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Multple Sclerosis and Consciousness

Multple Sclerosis (MS) is the leading cause of neurological disability for young adults in the UK and, according to the MS society, it affects around 100 000 people in the UK. The disease causes axonal demyelination. In simplistic terms, it removes the insulation from the connections between neurons; this is like stripping the plastic insulation from wires — the signal is weakened and, eventually, lost. As you can imagine, this causes a great deal of disruption to the brain most often to the frontal regions.

The “circuits” around the frontal areas are associated with monitoring and preventing attentional lapses, and the regulation of emotions. Both of these may impact on quality of life (QoL), after all being able to control our emotions and pay attention are arguably two of the most crucial processes required for everyday life. Despite their importance, then, it is interesting to note that before 2009 no previous study had investigated this with the use of the Cognitive Failures Questionnaire (CFQ) within MS. The CFQ is a psychometric test that requires a person to self-report on failures in memory, perception, and motor function (movement and action). Intended to be a simple measure of these areas for everyday life, in the case of MS the questionnaire allows for a measure of attentional lapses.

There is some evidence to suggest that white matter damage in MS impairs access to consciousness, meaning MS is almost certainly a disorder of consciousness caused by physical decline in structures within the brain. What is not so clear is how greatly this disorder of consciousness affects quality of life (although it is fairly certain it does affect QoL in a negative manner). The 2009 paper by Dr Phillips and colleagues found both emotional regulation and CFQ score to be predictors of QoL, meaning the two factors are intrinsically linked to QoL. Cognitive reappraisal (the ability to stop a train of thought, and reassess, in this case reassess emotions) was found to account for some of the emotional regulation scores and their reflection in QoL. In 2003, Gross and John found that people who use reappraisal to regulation emotions have a better life satisfaction, so it follows that QoL would be higher.

While a seemingly obvious finding, the paper struck new ground. Most measures of severity in MS are linked to physical symptoms but, from their findings, it appears to be that emotional-cognitive symptoms had just as great an influence. While a caveat of the paper was, indeed, that during self-report we are more likely to exaggerate our emotions and mood than physical symptoms — after all, sometimes simply watching a sad film clip can make a room full of people sad — the importance of emotional regulation in MS stands. MS is not simply a disease with physical symptoms, a battlefield of the mind.

Louise H. Phillips, Amber Saldias, Anna McCarrey, JulieD. Henry, Clare Scott, Fiona Summers3and Maggie Whyte. 2009. Attentional lapses, emotional regulation and quality of life in multiple sclerosis
Reuter F, Del Cul A, Malikova I, Naccache L, Confort-Gouny S, Cohen L, Cherif AA, Cozzone PJ, Pelletier J, Ranjeva JP, Dehaene S, Audoin B. 2009. White matter damage impairs access to consciousness in multiple sclerosis.

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