Multiple Sclerosis (MS)


Fact: The first symptoms of MS often start between ages 20 and 40.

What is multiple sclerosis?
MS is a chronic illness involving your central nervous system. The immune system attacks myelin, which is the protective layer around nerve fibers. This causes inflammation and scar tissue, or lesions. This can make it hard for your brain to send signals to the rest of your body. Types of MS include:

Relapsing-remitting MS (RRMS)
RRMS involves clear relapses of disease activity followed by remissions. During remission periods, symptoms are mild or absent and there’s no disease progression. RRMS is the most common form of MS at onset.

Clinically isolated syndrome (CIS) 
CIS involves one episode of symptoms lasting at least 24 hours. These symptoms are due to demyelination in your central nervous system.
The two types of episodes are monofocal and multifocal. A monofocal episode means one lesion causes one symptom. A multifocal episode means you have more than one lesion and more than one symptom.

Although these episodes are characteristic of MS, they aren’t enough to prompt a diagnosis. If lesions similar to those that occur with MS are present, you’re more likely to receive a diagnosis of RRMS. If these lesions aren’t present, you’re less likely to develop MS.

Primary-progressive MS (PPMS)
Neurological function becomes progressively worse from the onset of your symptoms if you have PPMS. However, short periods of stability can occur.
Progressive-relapsing MS was a term previously used for progressive MS with clear relapses. This is now called PPMS. The terms “active” and “not active” are used to describe disease activity.

Secondary-progressive MS (SPMS)
SPMS occurs when RRMS transitions into the progressive form. You may still have noticeable relapses, in addition to gradual worsening of function or disability.


What are the symptoms of MS?
People with multiple sclerosis (MS) experience a wide range of symptoms. Due to the nature of the disease, symptoms can vary widely from person to person. They can also change in severity from year to year, month to month, and even day to day.
Two of the most common symptoms are fatigue and difficulty walking.

About 80 percent of people with MS report having fatigue. Fatigue that occurs with MS can become debilitating, affecting your ability to work and perform everyday tasks.

Difficulty walking can occur with MS for a number of reasons:

  • numbness of your legs or feet
  • difficulty balancing
  • muscle weakness
  • muscle spasticity
  • difficulty with vision


Overwhelming fatigue can also contribute to the problem. Difficulty walking can lead to injuries due to falling.

Other fairly common symptoms of MS include:

  • speech disorders
  • tremor
  • cognitive issues involving concentration, memory, and problem-solving skills
  • acute or chronic pain

The first symptoms often start between ages 20 and 40. Most people with MS have attacks, also called relapses, when the condition gets noticeably worse. They’re usually followed by times of recovery when symptoms improve. For other people, the disease continues to get worse over time.

In recent years, scientists have found many new treatments that can often help prevent relapses and slow the disease’s effects.

What Causes MS?
Doctors don’t know for sure what causes MS, but there are many things that seem to make the disease more likely. People with certain genes may have higher chances of getting it. Smoking also may raise the risk.

Some people may get MS after they’ve had a viral infection -- like the Epstein-Barr virus or the human herpesvirus 6 -- that makes their immune system stop working normally. The infection may trigger the disease or cause relapses. Scientists are studying the link between viruses and MS, but they don’t have a clear answer yet.

Some studies suggest that vitamin D, which you can get from sunlight, may strengthen your immune system and protect you from MS. Some people with higher chances of getting the disease who move to sunnier regions seem to lower their risk.


Diagnosing MS
Your doctor will need to perform a neurological exam, a clinical history, and a series of other tests to determine if you have MS.

Diagnostic testing may include the following:

  • MRI scan. Using a contrast dye allows the MRI to detect active and inactive lesions throughout your brain and spinal cord. 
  • Evoked potentials test. This requires stimulation of nerve pathways to analyze electrical activity in your brain. The three types of evoked potentials doctors use to help diagnose MS are visual, brainstem, and sensory.
  • Spinal tap (lumbar puncture). Your doctor may use this test to find abnormalities in your spinal fluid. It can help rule out infectious diseases. 
  • Blood tests. Doctors use blood tests to eliminate other conditions with similar symptoms.

The diagnosis of MS requires evidence of demyelination occurring at different times in more than one area of your brain, spinal cord, or optic nerves.

It also requires ruling out other conditions that have similar symptoms, such as:

  • Lyme disease
  • Lupus
  • Sjögren’s syndrome

Treatment
There is no cure for MS right now, but a number of treatments can improve how you feel and keep your body working well.

Your doctor can also prescribe drugs that may slow the course of the disease, prevent or treat attacks, ease your symptoms, or help you manage the stress that can come with the condition.

Drugs that may slow your MS or help nerve damage include:

  • Beta interferon (Avonex, Betaseron, and Rebif)
  • Copolymer-1 (Copaxone)
  • Dalfampridine (Ampyra)
  • Dimethyl fumarate (Tecfidera)
  • Mitoxantrone (Novantrone)
  • Natalizumab (Tysabri)
  • Ocrelizumab (Ocrevus)
  • Teriflunomide (Aubagio)


Your doctor may give you steroids to make your MS attacks shorter and less severe. You can also try other drugs, like muscle relaxants, tranquilizers, or botulinum toxin (Botox), to ease muscle spasms and treat some of the other symptoms.

​A physical therapist can teach you exercises that will keep up your strength and balance and help you manage fatigue and pain. An occupational therapist can teach you new ways to do certain tasks to make it easier to work and take care of yourself. If you have trouble getting around, a cane, walker, or braces can help you walk more easily.

Along with treatment, you can do other things to ease your MS symptoms. Get regular exercise and avoid too much heat to boost your energy. Ask your doctor about trying yoga to ease fatigue or stress.

​Take care of your emotional health, too. It’s OK to ask family, friends, or a counselor for help with any stress or anxiety you may feel. Support groups are also great places to connect with other people living with MS.

What’s the Outlook for MS?
Research is giving doctors more treatment options for the condition, a better idea of what causes it, and the ability to diagnose it earlier. Stem-cell and genetic research may soon help doctors repair damaged nerves or stop the disease before it causes damage.

Scientists are also looking for new ways to treat MS in clinical trials. These trials test new drugs to see if they're safe and if they work. They're often a way for people to try new medicine that isn’t available to everyone. Ask your doctor if one of these trials might be a good fit for you.

​Information on this page taken directly from:
Healthline
National Multiple Sclerosis Society
WebMD

Want to learn more?

The following are organizations and/or websites dedicated to providing information and education surrounding Multiple Sclerosis. These organizations are dedicated to research, education, awareness, and/or support. They are listed in Alphabetical order without any preference or prejudice. Listing these organizations is not a recommendation or referral in any regard for seeking treatment or consultation or support for treatment.

Healthline
National Multiple Sclerosis Society
PubMed Library
WebMD