Multiple Sclerosis (MS)
What is multiple sclerosis?
Multiple sclerosis, often called MS, is a disease that affects the central nervous system —the brain and spinal cord. It can cause problems with muscle control and strength, vision, balance, feeling, and thinking.
Your nerve cells have a protective covering called myelin. Without myelin, the brain and spinal cord can't communicate with the nerves in the rest of the body. MS gradually destroys myelin in patches throughout the brain and spinal cord, causing muscle weakness and other symptoms. These patches of damage are called lesions.
MS is different for each person. You may go through life with only minor problems. Or you may become seriously disabled. Most people are somewhere in between. Generally, MS follows one of four courses:
What causes MS?
The exact cause is unknown, but most experts believe that MS is an autoimmune disease. In this kind of disease, the body's defenses, called the immune system , mistakenly attack normal tissues. In MS, the immune system attacks the central nervous system—the brain and spinal cord .
Experts don't know why MS happens to some people but not others. There may be a genetic link, because the disease seems to run in families. Where you grew up may also play a role. MS is more common in those who grew up in colder regions that are farther away from the equator.
What are the symptoms?
Symptoms depend on which parts of the brain and spinal cord are damaged and how bad the damage is. Early symptoms may include:
How is MS diagnosed?
Diagnosing MS isn't always easy. The first symptoms may be vague. And many of the symptoms can be caused by problems other than MS.
MS is not diagnosed unless a doctor can be sure that you have had at least two attacks affecting at least two different areas of your central nervous system. The doctor will examine you, ask you questions about your symptoms, and do some tests. An MRI is often used to confirm the diagnosis, because the patches of damage (lesions) caused by MS attacks can be seen with this test.
How is it treated?
Medicines are used to treat MS:
You may find it hard to decide when to start taking the drugs that slow the progression of MS. The drugs may not work for everyone, and they often have side effects. You and your doctor will decide together when you should start any of these drugs.
How do you live with MS?
There is no cure for MS. Treatment and self-care can help you maintain your quality of life.
Physical therapy, occupational therapy, and speech therapy can help you manage some physical problems caused by MS. You can also help yourself at home by eating balanced meals, getting regular exercise and rest, and learning to use your energy wisely.
Dealing with the physical and emotional demands of MS isn't easy. If you feel overwhelmed, talk to your doctor. You may be depressed, which can be treated. And finding a support group where you can talk to other people who have MS can be very helpful.
Frequently Asked Questions
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The cause of multiple sclerosis (MS) is unknown. Because a person's risk of MS is slightly higher in some families when a relative has MS, there may be a genetic link . For more information, see What Increases Your Risk.
The symptoms of multiple sclerosis (MS) vary from person to person depending on which parts of the brain or spinal cord (central nervous system) are damaged. The loss of myelin and scarring caused by MS can affect any part of the central nervous system. Myelin is the insulating coating around a nerve.
Symptoms may come and go or become more or less severe from day to day or, in rare cases, from hour to hour. Symptoms may become worse with increased body temperature or after a viral infection.
Common early symptoms of MS include:
As MS progresses, symptoms may become more severe and may include:
In general, multiple sclerosis follows one of four courses:
MS is different for every person. You may go through life with only minor problems. Or you may become seriously disabled. Most people are somewhere in between.
The duration of the disease varies. Most people who get MS live with it for decades.
Progress of MS
MS usually progresses with a series of relapses that occur over many years (relapsing-remitting MS). In many people the first MS attack involves just a single symptom. It may be weeks, months, or years before you have a relapse.
As time goes by, symptoms may linger after each relapse so you lose the ability to fully recover from the relapse. New symptoms often develop as the disease damages other areas of the brain or spinal cord .
Events that can mean you may have a more severe type of MS include:
Some people have a few mild attacks from which they recover entirely. This is called benign MS.
Although rare, a small number of people die within several years of the onset of MS. This is called malignant or fulminant MS.
Because MS may affect your ability to move and walk, it can place limits on your daily living, particularly as you age. If you or someone in your family has MS, talk to your doctor about how MS may affect daily living. Knowing what to expect will help you plan for the future.
