Multiple sclerosis

Multiple sclerosis (MS) is a long-term disease that attacks the central nervous system and impacts the brain, spinal cord, and optic nerves. As the nerve fibers deteriorate, MS causes communication problems between your brain and the rest of your body.

What causes MS?

Although we don’t yet know the cause of multiple sclerosis, it appears that genetics and environmental elements are major factors.

Is multiple sclerosis curable?

Unfortunately, not yet.

Since there is no cure, MS treatment typically focuses on managing symptoms, recovering from attacks, and finding ways to slow progression of the disease.

Symptoms of multiple sclerosis

The signs and symptoms of MS can vary depending on which nerve fibers are affected. Symptoms often include:

  • Blurry vision.
  • Dizziness.
  • Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign).
  • Fatigue.
  • Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement.

  • Problems with sexual, bowel and bladder function.
  • Prolonged double vision.
  • Numbness or weakness in one or more limbs. Typically occurs on one side of your body at a time, or your legs and trunk.
  • Slurred speech.
  • Tingling or pain in parts of your body.
  • Tremor, lack of coordination or unsteady gait.

Diagnosing multiple sclerosis

Patient listening to imaging technician

There isn’t a specific test to diagnose MS. Instead, doctors often rely on a differential diagnosis, which involves ruling out other conditions with symptoms similar to MS.

To start, you’ll provide your doctor with a thorough medical history and undergo an examination.

The process may also involve:

Blood tests. These tests help rule out other diseases with symptoms similar to MS.

A spinal tap. This procedure, also called a lumbar puncture, checks for abnormalities in antibodies by removing a small sample of cerebrospinal fluid from your spinal canal.

MRI. An MRI (Magnetic Resonance Imaging) is an imaging technique that produces images of different parts of the body, including your organs and soft tissues, using powerful magnets and computer-generated radio waves. Doctors use this test to find lesions on your brain and spinal cord.

Evoked potential tests. These tests measure how quickly information travels down the nerve pathways in your arms or legs.

Treatments for multiple sclerosis

Because there is yet no cure for multiple sclerosis, treatment typically focuses on managing symptoms, recovering from attacks, and finding ways to slow its progression.

Physical therapy and medication to manage symptoms

Two of the best ways to address MS symptoms are with physical therapy and medications.

Physical therapy can build muscle strength, so performing stretching and strengthening exercises with a physical or occupational therapist can make it easier to perform daily tasks.

If necessary, using a mobility aid like a walker can also help manage leg weakness and other gait problems.

Muscle relaxants and medications can help reduce fatigue and increase walking speed. Medications may also be prescribed for bladder or bowel control problems, depression, insomnia, pain, and sexual dysfunction that are associated with MS.

Treating attacks

Depending on the severity of the attack, there are a couple of courses of action available.

For milder episodes, corticosteroids can help reduce nerve inflammation.

If your symptoms are new, severe and haven’t responded to steroids, your doctor may suggest plasma exchange (plasmapheresis). In this process, the liquid portion of part of your blood (plasma) is removed, separated from your blood cells, mixed with a protein solution (albumin), and then put back into your body.

Rehab patient on treadmill with therapist

Slowing MS progression

Depending on your stage of MS, there are different disease-modifying therapies (DMT) available.

  • For primary-progressive MS, there’s only on FDA-approved DMT, ocrelizumab (Ocrevus), that’s been shown to slow progress slightly more than those who are untreated.
  • For relapsing-remitting MS, several DMTs are available, including injectable and oral medications.

It’s important to pursue aggressive treatment with these medications as early as possible because much of the immune response associated with MS occurs in the early stages of the disease. These medications have been shown to lower the relapse rate, slow the formation of new lesions, and potentially reduce risk of brain atrophy and disability accumulation.

Frequently asked questions (FAQs) about multiple sclerosis

Yes. MS is an autoimmune disease in which the body’s immune system malfunctions and attacks the fatty substance (known as myelin) that coats and protects nerve fibers in the brain and spinal cord.

Not at this time. Although blood tests can’t currently diagnose MS, they can help rule out other conditions.

People with MS can generally expect to see their quality of life impacted more than anything else. There are instances of rare types of MS potentially shortening lifespan, but they represent a small minority of cases. Even though living with MS means dealing with persistent, difficult, lifestyle-changing symptoms, people with MS can expect their life expectancy to mirror those for people without the disease.

According to the National Multiple Sclerosis Society (NMSS), around two-thirds of people with MS can walk without a wheelchair two decades after their diagnosis. Some people will need crutches or a cane to remain ambulatory. Others use an electric scooter or wheelchair to help them cope with fatigue or balance difficulties.

The four stages of MS are clinically isolated syndrome (CIS); relapsing-remitting MS (RRMS); secondary-progressive MS (SPMS); and primary-progressive MS (PPMS).

  • Clinically isolated syndrome (CIS). CIS isn’t technically an MS diagnosis since, as the name suggest, it’s an isolated incident and is the first appearance of symptoms. Only after an MRI shows another episode has occurred can a diagnosis of MS be made.
  • Relapsing-remitting MS (RRMS). Around 85 percent of people with MS are initially diagnosed with relapsing-remitting MS.
    RRMS follows a repeatable pattern, with alternating periods of worsening and then improving symptoms. Over time, the disease is likely to become more complex and may eventually progress to secondary-progressive MS.
  • Secondary-progressive MS (SPMS). As relapsing-remitting MS progresses, it can evolve into a more aggressive form of the disease known as secondary-progressive MS. This evolution generally happens within 10 years of the first diagnosis.

People with secondary-progressive MS may still experience relapses with partial recoveries or periods of remission in between. But, instead of disappearing between cycles, the disease steadily worsens.

  • Primary-progressive MS (PPMS). Primary-progressive MS, a relatively uncommon form of MS, afflicts approximately 15 percent of people diagnosed with MS. The disease progresses slowly and steadily with no remission periods. Some people with PPMS see their symptoms occasionally plateau and may experience minor, temporary improvements in function.

A relapse of MS (also known as an attack or flare-up) occurs when new symptoms appear, or old symptoms worsen.

Attacks are always different from person to person and can range from very mild to severe. Depending on the number of areas of inflammation in the central nervous system, you might experience a single symptom or multiple symptoms.