How does winter affect people with Multiple Sclerosis. What are the effects of cold temperatures on MS symptoms. Can disease activity be impacted by seasonal changes. How to manage MS symptoms during cold weather.

The Impact of Cold Weather on MS Symptoms

Winter can present unique challenges for individuals living with Multiple Sclerosis (MS). As temperatures drop, many MS patients experience changes in their symptoms and overall well-being. Understanding these effects is crucial for better management of the condition during colder months.

Common Symptoms Exacerbated by Cold

Cold temperatures can affect nerve and muscle activity in MS patients, leading to various symptom flare-ups:

• Increased pain
• Mobility challenges
• Muscle cramping
• Stiffness
• Spasticity

In some cases, the temperature change can cause difficulties in walking or using hands. The cold can also worsen the “MS hug,” a gripping sensation around the torso caused by spasticity of small muscles between the ribs.

Managing Cold-Induced Symptoms

MS nursing professionals recommend the following strategies to manage cold-induced symptoms:

1. Dress in layers to maintain body temperature
2. Drink warm beverages
3. Find a balance in indoor heating (avoid excessive heat)

Heat Sensitivity in MS: A Delicate Balance

While cold weather can exacerbate certain MS symptoms, it’s important to note that heat sensitivity is also a common issue for many MS patients. Excessive heat can trigger temporary worsening of symptoms such as:

• Fatigue
• Blurred vision
• Tremor
• Weakness
• Cognitive problems

Finding a comfortable temperature balance is crucial for MS patients, especially when transitioning between outdoor cold and indoor heating during winter months.

Seasonal Impact on MS Disease Activity

Beyond symptom management, research suggests that seasons may influence MS disease activity. Several studies have explored the relationship between environmental factors and MS progression.

Spring and Summer Relapse Patterns

Multiple studies have observed higher rates of relapse activity among MS patients during spring and summer months, regardless of geographical location. This pattern appears to be more pronounced in younger patients with relapsing-remitting MS.

Sunshine and MS Events

A large Northern European population-based study spanning a decade found a seasonal pattern in MS events, with peaks in late spring and early summer. This pattern was associated with monthly hours of sunshine, highlighting the potential role of environmental factors in disease expression.

Conflicting Evidence

While many studies support the spring/summer relapse pattern, a recent Danish study of over 13,000 RRMS patients treated with disease-modifying therapies (DMTs) observed a significantly lower number of relapses in July. These conflicting results underscore the complex and multifactorial nature of seasonal patterns in MS.

Strategies for Managing MS in Cold Weather

For individuals like Barbara Appelbaum, a 59-year-old semiretired motivational speaker and wellness coach, cold weather can significantly impact MS symptoms. Appelbaum experienced increased fatigue and occasional shooting pains, primarily in her feet, during Chicago’s harsh winters.

Prevalence of Cold-Induced Symptoms

According to Dr. Scott Ireland Otallah, a neurologist, approximately 10 to 15 percent of people with MS experience symptoms due to cold weather. While this is less common than heat sensitivity, it’s still a significant concern for many patients.

Tips for Cold Weather Management

To help MS patients cope with cold-induced symptoms, consider the following strategies:

• Dress in warm, insulating layers
• Use hand and foot warmers
• Stay hydrated with warm beverages
• Maintain a consistent indoor temperature
• Practice gentle exercises to improve circulation
• Consider temporary relocation to warmer climates if feasible

The Role of Vitamin D in MS and Seasonal Changes

Vitamin D deficiency has been linked to increased risk of MS and disease progression. Winter months often lead to reduced sun exposure, potentially impacting vitamin D levels in MS patients.

Importance of Vitamin D Supplementation

During winter, it’s crucial for MS patients to maintain adequate vitamin D levels. Consult with a healthcare provider to determine appropriate supplementation and consider regular blood tests to monitor vitamin D status.

Emotional and Mental Health Considerations

Winter can also affect the emotional and mental well-being of individuals with MS. Shorter days, reduced sunlight, and limited outdoor activities may contribute to seasonal affective disorder (SAD) or exacerbate existing depression and anxiety.

