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Multiple Sclerosis (MS)

What is multiple sclerosis?

Multiple sclerosis (MS) is a chronic disease of the central nervous system. It is thought to be an autoimmune disorder, a condition in which the body mistakenly attacks itself. It’s an unpredictable condition that can be relatively benign to disabling. Some people with MS may be mildly affected, while others may lose their ability to see clearly, write, speak, or walk when communication between the brain and other parts of the body becomes disrupted.

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Myelin is the fatty tissue that surrounds and protects nerve fibers. In MS, the myelin is destroyed in multiple areas. This loss of myelin forms scar tissue called sclerosis. These areas are also called plaques or lesions. When damaged in this way, the nerves are unable to conduct electrical impulses to and from the brain.

What causes multiple sclerosis?

There are many possible causes of MS, including:

  • Autoimmune disorders
  • Infectious agents, such as viruses
  • Environmental factors
  • Genetic factors

What are the symptoms of multiple sclerosis?

The symptoms of MS are often unpredictable. They may be mild or severe, of long duration or short. They may appear in various combinations, depending on the area of the nervous system affected. The following are the most common symptoms of MS. However, each person may have different symptoms.

Initial symptoms of MS

The following are often initial symptoms of MS:
  • Burred or double vision
  • Red-green color distortion
  • Pain and loss of vision because of swelling of the optic nerve (optic neuritis)
  • Difficulty walking
  • Paresthesia. This refers to an abnormal sensation, or pain, such as numbness, prickling, or "pins and needles."

Other symptoms of multiple sclerosis

  • Muscle weakness in the extremities
  • Difficulty with coordination. You may have problems walking or standing. You may also be partially or completely paralyzed.
  • Spasticity. The involuntary increased tone of muscles leading to stiffness and spasms.
  • Fatigue. This may be brought on by physical activity, but it may ease with rest. You may have constant tiredness that doesn't go away.
  • Loss of sensation
  • Speech problems
  • Tremor
  • Dizziness
  • Hearing loss
  • Bowel and bladder problems
  • Depression
  • Changes in sexual function

About half of all people with MS have thinking problems related to the disease. The effects of these problems may be mild. Your doctor may only find them after much testing. The problems may be with:

  • Concentration
  • Attention
  • Memory
  • Poor judgment

Symptoms of MS are grouped as primary, secondary, or tertiary as described below:

Primary symptoms. These symptoms are a direct result of the destruction of myelin may result in the following:

  • Weakness
  • Numbness
  • Tremor
  • Loss of vision
  • Pain
  • Paralysis
  • Loss of balance
  • Bladder and bowel dysfunction

 

Secondary symptoms. These are complications that may arise as a result of the primary symptoms, for example:

  • Paralysis can lead to bedsores.
  • Bladder dysfunction may cause repeated urinary tract infections.
  • Inactivity can result in weakness, poor posture muscle imbalances, decreased bone density, and breathing problems.
  • Becoming less mobile because of weakness and difficulty swallowing can lead to an increased risk of pneumonia.

 

Tertiary symptoms. These are the social, vocational, and psychological complications:

  • A person who becomes unable to walk or drive may lose his or her livelihood.
  • Strain of dealing with a chronic neurological illness may disrupt personal relationships.
  • Depression is often seen among people with MS.

 

The symptoms of MS may resemble other health conditions or problems. Always talk with your healthcare provider for a diagnosis.

How is multiple sclerosis diagnosed?

No specific test is available to diagnose multiple sclerosis. But a doctor can make a diagnosis by following a careful process to rule out other causes and diseases. Two things must be true to make a diagnosis of MS:

  1. You must have had two attacks at least one month apart. An attack is when any MS symptoms show up suddenly. Or when any MS symptoms get worse for at least 24 hours.
  2. You must have more than one area of damage to the central nervous system myelin. Myelin is the sheath that surrounds and protects nerve fibers. This damage must have occurred at more than one point in time and not have been caused by any other disease.

Generally a single attack along with certain patterns of changes in brain tissue seen on an MRI scan of the brain can mean that you have MS.

Evaluation for MS involves a complete health history and neurological exam. This includes:

  • Mental functions
  • Emotional functions
  • Language functions
  • Movement and coordination
  • Vision
  • Balance
  • Functions of the five senses

The following may be used when evaluating a person for multiple sclerosis:

  • MRI. A diagnostic test that uses a combination of large magnets, sound waves, and a computer to make detailed pictures of organs and structures within the body. It can find plaques or scarring caused by MS.
  • Evoked potentials. These tests record the brain's electrical response to visual, auditory, and sensory stimuli. These tests show if you have a slowing of messages in the various parts of the brain.
  • Cerebral spinal fluid analysis. This is also called a spinal tap or lumbar puncture. A procedure used to make an evaluation or diagnosis by looking at the fluid withdrawn from the spinal column. This test checks for cellular and chemical abnormalities seen with MS.
  • Blood tests. These are done to rule out other causes for various neurological symptoms.

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Evaluation and diagnosis of MS requires a variety of tools to rule out other possible disorders and a series of lab tests that, if positive, confirms the diagnosis.

How is multiple sclerosis treated?

Your healthcare provider will figure out the best treatment for you based on:

  • How old you are
  • Your overall health and past health
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long your condition is expected to last
  • Your opinion or preference

Treatments for the conditions seen with MS may include:

  • Medicine
  • Equipment such as canes, braces, or walkers
  • Rehabilitation activities

There is no cure yet for MS. But you can take steps to change the course of the disease, treat flare-ups, manage symptoms, and improve function and mobility.

Rehabilitation varies depending on your symptoms and how severe they are. MS rehabilitation may help you to:

  • Get back functions that are important for daily living
  • Be as independent as you can
  • Involve your family
  • Make the right decisions relating to your care
  • Learn about equipment like canes, braces, or walkers that can make is easier to move around
  • Set up an exercise program that builds muscle strength, endurance, and control
  • Get back motor skills
  • Speak more easily if you have weakness or a lack of coordination of face and tongue muscles
  • Manage bowel or bladder incontinence
  • Relearn thinking skills
  • Change the way your home is set up to keep you safe but allow you to move about as easily as possible

What are the complications of multiple sclerosis?

The complications of MS range from mild to severe. They can range from fatigue to the inability to walk. Other complications include loss of vision, balance, and bowel or bladder control. Depression can result from the difficulty of living with a chronic condition.

Living with multiple sclerosis

It's important to take your medicines as directed. You may get help by taking part in a clinical trial. Using equipment like canes or walkers can help you get around as walking become more difficult. Rehabilitation activities can also help you keep or get back functioning. Changing the way your home is set up can help you stay independent. Talk with your family and healthcare providers about what you need.

Key points

  • Multiple sclerosis is a chronic disease of the central nervous system.
  • MS is unpredictable. It can be relatively mild, or it can be disabling or devastating.
  • Early symptoms can include eyesight problems, problems with walking, and tingling sensations.
  • MS affects people differently but common problems are problems with movement and thinking, and bowel and bladder incontinence.
  • Medicines and rehabilitation can help to keep or restore functioning.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Online Medical Reviewer: Foster, Sara, RN, MPH
Online Medical Reviewer: Freeborn, Donna, PhD, CNM, FNP
Last Review Date: 1/15/2014
© 2000-2016 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.