Multiple Sclerosis

Multiple sclerosis (MS) is a nervous system disease that affects your brain and spinal cord. It is a potentially disabling disease of the brain and spinal cord (the central nervous system). In MS, the body’s own immune system attacks the protective sheath (myelin) that covers nerves and impairs the brain’s ability to communicate with the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged.

Signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently or at all, while others may experience long periods of remission without any new symptoms. Common symptoms of MS include visual disturbances, muscle weakness, problems with coordination and balance, sensations such as numbness, prickling, or "pins and needles", and thinking and memory problems.

The cause of MS is unknown. It may be an autoimmune disease, which happens when your immune system attacks healthy cells in your body by mistake. MS affects women more than men, and it often begins between the ages of 20 and 40. Usually, the disease is mild, but some people lose the ability to write, speak, or walk.

There is no cure for MS, but medicines may slow it down and help control symptoms. Physical and occupational therapy may also help.

MS signs and symptoms differ greatly from person to person and over the course of the disease, depending on the location of affected nerve fibers. The initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye. Other symptoms may include:

• numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or the legs and trunk
• partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
• prolonged double vision
• tingling or pain in parts of your body
• electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign)
• tremor, lack of coordination or unsteady gait
• slurred speech
• fatigue
• dizziness
• problems with bowel and bladder function

Most people with MS have periods of relapse and remission. They experience periods of new symptoms or relapses that develop over days or weeks and usually improve partially or completely. These relapses are followed by quiet periods of disease remission that can last months or even years.

Approximately 60% to 70% of people with relapsing-remitting MS eventually develop a steady progression of symptoms, with or without periods of remission, known as secondary-progressive MS. The worsening of symptoms usually includes problems with mobility and gait. The rate of disease progression varies greatly among people with secondary-progressive MS. Some people with MS experience a gradual onset and steady progression of signs and symptoms without any relapses. This is known as primary-progressive MS.

The cause of MS is unknown. It is considered an autoimmune disease in which the body's immune system attacks its own tissues. In MS, this immune system destroys the fatty substance that coats and protects nerve fibers in the brain and spinal cord (myelin). When the protective myelin is damaged and nerve fiber is exposed, the messages that travel along that nerve may be slowed or blocked. The nerve may also become damaged itself. A combination of genetics and environmental factors appears to be responsible for developing MS.

Several factors may increase the risk of developing MS, including:

• age. MS can occur at any age, but it most commonly affects people between the ages of 15 and 60 years.
• sex. Women are about twice as likely as men are to develop MS.
• family history. If a parent or sibling has had MS, you are at higher risk of developing the disease.
• certain infections. A variety of viruses have been linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis.
• race. White people, particularly those of Northern European descent, are at highest risk of developing MS. People of Asian, African or Native American descent have the lowest risk.
• climate. MS is far more common in countries with temperate climates, including Canada, the northern United States, New Zealand, southeastern Australia and Europe.
• certain autoimmune diseases. You have a slightly higher risk of developing MS if you have thyroid disease, type 1 diabetes, or inflammatory bowel disease.
• smoking. Smokers who experience an initial event of symptoms that may signal MS are more likely than nonsmokers to develop a second event that confirms relapsing-remitting MS.

There is no single test for MS. Doctors use a medical history, physical exam, neurological exam, MRI, and other tests to diagnose it. Your doctor may recommend blood tests, a lumbar puncture, or imaging studies to rule out other causes of your symptoms.

There are several self-care measures you can take to help relieve the signs and symptoms.

Get plenty of rest.

Exercise. If you have mild to moderate MS, regular exercise can help improve your strength, muscle tone, balance and coordination.

Cool down. MS symptoms often worsen when your body temperature rises. Avoid exposure to heat and use devices such as cooling scarves or vests.

Eat a balanced diet. A diet low in saturated fat but high in omega-3 fatty acids, such as those found in olive and fish oils, may help improve MS symptoms. Vitamin D may also have potential benefit for people with MS.

Relieve stress. Stress may trigger or worsen your signs and symptoms. Yoga, tai chi, massage, meditation or deep breathing may help.

People with multiple sclerosis also may develop:

• muscle stiffness or spasms
• paralysis, typically in the legs
• problems with bladder, bowel or sexual function
• mental changes, such as forgetfulness or mood swings
• depression
• epilepsy

Physical therapy and exercise can help preserve remaining function, and patients may find that various aids, such as foot braces, canes, and walkers, can help them remain independent and mobile.

Living with any chronic illness can be difficult. Manage the stress of living with MS by:

• maintaining normal daily activities as best you can
• staying connected to friends and family
• pursuing hobbies that you enjoy and are able to do
• joining a support group, for yourself or for family members.
• discussing your feelings and concerns about living with MS with your doctor or a counselor

There is no cure for multiple sclerosis. Treatment typically focuses on speeding recovery from attacks, slowing the progression of the disease, and managing MS symptoms. Some people have such mild symptoms that no treatment is necessary.

Several types of medications are available to treat MS.

Beta interferon. Three forms of beta interferon (Avonex, Betaseron, and Rebif) have been approved for treatment of relapsing-remitting MS. Beta interferon reduces the number of symptom flares and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe.

Immune-modifying treatment. Copolymer I (Copaxone) is a synthetic form of myelin basic protein and is approved for the treatment of relapsing-remitting MS. Other drugs used to treat relapsing forms of MS in adults include teriflunomide (Aubagio), dimethyl fumarate (Tecfidera), alemtuzumab (Lemtrada), and fingolimod (Gilenya). An immunosuppressant treatment, Novantrone (mitoxantrone), is available for the treatment of advanced or chronic MS. Dalfampridine (Ampyra) improves walking in individuals with MS.

Steroids. Corticosteroids, such as oral prednisone or intravenous methylprednisolone (Solu-Medrol), do not affect the course of MS over time, but they can reduce the duration and severity of attacks in some patients.

Symptoms of MS can also be managed with medication in some cases.

Spasticity, which can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, is usually treated with muscle relaxants and tranquilizers such as baclofen (Lioresal, Kemstro, Gablofen), tizanidine (Zanaflex), diazepam (Valium), clonazepam (Klonopin), and dantrolene (Dantrium, Revonto, Novaplus Revonto, Ryanodex).

If psychological symptoms of MS such as depression or apathy are evident, antidepressant medications may help. Other drugs that may reduce fatigue in some, but not all, patients include amantadine (Symmetrel) and pemoline (Cylert).