Coping Strategies for Winter Blues

• Light therapy using SAD lamps
• Regular exercise, even if indoors
• Maintaining social connections
• Practicing mindfulness and stress-reduction techniques
• Seeking professional mental health support if needed

Adapting MS Treatment Plans for Winter

As seasonal changes can impact MS symptoms and disease activity, it may be necessary to adapt treatment plans during winter months. This could involve adjusting medication dosages, incorporating additional therapies, or modifying lifestyle habits.

Importance of Regular Check-ups

Regular consultations with healthcare providers during winter can help monitor disease progression and ensure that treatment plans remain effective despite seasonal challenges.

Leveraging Technology for Winter MS Management

Advancements in technology offer new ways for MS patients to manage their condition during winter months. From smartphone apps that track symptoms to wearable devices that monitor body temperature, these tools can provide valuable insights and support.

Telemedicine for Winter Care

Telemedicine appointments can be particularly beneficial during cold weather, allowing patients to consult with healthcare providers without risking exposure to harsh conditions.

Understanding the impact of winter on MS is crucial for effective management of the condition. By recognizing how cold weather affects symptoms, adapting treatment plans, and implementing coping strategies, individuals with MS can navigate the winter months more comfortably and maintain their quality of life.

As research continues to explore the complex relationship between seasonal changes and MS, patients and healthcare providers alike must stay informed about the latest findings and recommendations. By working together and leveraging available resources, the MS community can develop increasingly effective strategies for managing the condition throughout all seasons.

Remember, while winter may present challenges for those living with MS, it’s important to approach the season with a proactive and positive mindset. With proper preparation, support, and management techniques, individuals with MS can continue to thrive despite the cold weather.

Winter and its impact on people with MS

EMSP News

Winter and its impact on people with MS

29.11.2021

Winter is fast approaching, with days getting shorter, and temperatures dropping, which made us think – as the seasons change, does this impact upon a person’s MS? And if so, how?

Effects of Colder Temperatures on MS Symptoms

Temperature changes can have an impact upon some symptoms experienced by people with MS. Colder temperatures can have an effect on nerves and muscle activity, leading to pain and mobility challenges including cramping, stiffness and spasticity. In certain cases, the temperature change can cause difficulties in walking or the use of hands.

The cold can also worsen the so-called MS hug. This is a gripping feeling around the torso caused by spasticity of small muscles between the ribs. Our advice form the MS nursing community to MS patients would be to dress in layers and to keep yourself warm by drinking warm beverages but it is essential not to turn the heating up too high inside as excessive heat can exacerbate MS.

This takes us to the next point, heat sensitivity in MS. Heat can also have an impact upon people with MS as they can often experience temporary worsening of their symptoms in hot weather. Common symptoms triggered by heat include fatigue, blurred vision, tremor, weakness and cognitive problems. Hence, it is important to keep yourself warm during winter but try finding a happy medium while inside.

Disease Activity Can Be Impacted

Disease activity can also be impacted by the seasons. A growing number of studies have addressed the importance of environmental factors in MS for ongoing activity of established disease, and seasonal variation in relapses has been demonstrated in some studies. Higher rates of relapse activity among individuals with MS have generally been observed in spring and summer months, irrespective of place of residence (latitude).

Furthermore, in a large Northern European population-based study spanning a decade, a seasonal pattern in MS events was observed, with a peak in late spring and early summer, and a decay in late summer. This pattern was most apparent in younger patients with relapsing–remitting disease and was associated with monthly hours of sunshine. You can read more about the study here.

However, this did not account for all variation observed, suggesting that seasonal patterns of MS events are highly complex and multifactorial. In contrast, a recent study of more than 13 000 Danish patients with RRMS treated with DMTs observed a significantly lower number of relapses in July. You can read more about this particular research here. These seasonal differences in relapse rates highlight the critical effects of environmental factors in the development and expression of the disease.

Learn more through MS Nurse PRO

This guest blog post is an excerpt of a more in-depth blog written by the MS Nurse PRO team which can be accessed here.

MS Nurse PRO is an initiative of EMSP. It is an European-focused, e-learning training curriculum for nurses who work with people living with multiple sclerosis and carers. It covers 6 extensive courses in 12 languages. Members are not only a part of an educational programme but they can also take an active part in an pan European MS community of nurses and carers!

To read more about the effects of winter on people living with MS or other interesting reads, please refer to the MS Nurse PRO blog, found here.

