What is multiple sclerosis?
Multiple sclerosis (MS) is a rare autoimmune disease that affects the central nervous system (CNS). 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 attacks the body. Antibodies destroy the substance that surrounds and protects your nerve cells, called the myelin sheath.
The CNS is made up of your brain, spinal cord, and optic nerves. Its job is to quickly send messages back and forth from the brain to different parts of the body. Damaged or destroyed myelin can slow down and block these messages.
There are four forms of MS:
- Clinically Isolated Syndrome (CIS). This is a 24-hour episode with neurologic symptoms similar to MS. It is caused by swollen and damaged myelin. People who have CIS should get a MRI on their brain. If lesions are found, the risk of having MS is increased. Some people may not have future episodes or develop MS.
- Relapsing-remitting MS (RRMS). This is the most common form of MS. People who have RRMS have relapses, or flare-ups, where new symptoms occur or old symptoms become worse. Then, there is a period of recovery, or remission, where symptoms get better or go away for some time. In RRMS, relapses may be triggered by an infection, such as the flu. The disease does not worsen between flare-ups.
- Primary progressive MS (PPMS). About 15% to 20% of people who have MS develop PPMS. In this form of MS, the disease gets steadily worse, with few or no relapses, remissions, or new brain lesions.
- Secondary progressive MS (SPMS). About 50% of people who have RRMS will develop SPMS. In this form, ongoing relapses and remissions may cause an increase in level of disability and new brain lesions over time.
Symptoms of multiple sclerosis
MS affects normal sensation, thinking, and movement. Symptoms vary depending on the part(s) of the body where the myelin sheath is damaged. Symptoms of MS are often mild. In rare cases, people may have some paralysis and lose the ability to write, speak, or walk.
Common symptoms include:
- Vision problems, including double vision, blurriness, partial color blindness, eye pain, and partial or complete loss of vision
- Thinking and memory problems
- Muscle weakness
- 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 (called “pins and needles”)
- Tremors, spasms, or seizures
- Electric-shock sensations caused by moving your head in a certain way
- Vaginal dryness in women
- Erectile dysfunction in men
Symptoms of MS often come and go. Relapses may last for days, weeks, or months. For it to be considered a relapse, symptoms must last at least 24 hours and occur at least 30 days after the last relapse. During remission, your symptoms may continue or disappear for a while. Lesions can form and permanently affect nerves in that area.
For pregnant women, MS symptoms improve during pregnancy. Unfortunately, symptoms return within a few months of giving birth. MS doesn’t increase the risks that can occur during any pregnancy. This includes pregnancy-induced hypertension (high blood pressure).
What causes multiple sclerosis?
The exact cause of MS in unknown. It is most likely the result of genetic and environmental factors. A number of viruses have also been linked to MS. A childhood virus may trigger MS later in life.
MS affects women more than twice as often as men. White (Caucasian) people are more likely to develop it than people of other races. MS can run in families. Your risk of MS increases if someone in your family, such as a parent or sibling, has it. 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 MS is higher. Some studies show that where you live can affect your risk of getting MS. People who grow up in areas with a mild climate, such as northern United States or southern Canada, seem to be at a higher risk for MS.
How is multiple sclerosis diagnosed?
Like other autoimmune diseases, MS can be difficult to diagnose. Most often, the first symptoms of MS are vision problems. Symptoms can also affect different parts of the body. Your doctor will ask about your health history and do a full exam.
Before making a diagnosis, your doctor will want to rule out other possible causes of your symptoms. To do this, they may order certain tests, such as:
- Blood tests. Your blood can show signs of illnesses that cause symptoms similar to those of MS.
- Neurological tests.Your doctor may want you to see a specialist. A neurologist can test how well your central nervous system is working. They 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 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, or scars. Lesions aren’t always caused by MS.
In order to diagnose MS, you must:
- Have damaged myelin in at least two areas of the CNS.
- Have had at least two relapses, or episodes, that caused damage.
Your doctor also must have ruled out all other potential diagnoses.
Can multiple sclerosis be prevented or avoided?
You cannot prevent or avoid MS since the cause is unknown.
Multiple sclerosis treatment
There is currently no cure for MS. The goal of treatment is to help you cope with and relieve symptoms, slow the progress of the disease and maintain a good quality of life. This can be done through a combination of medicine and physical, occupational, and speech therapy.
People who have mild symptoms may choose not to take medicine due to potential risks and side effects. Talk to your doctor about the benefits and risks of all drug options.
Certain medicines can help relieve symptoms and treat short-term problems caused by MS.
- Bladder problems: tolterodine, oxybutynin.
- Constipation: stool softener, laxative.
- Depression: venlafaxine, paroxetine.
- Pain: phenytoin, gabapentin.
- Muscle stiffness and spasms: dantrolene, baclofen.
- Urinary problems: desmopressin, methenamine, phenazopyridine.
- Erectile dysfunction: tadalafil, alprostadil.
Other types of medicine can affect the long-term outcomes of the disease.
- Interferons are a group of natural proteins made by human cells. Studies show they can slow down the worsening of symptoms. These medicines are often given as an injection (a shot). Examples of interferons used to treat MS are IFN Beta-1a and IFN Beta-1b. Interferons may cause serious liver damage. Other side effects include flu-like symptoms and depression.
