Multiple Sclerosis

Multiple sclerosis is a chronic disease where the body’s immune system mistakenly attacks the protective covering of nerve cells in the brain, spinal cord, and optic nerves. While there is no cure, modern treatments can help control the disease so effectively that many people continue living full, active lives with minimal disruption.

Table of contents

• What Is Multiple Sclerosis?
• Types of Multiple Sclerosis
• Signs and Symptoms
• Who Gets Multiple Sclerosis?
• How Multiple Sclerosis Is Diagnosed
• Treatment Options
• Living Well With Multiple Sclerosis
• Life Expectancy and Outlook

What Is Multiple Sclerosis?

Multiple sclerosis is a disorder in which the body’s immune system attacks the protective covering of nerve cells in the brain, optic nerve, and spinal cord. This protective covering is called myelin, which is a mixture of protein and fatty acids that coats nerve fibers. The myelin sheath is often compared to insulation on an electrical wire—when that covering is damaged, it exposes the actual nerve fiber, which can slow or block the signals being transmitted within it.^[1]

Because multiple sclerosis is an autoimmune disorder, it means the immune system—which normally protects us from viruses, bacteria, and other threats—mistakenly attacks healthy cells.^[2] In addition to damaging the myelin sheath, MS also damages the nerve cell bodies found in the brain’s gray matter, as well as the nerve fibers themselves.^[2]

The attack on myelin by the immune system creates distinctive areas of scar-like tissue, also called plaques or lesions. The name “multiple sclerosis” comes from these multiple scars. These patches of scar-like tissue can be as small as the head of a pin or as large as a golf ball, and they are visible on an MRI scan.^[2]

• Brain
• Spinal cord
• Optic nerves
• Central nervous system

Types of Multiple Sclerosis

The course of MS is different for each person, which makes it difficult to predict how an individual will do with the disease. Multiple sclerosis is classified into several types based on how symptoms progress over time.^[2]

Relapsing-remitting multiple sclerosis (RRMS) is the most common way that multiple sclerosis begins, affecting an estimated 85% of people diagnosed with MS. This type causes flare-ups, also called relapses or attacks, of new or old symptoms. These are followed by periods of remission when symptoms stabilize or go away.^[3]

Clinically isolated syndrome (CIS) describes when a person has the first episode of symptoms suggestive of MS but doesn’t yet meet the criteria for having MS. Inflammation and myelin damage cause the symptoms, and CIS may develop into multiple sclerosis.^[3]

Secondary progressive multiple sclerosis (SPMS) occurs when relapsing-remitting MS eventually progresses to a stage where nerve damage accumulates and symptoms gradually worsen. People may still experience some relapses or flares, but periods of remission are less likely to happen.^[3]

Primary progressive multiple sclerosis (PPMS) describes cases where MS symptoms start slowly and gradually worsen over time from the very beginning, without any periods of clear relapses or remission. About 10% to 15% of people with MS will have this type.^[2][14]

Signs and Symptoms

Multiple sclerosis symptoms usually begin in young adults, between the ages of 20 and 40. The symptoms depend on the severity of the attacks as well as the location and size of the plaques in the central nervous system.^[2]

Early Symptoms

Early signs and symptoms of MS include changes to vision such as optic neuritis (inflammation of the optic nerve), double vision, or vision loss. Muscle weakness usually affects one side of the face or body, or below the waist. Numbness or abnormal sensations also typically affect one side of the face or body, or below the waist.^[3]

Common Symptoms

Some of the most common symptoms include feeling extremely tired, which is called fatigue. Problems with eyes or vision such as blurred vision or eye pain are frequent. Many people experience numbness or a tingling feeling in different parts of the body.^[4]

Other common symptoms include feeling off balance, dizzy, or clumsy. Muscle cramps, spasms, and stiffness can occur. Many people need to urinate more often or have difficulty controlling when they urinate. Problems with memory or concentration are also common, along with sexual problems including vaginal dryness or difficulty with erections.^[4]

Additional symptoms that people may experience include clumsiness, dizziness, difficulty with bladder regulation, loss of balance, pain, speech problems, tremor, and walking difficulties.^[3]

Who Gets Multiple Sclerosis?