Conclusion

People living with MS can face additional challenges with seasonal changes. Winter, with its lower temperatures, can lead to difficulties in walking, the use of hands or spasms. Yet, one must also pay attention to high temperatures when inside, as heat can worsen MS symptoms such as fatigue. Furthermore, numerous studies have investigated disease activity, all proving that environmental factors play a crucial role in the development of MS.

What to Do When Cold Weather Worsens MS Symptoms

Overheating during hot weather or in a hot bath is known to magnify symptoms in many people with multiple sclerosis (MS).

But for some, cold weather can be just as problematic. No one knows this better than Barbara Appelbaum, a 59-year-old semiretired motivational speaker and wellness coach who spent much of her life enduring the unforgiving winters of Chicago. She now relocates to the California desert during the most frigid months of the year.

Appelbaum felt certain symptoms of her MS appear or worsen on “bitterly cold” days. “I would get increased fatigue and also experience occasional shooting pains, primarily in my feet,” she says.

10 to 15 Percent of People With MS Experience Symptoms Due to Cold Weather

It’s more common for people with MS to experience symptoms due to heat rather than the cold, says Scott Ireland Otallah, MD, a neurologist who specializes in multiple sclerosis at Atrium Health at Wake Forest Baptist in Winston-Salem, North Carolina.

Indeed, now that Appelbaum winters in a warmer climate, heat is her winter nemesis. “It causes fatigue, not in a ‘sleepy tired’ way, but rather a fatigue of my muscles and bones, along with a dizziness that occasionally gives me wobbly legs,” she says.

According to Dr. Otallah, “Cold weather’s impact on MS is a little less understood. It doesn’t seem to have the same impact as heat, because it doesn’t cause conduction block in the same way.”

A temporary worsening of neurological function due to an increase in core body temperature, known as Uhthoff phenomenon, happens in about 60 to 80 percent of MS patients, Otallah says.

“Worsening of symptoms due to cold only happens in about 10 to 15 percent of patients, at least in the surveys that have been done,” he adds.

Why Does Cold Weather Cause MS Symptoms to Get Worse?

There isn’t a lot of research on how and why some people with MS can have symptoms related to the cold, says Otallah. “I have observed people who have certain pain-related symptoms due to a demyelinating event of MS — a common example of that would be trigeminal neuralgia.”

Trigeminal neuralgia is a chronic pain disorder that typically causes severe, shock-like pain in the face, and it’s more common in people with MS. “If there is a lesion [affecting the trigeminal nerve], then this can often be provoked by cold,” Otallah says.

A small study published in January 2021 in the Korean Journal of Pain found that even though light touch was the most common trigger for trigeminal neuralgia, weather triggers were reported by 12 out of the 60 participants (20 percent). Strong winds, cold temperatures, and cold winds were all cited as causes for a painful episode.

There’s also some speculation that having a demyelinating lesion on the hypothalamus … could make it harder to regulate your own body temperature, says Otallah. “That would explain why cold in general would affect you more, making you feel slowed down and fatigued, and so on,” he says.

Cold Temperatures May Cause Worsening Spasticity 

Spasticity is a common symptom in MS, described as tightness, stiffness, or involuntary muscle spasms, according the National Multiple Sclerosis Society. Bouts of spasticity can be painful or painless and range from mild to very severe.

Cold weather is one of the most common triggers for worsening spasticity, per the organization. The “MS hug” — a tightening or constricting sensation caused by muscle spasms surrounding the rib cage — may also get more severe in freezing temperatures, according to the Multiple Sclerosis Foundation.

If your symptoms are interfering with your quality of life, you may want to discuss possible treatment options for spasticity. Per the Cleveland Clinic, oral medications used to treat spasticity include:

• Baclofen
• Zanaflex (tizanidine)
• Dantrium (dantrolene)
• Valium (diazepam)
• Klonopin (clonazepam)
• Neurontin (gabapentin)

Other options include an injection of medication such as Botox in the most affected muscles.

Stretching and doing yoga can be beneficial for increasing mobility and reducing muscle stiffness, says Otallah.

“Going to a physical therapist — even just a one-time visit — could also help with symptoms exacerbated by cold weather. A physical therapist can assess what you need to work on and provide in-depth recommendations on exercise for you,” he says.

