Multiple sclerosis (MS) is a disease of the brain and spinal cord. It is a long term health issue that causes damage to the brain and spinal cord. There are several types of MS:
- Relapsing-remitting MS—New symptoms start and get worse over a few days and weeks. This is called relapse. They last for a few weeks or months. This is followed by a period of no symptoms called remission. Symptoms may get worse with each relapse.
- Primary progressive MS—Symptoms slowly get worse after they first appear. Relapses and remissions usually do not occur.
- Secondary progressive MS—Symptoms occur in relapses and remissions for years. Then symptoms suddenly begin to get worse.
MS is caused by a problem with the immune system. Parts of the immune system attack nerve fibers in the brain, spinal cord, and nerves to the eyes. The exact reason why the immune system does this is not known. Things that may play a role in a person having MS include:
- Issue with genes (can be passed down in families)
- Viral or other infection
- Environmental factors
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MS is more common in women. It often first appears in people aged 15 to 50 years of age. Other things that may raise the chance of MS include:
- Having family members who have MS or other autoimmune disorders, such as systemic lupus erythematosus
- Exposure to Epstein-Barr virus
- Being of Northern European descent
- Growing up in a colder climate, as opposed to a tropical climate
- Having certain immune system genes
- Having swelling of the nerve to the eye
- Having low vitamin D levels
Symptoms may range from mild to severe and may include:
- Numbness or tingling in the face or limbs
- Eye pain or sudden vision changes in one or both eyes, including blurred or double vision and loss of vision
- Muscle weakness, stiffness, and spasms, or weakness in one or more limbs
- Trouble walking or maintaining balance, clumsiness, or falling
- Bladder problems such as trouble with urgency, starting urination, or emptying; may also have loss of bladder control
- Bowel problems such as constipation
- Sexual dysfunction
- Slurred speech
- Difficulty swallowing
- Forgetfulness, memory loss, confusion, or problems concentrating or solving problems
Symptoms may get worse with:
- Heat, including weather, hot baths or showers, and fever
- Intense physical activity
The doctor will ask about symptoms and past health. A physical exam will be done. There is no test to confirm MS. Instead the doctor will rule out other conditions that cause similar problems. Tests may include:
- Blood tests—to rule out other diseases that may look like MS
- MRI scan
- Lumbar puncture—sample and test of fluid around the brain and spinal cord
- Sensory evoked potentials—check how you respond to stimulus
- Visual evoked potential test—test the brain's response to what you see
- Optical coherence tomography (OCT)—to look at the eye and nerve to the eye
There is no cure for MS. Treatment can help ease symptoms and prevent or slow them from happening again. For primary and secondary progressive MS, treatment can also slow the progress of the disease. It may delay disability. Options include:
There are no current guidelines to prevent MS.
Medicine can help slow MS. It may also help manage symptoms. Types of medicine that can slow the progression of MS or prevent damage to nerve fibers include:
- Interferon betas
- Glatiramer acetate
Corticosteroids may be given during active phases. It can help reduce swelling. It may lessen damage to the nerve fibers and shorten the length of relapses.
Symptoms may be managed with:
- Muscle relaxants—to reduce muscle spasms
- Potassium channel blockers—to help with vision and motor skills, and ease fatigue
- Botox injections—to reduce tremor and muscle tone
- Pain relievers
- Medicine to help with bladder or bowel problems
- Multiple sclerosis (MS). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/multiple-sclerosis-ms/.
- Multiple sclerosis. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/health-information/disorders/multiple-sclerosis.
- What is MS? National Multiple Sclerosis Society website. Available at: https://www.nationalmssociety.org/What-is-MS.
- 5/25/2022 EBSCO DynaMed Systematic Literature Surveillance https://www.dynamed.com/condition/multiple-sclerosis-ms: Bjornevik K, Cortese M, et al. Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science. 2022;375(6578):296-301. doi:10.1126/science.abj8222.
- Rimas Lukas, MD
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