Complications of MS
Complications that may result from MS include:
What Increases Your Risk
Your risk for multiple sclerosis (MS) increases with:
When To Call a Doctor
Some of the symptoms of multiple sclerosis (MS) are similar to those of many other illnesses. See your doctor if over a period of time you have more than one symptom, such as:
If you have been diagnosed with MS, see your doctor if:
Milder MS-type symptoms can be caused by many other conditions or may occur now and then in healthy people. For example, lots of people have minor numbness in their fingers or a mild dizzy spell once in a while. Stiffness and muscle weakness can result from being more active than usual. A wait-and-see approach ( watchful waiting ) is appropriate for these types of everyday aches and pains, so long as they do not continue.
If your symptoms occur more often or don't go away, talk to your doctor.
For people with MS
Talk to your doctor about what to expect from the disease and from treatment. MS is an unpredictable disease, but you probably can get some idea of what is "normal" and what symptoms or problems are reasons for concern.
Some people who have MS want active, regular support from their doctors. Others want to manage their condition on their own as much as possible. Wherever you are in this range, find out which signs or symptoms mean that you need to see your doctor. And seek help when you need it.
Who to see
Health professionals who may be involved in evaluating symptoms of MS and treating the condition include:
Many university medical centers and large hospitals have MS clinics or centers staffed by neurologists and other health professionals who specialize in diagnosing and treating MS. They may be able to provide the most thorough evaluation.
If you have been diagnosed with MS, at some point you may need to seek the help of:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Diagnosing multiple sclerosis (MS) isn't always easy and in some cases may take time.
Your medical history and neurological exam can identify possible nervous system problems and are often enough to strongly suggest a diagnosis of MS. Tests may help confirm or rule out the diagnosis when your history and exam do not provide clear evidence of the disease. MRI and neurological exam may help doctors predict which people will develop MS after a first attack of symptoms.
Tests to diagnose MS
Confirming the diagnosis
MS is diagnosed when it is clear from neurological tests and a neurological exam that lesions (damaged areas) are present in more than one area of the central nervous system (usually the brain, spinal cord, or the nerves to the eyes). Tests will also clearly show that damage has occurred at more than one point in time.
Some people have had only one episode of a neurological symptom such as optic neuritis, but MRI tests suggest they may have MS. This is known as a clinically isolated syndrome. Many of these people go on to develop MS over time.
Tests to diagnose other health problems
Urinary tract tests may be needed to help diagnose a problem with bladder control in a person who has MS.
Neuropsychological tests may be needed to identify thinking or emotional problems, which may be present without the person being aware of them. Typically, these tests are in a question-and-answer format.
A blood test for JC virus antibodies may be done if you are being treated with or plan to be treated with natalizumab (Tysabri). This test can help you and your doctor understand your risk for getting a rare but serious brain infection called PML (progressive multifocal leukoencephalopathy).
Treatment can make living with multiple sclerosis (MS) easier. Your type of treatment will depend on how severe your symptoms are and whether your disease is active or in remission. You may get medicines, physical therapy, and other treatment at home.
Medicines are used to treat relapses, control the course of the disease (disease-modifying drugs or DMDs), or treat symptoms.
The National Multiple Sclerosis Society recommends that people with a definite diagnosis of MS and who have active, relapsing disease start treatment with medicines. This group also recommends treatment with medicine after the first attack in some people who are at a high risk for MS. 3
If you decide not to try medicines at this time, meet with your doctor regularly to check whether the disease is progressing.
You and your doctor will set up a schedule of periodic appointments to monitor and treat your symptoms and follow the progress of your MS. Monitoring your condition helps your doctor find out if you may need to try a different treatment.
In rare cases, MS is life-threatening. If your condition gets considerably worse, you may want to make a living will, which allows your wishes to be carried out if you are not able to make decisions for yourself. For more information, see the topic Care at the End of Life.