Studies show that there are almost 1 million adults in the United States living with multiple sclerosis.^[3] Multiple sclerosis can affect anyone, but it is three times more common among women. The disease can appear at any age, but symptoms often begin between the ages of 25 and 40.^[14]

Multiple sclerosis affects people differently. A small number of people with MS will have mild symptoms with little disability, whereas others will experience worsening symptoms that will lead to increased disability over time. Most people with MS have short periods of symptoms that resolve fully or partially after they appear, followed by long stretches without noticeable symptoms. Most people with MS have a normal life expectancy.^[2]

How Multiple Sclerosis Is Diagnosed

If your doctor thinks you could have multiple sclerosis, they will refer you to a neurologist, a brain and nerve specialist. There is no single test to diagnose MS.^[4]

Medical History and Neurological Exam

At your appointment, the neurologist will ask about your symptoms, review your medical and family history, and want to know about other medical conditions and medications you’re taking. They will conduct a neurological exam to test your reflexes, coordination, balance, and vision. This exam checks on your movement, coordination, vision, balance, and reflexes to identify any abnormalities or signs pointing to an MS diagnosis.^[4][10]

Blood Tests

Blood tests help rule out other possible causes of your symptoms. The results can exclude conditions such as autoimmune disorders, vitamin deficiencies, infections, and metabolic issues.^[10]

MRI Scan

An MRI (magnetic resonance imaging) scan is an essential tool for diagnosing multiple sclerosis. It can detect brain or spinal cord lesions that indicate inflammation and loss of myelin in the central nervous system. Contrast dye often gets injected intravenously to highlight the problem areas.^[10]

Lumbar Puncture

A lumbar puncture, also called a spinal tap, collects a small sample of spinal fluid from your lower back using a needle. Analysis of the sample can help detect abnormalities associated with MS, such as an increase in white blood cells or elevation of specific proteins.^[4][10]

Evoked Potential Test

An evoked potential test measures your brain’s electrical activity in response to specific visual and auditory stimuli. The test measures how fast electrical messages travel from your sensory nerves to the brain. Abnormalities in the test could indicate evidence of nerve damage and loss of myelin associated with multiple sclerosis.^[10]

Treatment Options

There is currently no cure for multiple sclerosis. However, there are treatments that can slow the progression of MS and help ease symptoms. The type of treatment depends on the type of MS you have and your symptoms.^[4]

Disease-Modifying Therapies

Disease-modifying therapies (DMTs) are medications developed to slow disease activity. They work by reducing the number and severity of relapses, reducing areas of inflammation within the central nervous system as seen on MRI scans, and delaying disease progression and disability.^[9]

DMTs have been a game changer in improving life expectancy and quality of life for many people with MS. These treatments can prevent a new lesion in 99% of MS patients and are very effective. When appropriate, most neurologists recommend starting a DMT as soon as possible after diagnosis.^[14][9]

Depending on the specific DMT prescribed, the medication may be given via self-injection, intravenous (IV) infusion, or by oral administration. Common medications include beta interferons, glatiramer acetate, teriflunomide, dimethyl fumarate, fingolimod, natalizumab, and mitoxantrone.^[5][10]

Treatment for Relapses

Treating relapses helps control the sudden flare-up of symptoms, also referred to as exacerbations or attacks. The first line of treatment for moderate to severe relapses is typically a course of high-dose steroid medicine given intravenously over a period of three to five days to reduce swelling and help nerves work better. This can also be given as an equivalent high-dose oral regimen. Mild relapses not impacting one’s ability to perform daily activities are often treated using symptom-management medications and strategies.^[9][4]

Symptom Management

Treatment and support for the symptoms of MS is an important area of overall treatment. Support may include muscle relaxant medicine to help relieve muscle spasms, cramps, or stiffness, and medicine to treat pain, vision problems, and other symptoms.^[4]

