Multiple Sclerosis

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Overview

What is multiple sclerosis (MS)?

Multiple sclerosis is an autoimmune disease that affects the nervous system. Normally, antibodies produced by the immune system help protect the body against viruses, bacteria and other foreign substances. In people who have MS, the immune system destroys the substance that surrounds and protects your nerve cells – the myelin sheath. The job of the nervous system is to send electrical messages back and forth from the brain to different parts of the body. Normally, the brain quickly sends signals through the spinal cord and then through nerves that branch out to all organs and body parts. When myelin around nerves is damaged or destroyed, the nerves can't function properly to deliver these signals in the right way. This can cause symptoms throughout the body.

What is it like living with multiple sclerosis?

The most common form of MS is known as relapsing-remitting MS (RRMS). When people who have this kind of MS have flare-ups, the symptoms become noticeably worse. Then there is a period of recovery, when symptoms get better or disappear completely for some time. In RRMS, symptom flare-ups may be triggered by an infection, such as the flu. More than 50% of people who have RRMS develop the secondary progressive type in which there are relapses followed by a gradual worsening of the disease. About 15% to 20% of people who have MS have a form known as primary-progressive MS (PPMS). In this kind of MS, the disease gets steadily worse, without any remissions. A fourth type—progressive relapsing MS—is rare, but the pattern follows a worsening of the disease with sudden, clear relapses. Often MS is mild, but some people lose the ability to write, speak or walk.

This information was developed as part of an educational program made possible through support from AstraZeneca.

Symptoms

What are the symptoms of multiple sclerosis (MS)?

MS affects normal sensation, thinking and movement. Symptoms vary from person to person, depending on the area of the body where the myelin sheath is damaged. Symptoms of MS may come and go. Flare-ups may last for days, weeks or months. After an episode, your symptoms may disappear for a while (go into remission), but scars can form and permanently affect nerves in that area. Common symptoms include:

  • Vision problems, including double vision, blurriness, partial color blindness, eye pain, partial or complete loss of vision in one eye
  • Thinking and memory problems
  • Fatigue
  • Muscle weakness, dizziness or tremor
  • Numbness or weakness on one side or the bottom half of your body
  • Trouble with coordination and balance
  • Loss of bowel or bladder control
  • Sensations such as numbness or tingling, "pins and needles"
  • Electric-shock sensations caused by moving your head in a certain way

Causes & Risk Factors

Who gets multiple sclerosis (MS)?

MS affects women more than twice as often as men. White (Caucasian) people are more likely to develop it than people of other races. If someone in your family--such as a parent or sibling--has MS, you have a greater risk of developing it, too. MS can affect people of any age, but it often begins between the ages of 20 and 40. If you have another autoimmune disease, such as thyroid disease or Type 1 diabetes, your risk of developing MS is slightly higher. Some studies show that where you live can affect your risk of getting MS. People who spend their childhood in areas with a temperate climate, such as northern United States or southern Canada, seem to be at higher risk for MS.

What causes MS?

No one really knows for sure what causes MS. It's most likely the result of a combination of environmental, viral and genetic factors. A number of different viruses have been linked to MS. A childhood virus may trigger MS later in life.

Diagnosis & Tests

How do I know if I have multiple sclerosis (MS)?

There is no one test to tell if you have MS. Like other autoimmune diseases, MS may be difficult to diagnose. Often, the first symptoms of MS affect the eyes, causing blurred or double vision, or red-green color distortion. However, symptoms can also affect different parts of the body. Your doctor will ask you about your medical history, and use several strategies to determine if you have MS. Before making a diagnosis, your doctor will rule out other possible causes of your symptoms. Your doctor may also order tests: Blood test. Your blood can show signs of other illnesses that cause symptoms similar to the symptoms of MS. Neurological tests. Your doctor may want you to see a neurologist who can test how well your nervous system is working. The tests will look for changes in eye movements, muscle coordination, weakness, balance, sensation, speech, and reflexes. Spinal tap (lumbar puncture). A small amount of fluid taken from your spine can show abnormal amounts of blood cells or proteins associated with MS. A spinal tap can also rule out a viral infection or other possible conditions. Magnetic Resonance Imaging (MRI). An MRI can show detailed pictures of the brain and spinal cord, and if there are any lesions present. However, lesions aren't always caused by MS.

Treatment

How is multiple sclerosis (MS) treated?

There is currently no cure for multiple sclerosis. A combination of medicines, physical, speech and occupational therapies may help you cope with and relieve your symptoms, slow the progress of the disease and maintain a good quality of life.

How can medicines help?

Some medicines for MS can help relieve symptoms and treat specific problems. Other medicines can affect the long-term outcomes of the disease.

Some people who have mild symptoms choose not to take certain medicines because of the risks associated with them and the possibility of serious side effects. Your doctor will talk to you about the risks and benefits of taking medicines to treat MS.

What symptoms of MS can medicines treat?