In general, there is no way to prevent multiple sclerosis (MS) or its attacks. For people with relapsing-remitting MS and secondary progressive MS , treatment with medicine may reduce the frequency of relapses and delay disability.
If you have multiple sclerosis (MS), it is important to find ways of coping with the practical and emotional demands of the disease. These are different for everyone, so home treatment varies from person to person.
Home treatment may involve making it easier to get around your home, dealing with depression , handling specific symptoms, and getting support from your family and friends.
Make all efforts to preserve your health. Proper diet, rest, wise use of energy, and practical and emotional support from your family, friends, and doctor can all be very helpful.
For more advice about coping with MS at home, contact the National Multiple Sclerosis Society at www.nationalmssociety.org.
Medicines for multiple sclerosis (MS) may be used:
Controlling a relapse
These medicines can shorten a sudden relapse and help you feel better sooner. They have not been shown to affect the long-term course of the disease or to prevent disability.
Strong evidence suggests that MS is caused by the immune system causing inflammation and attacking nerve cells and myelin, which is the protective coating surrounding the nerve fibers. Medicines that change the way the immune system works can reduce the number and severity of attacks that damage the nerves and myelin.
For people who have relapsing-remitting MS , disease-modifying therapy can reduce the number and severity of relapses. It may also delay disability in some people. Some of these medicines may also delay disease progression and reduce relapses in some people who have secondary progressive MS .
Disease-modifying therapies include:
There is no effective disease-modifying treatment for primary progressive MS .
Some people have only one episode of a neurological symptom such as optic neuritis . Yet MRI or other tests suggest that these people have MS. This is known as a clinically isolated syndrome. Many of these people go on to develop MS over time. In most cases, doctors will prescribe medicine for people who have had a clinically isolated syndrome. These medicines, when taken early or even before you have been diagnosed with MS, may keep the disease from getting worse or extend your time without disease. 3
Treating specific symptoms can be effective, even if it doesn't stop the progression of the disease. Symptoms that can often be controlled or relieved with medicine include:
Medicines can also help with sexual problems, emotional problems, and walking problems. Sildenafil (Viagra) can help with sexual problems in both men and women. Yohimbine and clomipramine may also be given to improve erectile dysfunction . Dextromethorphan and quinidine (Nuedexta) is a medicine that can be used for uncontrollable outbursts of crying or laughing at strange or inappropriate times. Dalfampridine (Ampyra) is a medicine that can be used to help with walking problems.
Medicine may be used only some of the time or regularly, depending on how severe or constant a certain symptom is. Changes in diet, schedule, exercise, and other habits can also help manage some of these symptoms. See Home Treatment.
Medicines being studied
A variety of other medicines and biological chemicals have been tried or are being studied as therapy for MS. None of them have been clearly proved as beneficial, and none have been approved for treatment of MS.
Several medicines are being tested in clinical trials. People with MS who have not responded to standard therapy sometimes choose to take part in these trials. To learn more about clinical trials, talk to your doctor or contact the National Multiple Sclerosis Society at www.nationalmssociety.org.
Deciding about disease-modifying therapy
The National Multiple Sclerosis Society recommends that people with a definite diagnosis of MS and active, relapsing disease start treatment with interferon beta or glatiramer. Most neurologists support this recommendation and now agree that permanent damage to the nervous system may occur early on, even while symptoms are still quite mild. Early treatment may help prevent or delay some of this damage. In general, treatment is recommended until it no longer provides a clear benefit.
The National MS Society also says that treatment with medicine may be considered after the first attack in some people who are at a high risk for MS (before MS is definitely diagnosed).
Despite the recommendation, some people find it hard to decide whether to begin disease-modifying therapy, especially when their symptoms have been fairly mild. Some may not want to bear the risks and side effects of medicine when they are not sure they need it. Some may want to see whether their disease gets worse before they start therapy. A small percentage of people diagnosed with MS may never have more than a few mild episodes and may never develop any disability, but the disease is unpredictable.