Additional support includes advice about how to manage tiredness, physiotherapy and exercises to help with movement problems and muscle pain, and mobility equipment such as walking sticks, frames, and wheelchairs. Cognitive behavioral therapy (CBT) can help with anxiety, depression, and fatigue. Activities to improve memory, concentration, thinking, and mood are available, along with advice, exercises, and medicines to help with bowel or bladder problems.^[4]

Living Well With Multiple Sclerosis

With so many effective medications available to treat multiple sclerosis, life can continue normally for many patients, especially those diagnosed early and treated appropriately. Lifestyle plays an integral role in both symptom management and overall wellness.^[15]

Diet and Nutrition

Good nutrition maximizes your energy, general sense of well-being, and healing capacities. A dietary routine also contributes to regular bowel habits. The main diet shown to be protective for the nerves is the Mediterranean diet, which is high in fish, vegetables, and nuts, and low in red meat. Eating foods high in fiber and low in saturated fats can have a significant impact on factors such as energy level and bowel and bladder function.^[6][12][15]

Exercise and Physical Activity

Exercise can help retain flexibility and balance, promote cardiovascular fitness and a sense of well-being, and prevent complications from inactivity. Exercise is strongly recommended and is protective to the brain and spinal cord. It’s important to note that heat does not cause an MS attack or relapse, and you’re not doing any permanent damage if symptoms temporarily worsen during exercise.^[6][12]

Physical activity improves mood and sleep and strengthens your brain along with your muscles and bones. Activities like yoga, Pilates, cycling, or swimming are good for MS symptoms. Some patients benefit from physical therapy to learn specific exercises to stay more active.^[15][18]

Managing Stress

Stress can impact the onset and severity of MS symptoms. By recognizing the impact stress can have on symptoms, you can understand how managing stress can have a positive impact. Any reduction in stress will be associated with an improved sense of well-being and increased energy.^[12][16]

Useful stress reduction techniques include identifying causes of stress in your life and sharing your thoughts and feelings, simplifying responsibilities by setting priorities, trying relaxation and meditation exercises, managing time and conserving energy, and asking for help when needed.^[12]

Temperature Management

MS symptoms can worsen when body temperature rises, though this doesn’t mean your disease is worsening. When it’s hot outdoors, try to stay in an air-conditioned space. When outside, wear loose, breathable clothing. Devices such as cooling vests or scarves can also help.^[15]

Vitamin Supplements

The key preventable risk factor is vitamin D deficiency, and many patients benefit from vitamin D supplements. Vitamin B12 can also help MS patients. However, be careful with supplements—vitamin D toxicity is possible, and high doses of vitamin B6 are known to damage nerves.^[12][15]

Avoiding Smoking

Smoking is a significant risk factor for worsening MS. If you smoke, quit. Smoking has been associated with worsening the number of MS spots and causing more aggressive relapses.^[15]

Building a Support System

No one should go through a chronic illness alone. Families and caregivers play a large role for many people throughout their entire MS journey. It’s important to feel like you have people with whom you can be yourself, share your challenges, and feel supported along the way. Support groups introduce you to other people living with multiple sclerosis and allow you to tap into a community built on commonality.^[16]

Life Expectancy and Outlook

While there is no cure, multiple sclerosis is not considered a fatal disease. A study found that people with MS, on average, lived to be 75.9 years old, while those without MS lived to an average age of 83.4 years old. A couple of decades ago that gap was much bigger. Fortunately, therapies today are much better, and MS can be diagnosed earlier, when treatment is more effective.^[14]

Everyone loses brain cells and spinal cord cells as they get older. But if part of the brain or spinal cord has been damaged by MS, the nerve cells in that area will die off faster than the areas around it that are normal. This happens very slowly, usually over decades, and typically shows up as gradual walking difficulty happening over several years.^[1]

At the time of diagnosis, most patients are young people who have just graduated or are about to get married or have their first child. Many are young with big dreams, and an MS diagnosis can feel overwhelming. However, modern treatments offer more hope than ever before. While MS cannot be ignored, it often can be controlled so effectively that people barely remember they have it and continue doing everything they want.^[14]