Typical Winter Health Issues May Be Harder for People With MS

Often when people are talking about cold exacerbations in MS, they’re talking about feeling worse during the winter, says Otallah. “That’s tricky, because there are a variety of things that can make everyone — with or without MS — feel worse in the winter, but the issues can be even more problematic when you do have MS,” he says.

“For example, when the days are shorter and we’re getting less exercise, it is easier for our mood to get down and for our sleep to be disturbed, which causes us to feel more fatigued, because we’re being less active and not sleeping as well,” he says. A lot of gray matter symptoms such as fatigue and “brain fog” are worsened by changes in mood or poor sleep, he adds.

“Even healthy individuals can have more problems with cognitive and processing abilities during the winter months, but they can affect people with MS quite significantly,” says Otallah.

RELATED: The Ultimate Winter Wellness Guide

If Cold Weather Is Impacting Your MS and Overall Health, Talk With Your Doctor

“If the worsening symptoms are more cognitive and include trouble with sleep, we would want to make sure you’re getting as much sun as you can and remaining as active as you can — this can help with sleep at night and may help improve your mood,” he says. Otallah recommends talking with your provider about any symptoms that get worse in the winter, in part because there may be an underlying condition that needs to be treated.

Sometimes relatively simple fixes can make a big difference, he says. “For example, practicing yoga or using a light therapy box may can help with seasonal affective disorder (SAD),” he says.

If your mood is more significantly impacted, counseling or medication may be recommended, he adds.

Worsening MS symptoms could also be related to an underlying sleep disorder, such as obstructive sleep apnea, says Otallah. “That can occur at an increased rate in people with MS,” he says.

Strategies for Dealing With Cold Weather When You Have MS

The way to work around cold-weather MS issues depends on the type of symptom that you’re having in the cold, says Otallah. “If it’s pain, then you might truly need to avoid the cold; you don’t want to go out in a really cold place.”

And if you can’t avoid going out, you may want to put a scarf around your face and really bundle up, he says.

Appelbaum also recommends dressing in layers, both to stay warm and so that you can quickly remove one if you begin to get too hot.

She also recommends preheating the car before setting out and, if you’re in the market for a new car, considering getting a heated steering wheel to keep your hands warm while driving. If you’re not buying a new car soon, you can find a variety of heated steering wheel covers for purchase online.

Finally, Appelbaum combats the cold by practicing restorative yoga, which, she says, allows her to warm up her body without overheating, enabling her to avoid the dizziness and weakness she experiences when her body temperature is too high.

Additional reporting by Tammy Worth.

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Terminology used in weather forecasts and storm warnings

Terminology used in general short range weather forecasts and storm warnings
(in accordance with Guidance document RD 52.27.724-2009 “Manual on short range general weather forecasts”)

Short-term general weather forecasts indicate the following meteorological quantities (elements): cloudiness, precipitation, wind direction and speed, minimum air temperature at night and maximum temperature during the day (in ˚С), as well as weather phenomena. In table. Tables 1–5 show the terms used in forecasts for various meteorological quantities (elements), weather phenomena and their corresponding quantitative characteristics.

To take into account the specifics of the expected synoptic process and / or the influence of regional features of the territory for which the forecast is made, if the forecasted meteorological values ​​and weather phenomena in certain parts of the territory differ significantly, they are performed by detailing the forecast, applying additional gradations. To distinguish individual parts of the territory, the characteristics of the geographical position are used (west, south, northern half, central regions, right bank, coastal regions, suburbs, etc.), as well as terrain features (low places, lowlands, valleys, foothills, passes, mountains, etc.). etc.).

Detailing the forecast for a territory or point using additional gradation and the terms “in certain areas” or “in places” is allowed, as a rule, if there is an influence (impact) of atmospheric processes (phenomena) on a mesometeorological scale:

– heavy rainfall, thunderstorms, hail, squall associated with the development of intense convection;

– fog and air temperature (including frost in the air and on the ground) due to the influence of terrain features or radiation factors (inflow of solar radiation into the atmosphere and on the earth’s surface, its absorption, scattering, reflection, own radiation of the earth’s surface and atmosphere) .

In order to take into account the influence of radiation factors, it is allowed to detail the air temperature forecast using additional gradation and the terms “during clearings”, “during the intrusion of clouds”.

The use of the terms “in places” or “in separate areas (points)” in a weather forecast implies that the expected weather phenomenon or the value of a meteorological quantity will be confirmed by observational data from no more than 50% of meteorological observation units located in the territory over which made a forecast.