Treating symptoms and relapses
The need and desire for medicine vary. If your symptoms are mild, you may choose to manage them without any medicine. If you have specific symptoms that are causing problems, certain medicines may help you keep them under control. Or you may want to use medicine only during a relapse.
You may also want to think about:
Also keep in mind that it can be hard to tell if medicine is helping. Multiple sclerosis is a disease with spontaneous remissions. This means that your condition can improve on its own, without any treatment. Just because your symptoms improve after treatment doesn't mean that a treatment is working.
People with multiple sclerosis (MS) who have severe tremor (shakiness) affecting movement may be helped by surgery. People with severe spasticity (muscle stiffness) may be helped by insertion of a spinal pump to deliver medicines when oral medicines fail.
Surgery options include:
The unpredictability and variety of symptoms caused by multiple sclerosis (MS) make it a disease that people have tried to treat in many different ways.
Many complementary therapies have been proposed as treatments for MS. None of these treatments have been shown to modify the course of the disease. Some of those most commonly used are:
Although clinical research has not shown any of these complementary therapies to be effective, a person with MS may benefit from safe nontraditional therapies along with conventional medical treatment. Some complementary therapies may help relieve stress, depression, fatigue, and muscle tension. And some may improve your overall well-being and quality of life. Talk to your doctor if you are interested in trying any of these complementary therapies or alternative medical approaches to MS treatment.
Clinical research also has been unable to show that treatments such as bee venom therapy, Prokarin (a caffeine and histamine combination), removal of mercury fillings (dental amalgams), and hyperbaric oxygen therapy have any benefits for people who have MS. Some of these therapies may be harmful as well as expensive and are not recommended by most experts.
Experimental medical treatments
Experimental treatments for MS involve reducing the activity of the immune system . This may be done with medicines and biological chemicals or through methods such as total lymphoid irradiation, in which the entire lymph node system is exposed to radiation. While these methods have been used with success in the treatment of certain other medical conditions, they have failed to produce significant benefits when tested in controlled clinical trials. They remain experimental treatments for MS.
Stem cell transplant , which uses immature cells from the bone marrow, has been studied. Early results suggest that stem cell transplant may delay disability, especially in people with relapsing-remitting MS. 4 Stem cell transplant may be an option for people who have very aggressive or malignant forms of MS. 5 It remains unproved and isn't recommended for treating relapsing-remitting MS.
What to think about
There is no cure for MS. So far, the only treatments proved to affect the course of the disease are approved disease-modifying therapies. Other types of treatment should not replace these medicines if you are a candidate for treatment with them.
Some people who have MS report that complementary therapies have worked for them. This may be in part due to the placebo effect . The placebo effect means that you feel better after getting treatment, even though the treatment has not been proved to work. And even if some complementary therapies don't treat the disease itself, they may affect a person's sense of well-being and help the person feel better and healthier.
If you are thinking about trying a complementary treatment, get the facts first. Discuss these questions with your doctor:
With a hard-to-treat disease like MS, it can be tempting to jump at the promise of an effective treatment. Be cautious about trying unproven treatments.
Other Places To Get Help
Last Revised: October 26, 2012
Tremlett H, et al. (2010). New perspectives in the natural history of multiple sclerosis. Neurology, 74(24): 2004–2015.
Ropper AH, Samuels MA (2009). Multiple sclerosis and allied demyelinative diseases. In Adams and Victor's Principles of Neurology, 9th ed., pp. 874–903. New York: McGraw-Hill.
National Clinical Advisory Board of the National Multiple Sclerosis Society (2008). Disease Management Consensus Statement. New York: National Multiple Sclerosis Society. Available online: http://www.nationalmssociety.org/for-professionals/healthcare-professionals/publications/expert-opinion-papers/index.aspx.
Burt RK, et al. (2009). Autologous non-myeloablative haemopoietic stem cell transplantation in relapsing-remitting multiple sclerosis: A phase I/II study. Lancet Neurology, 8(3): 244–253.
Fassas A, et al. (2011). Long-term results of stem cell transplantation for MS: A single-center experience. Neurology, 76(12): 1066–1070.
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