally viewed as the same thing as mild spasticity. However, even when considered mild, stiffness can lead to problems with walking and gait, especially if your spasticity seems to favor one side over the other.

    Join the MS forums: an online community especially for patients with MS.

    Triggers for leg spasms

    Several triggers can worse spasticity in the legs:

    • temperature extremes
    • humidity
    • a change in body position
    • clothing that is binding
    • constipation
    • posture problems
    • generalized pain (not necessarily related to MS)
    • broken skin or sores
    • fever
    • overheating from excessive exercise
    • anxiety
    • infection elsewhere in the body (which leads to inflammation)

    What you can do about spasms in your legs

    There are some approaches you can take to reduce or relieve leg spasticity. Some options work better than others, so if one doesn’t work for you, try another.

    • Treat separate conditions such as arthritis, a pulled muscle, or restless legs syndrome. Any kind of inflammation can lead to leg spasticity. Discuss your concerns with your doctor. Treating other causes of muscle pain and stiffness can greatly improve overall comfort.
    • Start an easily maintained stretching plan. You can work with a physical therapist to create a plan or consult other resources (books, websites, and videos) of MS-specific stretching exercises.
    • Aquatic therapy, tai chi, and gentle (Hatha) yoga are forgiving to the joints and help with strength and relaxation.
    • Try progressive muscle relaxation. It’s useful for releasing tension not only in the muscles but also in the mind, putting a cap on anxiety, which also can lead to muscle tension.
    • Massage from a practitioner is fantastic. Deep tissue is less comfortable but longer-lasting. A gentler massage, though more temporary, can be the pick me up you need during a rough day. Bedtime massage, either using a foam roller or other self-massaging products or from the fingers of a loved one, can be effective.
    • A warm bath, also and especially at bedtime, can help calm the muscles and inspire them to “let go.”
    • Transcutaneous electrical nerve stimulation (TENS) uses electrode-like patches applied to specific muscles to generate stimulation that brings relief to specific parts of the body (i.e., the calves, the bottom of the feet, and the thighs).
    • Medications for spasticity include muscle relaxants, certain benzodiazepines, dopamine agonists (like those used for restless legs syndrome) and even Botox. Consult your doctor.
    • Some people swear by oral applications of the cannabis product known as Sativex.
    • Certain kinds of braces for the feet and legs can help keep muscles and joints in proper alignment, preventing the development of contractures (see below).

    If you don’t treat leg spasms

    Obviously, if you can’t ignore the pain and stiffness in your legs, you’ll feel miserable. But even worse, you could develop something known as contractures, which are joints that are frozen or immobilized by perpetually stiff muscles. Unfortunately, contractures can also trigger more spasticity, so don’t be a hero. Find ways to release the unpleasant rigidity in your muscles; you don’t have to suffer needlessly.


    Have you found the secret solution for managing your leg spasms? If so, others who are plagued by this problem would love to read about your success. If not, reaching out to other people with MS may be fruitful if you think you’ve exhausted your options. Post your replies in the comment section or at the original “Leg spasticity, How do you manage it? ” forum entry.


    Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.

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