Terms used in cloud forecasts

Table 1

If a significant change in the amount of cloudiness is expected during half a day, then it is allowed to use two characteristics from the terminology given in Table 1, and also to use the words “decrease” or “increase”. For example: In the morning partly cloudy, in the afternoon an increase in cloudiness to significant.

Terms used in precipitation forecasts

state), quantity, duration ( recommended but not required). The terms and their corresponding quantitative values ​​for liquid and mixed precipitation are given in Table. 2a, for solid precipitation – in table. 2b.

Table 2a

Table 2b

For a more detailed description of the expected distribution of precipitation over the territory, it is recommended to use additional (usually neighboring) gradations of precipitation in the forecast, it is also possible to use the terms “in separate areas” and “in places”.
For example: In the second half of the day, thunderstorms are expected in the region, in some places heavy showers.

To characterize the type of precipitation (liquid, solid, mixed), the following terms are used: “rain”, “snow”, “precipitation”. The term “precipitation” can only be used with the obligatory addition of one of the terms given in Table. 3.

Table 3

For a qualitative description of the duration of precipitation, it is recommended to use the terms given in Table. 4.

Table 4

If the forecasts indicate “slightly cloudy” or “partly cloudy”, the term “clear weather” is allowed not to be used.

Terms used in wind forecasts

Wind direction and speed are indicated in weather forecasts and storm warnings. It is allowed to use the detailed forecast of wind characteristics (direction, speed) by parts of the territory. The direction of the wind is indicated in quarters of the horizon (where the wind blows from): northeast, south, southwest, etc.). If during half a day a change in wind direction is expected within two adjacent quarters of the horizon, then two adjacent quarters are indicated; if the wind direction is expected to change by more than two-quarters of the horizon, then the term “transitional” is used. H example: 1. The wind is southeast, south.

2. South wind with transition to northwest.

In weather forecasts and storm warnings indicate the maximum wind speed in gusts in meters per second (hereinafter – the maximum wind speed) or the maximum average wind speed if gusts are not expected.

Note: The maximum average wind speed is the highest average wind speed expected in any 10-minute interval during the forecast or storm warning period.

In weather forecasts and storm warnings, wind speed is indicated in gradations with an interval of no more than 5 m/s. In case of light wind (speed ≤5 m/s), it is allowed not to indicate the direction or to use the term “weak, variable directions”.

If the wind speed is expected to change significantly during half a day, then the indication of these changes is formulated using the terms “weakening” or “strengthening” with the addition of a characteristic of the time of day.

N Example: South wind 3-8 m/s with an increase in the afternoon to 20 m/s (i.e. the maximum wind speed with gusts will reach 15-20 m/s).

When forecasting a squall, wind direction is not indicated. It is recommended to use the terms “squally wind increase up to …. m/s” or “squall up to … m/s” indicating the maximum wind speed.
For example: during a thunderstorm, a squally wind increase up to 20-25 m/s (or a squall up to 25 m/s).

In weather forecasts, in addition to the quantitative value of wind speed, its qualitative characteristic can be used in accordance with Table 5.

Table 5

Qualitative characteristic of wind speed

Wind speed range, m/s

Weak

0-5

Moderate

6-14

Strong

15-24

Very strong

25-32

Hurricane

33 and over

If the predicted wind speed interval can be characterized by two qualitative characteristics, then the characteristic for the upper limit of the interval is used.

17 m/s is included in the speed range of 15-24 m/s.

Terms used in weather forecasts

Weather forecasts should include the following expected weather phenomena: precipitation (rain, snow), thunderstorm, hail, squall, fog, hail ice, frost, sticking (deposition) of sleet on wires (wires) and trees (trees), drifting snow, snowstorm, dust (sand) storm, as well as ice on the roads and snow drifts on the roads.

In weather forecasts, the term “heavy” and for precipitation “very heavy” is used when the event is expected to reach the OH criteria in intensity. In other cases, the characteristics of the intensity of phenomena (“weak” or “moderate”), with the exception of the intensity of precipitation, are allowed not to be indicated.

When forecasting a squall, indicate the maximum wind speed.

In weather forecasts, if necessary, the terms “intensification”, “weakening”, “cessation” are used, indicating the time of day.