- Glatiramer acetates are thought to block the cells that damage myelin. It can lead to fewer relapses and fewer new lesions. The medicine is taken as a shot once a day. Side effects may include hives or pain at the injection site, heart tremors, and shortness of breath.
Two other type of medicine may be used to treat severe or advanced MS.
- Natalizumab: This is an option for people who have tried other drugs first and not had good results. It can have serious side effects, and should not be used in combination with other disease-modifying drugs. One known side effect is an increased risk of a fatal brain infection.
- Mitoxantrone: This is an option for people who have increased relapse and remission periods, progressive MS, or worsened symptoms. Side effects include weakened immune system and an increased risk of blood and heart disease.
During relapses, affected nerve areas can become inflamed. You may have severe pain and loss of vision or bodily function. Steroids can reduce swelling and allow you to return to normal function sooner. Examples of steroids used to treat MS are prednisone (a pill) and methylprednisolone (a shot). Steroids should be taken to treat short-term symptoms. They do not treat long-term effects of MS.
Different therapies can be helpful for people who have MS.
- 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 therapist can help you adapt your exercise routine to accommodate your symptoms and flare-ups.
- Occupational Therapy (OT) can improve your level of freedom and safety at home and at work. Your therapist can show you how to use tools to help in daily tasks. They can also recommend changes to your home or work space to make tasks easier. Your therapist may help you learn how to adapt to activities or hobbies that you enjoy.
- Speech Therapy can help you better control muscles used for talking and swallowing.
- Pre-pregnancy planning is important for women. Certain medicines used to treat MS symptoms are not safe for your baby during pregnancy. These include medicines called “disease-modifying drugs.” Another group is called “chemotherapeutic drugs.” This includes azathioprine or methotrexate. Your doctor may suggest that you stop taking these medicines before trying to get pregnant. Some other medicines that are considered safe during pregnancy can be helpful in treating MS symptoms. Your doctor may recommend that you change medicines while you are trying to get pregnant and during your pregnancy. Some medicines used to treat MS may be passed on to babies during breastfeeding. This is not safe for the baby. Talk to your doctor about your breastfeeding plans.
Living with multiple sclerosis
Living with MS, a chronic (ongoing) illness, can be physically and emotionally hard. Certain lifestyle changes can help improve your quality of life and keep you as strong and healthy as possible.
- Eat a well-balanced diet that is low in fat and high in fiber. A nutritious 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 improve your muscle tone and strength, balance, coordination, and even your mood. Stretching exercises can help with stiffness and mobility.
- It is also important to get plenty of rest. MS causes fatigue, so pay attention to your needs. You may have to adapt your work or personal schedule to include time for rest.
- Too much heat can cause nerve pain and lead to extreme muscle weakness. Be careful using hot tubs or saunas, and taking hot baths or showers. If heat bothers you, find ways to cool down. A cool bath or air conditioning may help.
- Get support from your friends, family, and community. They can provide encouragement to help you cope with your disease. You can also look to your doctor, who may recommend a counselor or support group. Try to maintain as normal a life as you can, and continue to do the things you enjoy. This can help you keep a good mood and healthy state of mind.
- Pregnancy care. If MS affects your ability to walk, you may notice that walking is more difficult during pregnancy. This is because the weight you gain during pregnancy can shift your balance. Be extra careful to avoid falls. You may need crutches or other walking assistance devices. You may need to use a wheelchair. You may become tired more easily. This is true later in the pregnancy. Plan ahead so your schedule allows for plenty of rest. Talk to your partner, family, and friends if you need help taking care of other children, doing chores, or running errands. Urinary tract infections (UTIs) are more common in pregnant women who have MS. Drink plenty of water. Let your doctor know if you have any symptoms. Your doctor may want you to have monthly urine tests to make sure a UTI doesn’t sneak up on you.
- Labor and delivery. Some women who have MS have damage to the spinal cord. This interferes with the ability to tell when labor starts. This is rare. But it may be a concern for some women. If you have reduced feeling in your pelvic area or abdomen, talk to your doctor. He or she can talk to you about other clues that labor has started. Some women who have MS experience nerve damage that prevents the muscles from pushing during delivery. If so, you may need extra help to deliver your baby vaginally. You may need a cesarean section (C-section). You may also need a C-section if you become overly tired during labor. Anesthesia is not any more risky for women who have MS than other women. Babies born to women who have MS have no greater risk of birth defects, physical, or intellectual disabilities.
- Post-pregnancy. Plan ahead for life after giving birth. Some women experience a “flare” or increase in symptoms after the delivery. You may be extra tired. The risk for post-partum depression is the same for women who have MS and those who do not. Talk to your doctor if you are experiencing depression.
Questions to ask your doctor
- Does MS run in families? Am I at risk of getting it or passing it to my children?
- How can I be sure that I have MS, or if my symptoms are caused by another disease?
- What treatment options are best for me, and what are the benefits and risks?
- What are the possible side effects of medicines used to treat MS?
- Is there anything I can do to prevent a relapse or keep the condition from getting worse?
- What should I do if I think I’m having a relapse?
- How often should I get tests, such as an MRI?
- What research is being done to help treat and cure MS?
- Does MS change my life expectancy?
- Does MS put me at risk of having other health issues?
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.