Specific medicines can treat some of the common symptoms of MS. These include:

  • Bladder problems: tolterodine, oxybutynin
  • Constipation: stool softener, laxative
  • Depression: venlafaxine, paroxetine
  • Erectile dysfunction: tadalafil, alprostadil
  • Pain: phenytoin, gabapentin
  • Muscle stiffness and spasms (spasticity): dantrolene, baclofen
  • Urinary problems: desmopressin, methenamine, phenazopyridine

What about steroids?

During flare-ups, affected nerve areas can become inflamed. You may have pain and loss of function in parts of your body. Steroids reduce inflammation, so that you can return to normal function sooner. Some examples of steroids given for MS include prednisone (taken by mouth) and methylprednisolone (given as a shot). Steroids are usually taken for a short period of time to help with symptoms. They do not treat the long-term outcomes of MS.

What medicines treat the long-term effects of MS?

Interferons are a group of natural proteins made by human cells. Interferons seem to slow the worsening of symptoms of MS over time. These kinds of medicine are usually given as an injection (a shot). Some examples of interferons used to treat MS include IFN Beta-1a and IFN Beta-1b. Interferons may cause serious liver damage as a side effect. Other side effects include flu-like symptoms and depression. Glatiramer acetates are thought to block the cells that damage myelin, the substance that surrounds and protects your nerve cells. People taking this drug usually experience fewer relapses and fewer new nerve cell lesions. The medicine is given as a shot (injected with a needle) once a day. Side effects may include hives or pain at the injection site, heart palpitations and shortness of breath.

What other medicines are used to treat MS?

Natalizumab and mitoxantrone are 2 other kinds of medicine that treat more serious or advanced multiple sclerosis. People who have tried other drugs first and have not had good results may try natalizumab. However, natalizumab can have serious side effects, and it should not be used in combination with other disease-modifying drugs. One of the known side effects is an increased risk of a fatal brain infection. Mitoxantrone is sometimes used by people whose relapsing-remitting MS has worsened or changed to progressive MS, in which symptoms get steadily worse. Side effects include lowered resistance to infection, and increased risk of blood and heart disease.

How can other therapies help?

Different therapies can be helpful for some people who have MS. Some of the common ones are listed below. Physical Therapy (PT) can help with walking, strength, balance, posture, fatigue and pain. PT can include stretching and strengthening exercises, and training to use mobility aids like canes, scooters or wheelchairs. Your physical therapist can also help you adapt your exercise routine to accommodate your symptoms or flare-ups. Occupational Therapy (OT). The goal of OT is to help improve your level of independence and safety at home and at work. Your therapist can show you how to use tools to help in daily tasks. Your therapist can also recommend changes to your physical living or working space to make your tasks easier. Your therapist may help you continue to pursue activities or hobbies that you enjoy. Speech Therapy. MS can cause problems with the control of the muscles used for talking and swallowing. A speech therapist can help you learn to communicate as clearly as possible, and also teach you to practice safe swallowing.

How can I keep myself as healthy as possible?

Living with MS may require you to make some lifestyle changes. These changes can help keep you as strong and healthy as possible. Below are some tips that may help. Nutrition. Eat a nutritious, well-balanced diet that is low in fat and high in fiber. A healthy diet will keep your immune system strong, and give you the best chance of good health. Physical Activity. Continue to exercise if your doctor says it is okay. Exercise can help you improve muscle tone and strength, balance and coordination. Stretching exercises can help with stiffness and mobility. Exercise can also help lift your mood. Rest. It is important to get enough exercise, but it is also important to get plenty of rest. MS causes fatigue, so pay attention to your needs. You may have to make accommodations in your work or family schedule to include time for rest. Temperature. Some people who have MS aren't bothered by heat, but be careful using hot tubs or saunas, and taking hot baths or showers. Too much heat can lead to extreme muscle weakness. If heat bothers you, find ways to cool down. A cool bath or air conditioning may help. Support. Get support from friends, family, your community, a support group, your doctor or other health care professionals. Encouragement and reassurance from others will help you better cope with the challenges of living with MS. Try to maintain as normal a life as you can, and continue to do the things you enjoy.

Complications

How else can multiple sclerosis (MS) affect my life?

Living with a chronic illness can often be challenging to your emotional well-being. MS can affect your work, your relationships, your sleep, your diet and your ability to exercise. All of these factors contribute to your mood and mental health. Talking with a trained therapist can help you learn to deal with these challenges, and help you develop ways to get the support you need. A trained therapist can also meet with other family members.

Questions to Ask Your Doctor

  • Does multiple sclerosis run in families? Am I at risk?
  • I've been diagnosed with MS. What can I do to prevent a relapse and prevent the condition from getting worse?
  • How can I be sure that I have MS? How can I be sure I don't have MS?
  • Is there a cure for MS? What research is being done to help treat and cure MS?
  • What are the possible side effects of the medicine I'm taking?
  • What should I do if I think I'm having a relapse?