Terms used in air temperature forecasts

900 09

anomalous course of 5˚ or more per half day.
The expected minimum and maximum air temperatures are indicated in gradations in the interval for the point 2˚, and for the territory – 5˚. In forecasts of air temperature for a point or for a separate part of the territory, it is allowed to indicate the air temperature as a single number (for a point – using the preposition “about”, and for a part of the territory – using the preposition “before”). In the first case, we mean the middle of the predicted temperature range for the point, in the second case, its limiting value for the specified part of the territory.

For example: 1. Temperatures up to 20˚ were predicted in the west of the territory. This means that a temperature of 15…20˚ is expected.

2. Air temperature in the city is predicted to be around 20°C. This means that the temperature in the city is expected to be 19…21°

If the expected temperature distribution over the territory does not fit into the interval equal to 5˚, then it is recommended to apply additional temperature gradations, using the detailing of the temperature forecast by parts of the territory. At the same time, the forecast should indicate the areas where these deviations in air temperature are expected (or the conditions under which they will be observed, for example, “during clearings”).
For example: Temperature at night 1…6˚, during clearings (or in the northern regions) down to -2˚.

If an anomalous change in air temperature is expected, then its highest (lowest) value is indicated, indicating the period of the day when it is forecast.

For example: The temperature in the evening is -10…-12°, in the morning the temperature rises to -2° .

When using the terms “increase” (“warming”) or “decrease” (“cooling”), “intensification (“weakening”) of frost (heat)”, the predicted temperature value can be indicated in one number with the preposition “before”.

If, during the period of active vegetation of agricultural crops or harvesting, values ​​below 0˚ fall into the predicted range of air temperature, then negative values ​​of air temperature are indicated in the weather forecast with the addition of the term “frost”. The term “freeze” is also used if temperatures below 0˚ are expected at the soil surface.

For example: 1. If the expected air temperature at night is from -2 to +3˚, the temperature forecast is formulated as follows: temperature 0 … 3 °, in some places (in the east, in the north, in low places) frosts down to -2 °.

. down to -2°.

If the value of the maximum (minimum) temperature in HH gradations is expected, then the term “severe heat” (“severe frost”) is used in the forecast.

Definitions

Hazardous meteorological phenomena damaging effect on people, farm animals and plants, economic facilities and the environment.

Cooling in Moscow will continue. When will the warmth return?

Cold air masses from the Arctic will continue to move through the territory of Moscow and the Moscow region. The values ​​of the average daily temperature will lag behind the climatic norm by 7-9° on May 6 and 7, then by May 9-10 this difference will slightly decrease to 4-5°. Frosts are predicted even in Moscow, with the exception of the city center.

May 6 may become one of the coldest days in the history of MS VDNKh. So far, the coldest day on May 6 was observed in 1965, when the daytime temperature did not rise above 5.5 °. The average daily temperature was only 2.3°C. It will be very cold on May 7th.

On Saturday, May 6, light rain and sleet are predicted in places, the weather will be windy, wind gusts in places can reach 15 m/s, the weather will feel even colder than thermometers show. Until May 10, inclusive, in the anticyclone area, the probability of precipitation will be minimal. In the afternoon on Monday, May 8, the wind will be weaker, after a cold night it will be possible to feel that the air will gradually begin to warm up, in the afternoon 10 … 12 °. Day 9 will be even warmerMay, when with a light wind the maximum temperature will reach 12 … 14 °.

It remains to be reminded that in the previous 2 years the 1st decade of May was also cold, but still approximately 1.5-2 degrees warmer than this year. It was even a little colder in 2007. Preliminarily, we can say that this first decade of May is the coldest since 2008.

Saturday, May 6, at night partly cloudy, mostly without precipitation, frosts in Moscow, temperature -2…0°, in freezing area, temperature -5…0°, northwest wind 3- 8 m/s. Cloudy with clearings in the afternoon, light precipitation in places (rain, sleet), temperature in Moscow 5…7°, in the region 4…9°, northwest wind 6-11 m/s, gusts up to 15 m/s in places.

Sunday, May 7, partly cloudy. No precipitation. Frosts in Moscow at night, temperature -3…-1° (in the city center 0…2°), in the area of ​​freezing, temperature up to -5°, in the daytime in Moscow 8…10°, in the region 5.