Multiple Sclerosis

What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is a long-term (chronic) disease of the central nervous system. It affects the brain and spinal cord. MS may be an autoimmune disease. This is when the body’s immune system attacks healthy cells by mistake. When you have MS, the material (myelin sheath) that protects your nerve cells is damaged. This damage disrupts messages between your brain and other parts of your body, causing MS symptoms.

MS symptoms can vary. They may come and go, or they may be long-lasting. Some people may only have a few mild symptoms. But others may lose their ability to see clearly, write, speak, or walk. MS is more common in women than in men. It most often occurs between the ages of 20 and 40.  

What causes MS?

Health experts don’t know what causes MS. There are many possible causes, including:

  • Autoimmune disorders, where the body’s immune system attacks healthy cells by mistake

  • A virus or other infectious agent

  • Environmental factors

  • Genetic factors

What are the symptoms of MS?

The symptoms of MS vary greatly. They may be mild or severe. They may be short-term or long-lasting. Some symptoms may appear together, depending on what part of the nervous system is affected. Below are some of the most common symptoms of MS.

Early symptoms of MS

The first symptoms of MS are often:

  • Double vision

  • Blurred or grayed vision 

  • Eye pain and vision loss

  • Trouble walking, being clumsy

  • Pain, numbness, prickling, or pins and needles

  • Painful muscle spasms

  • Bladder control problems

Other symptoms of MS

Over time, the following symptoms may occur:

  • Muscle weakness in the arms or legs

  • Trouble with coordination, which affects walking or standing. Partial or full paralysis is possible.

  • Muscle stiffness and spasms

  • Extreme tiredness, or fatigue  

  • Loss of feeling or sensation

  • Speech problems

  • Tremors, or shaking that can’t be controlled

  • Feeling dizzy

  • Hearing loss

  • Bowel and bladder problems

  • Depression

  • Sexual problems

About 50% of all people with MS have some problem with their thinking (cognitive impairment) that is linked to the disease. This may be mild or it may be more severe. It can include having any of the following:

  • Trouble focusing

  • Trouble paying attention

  • Memory loss

  • Poor judgment

Symptom categories of MS

Primary symptoms. Damage to the material protecting your nerve cells may cause the following:

  • Weakness

  • Numbness

  • Tremors or shaking

  • Vision loss or blurred vision

  • Pain

  • Paralysis

  • Loss of balance

  • Bladder and bowel problems

Secondary symptoms. Primary symptoms can lead to other problems such as:

  • Being paralyzed can lead to bedsores.

  • Bladder problems may cause repeated urinary tract infections.

  • Not being active can result in weakness, poor posture and trunk control, muscle problems, decreased bone density, or shallow, inefficient breathing.

  • Being less mobile because of weakness can lead to an increased risk of pneumonia.

Tertiary symptoms. Primary and secondary symptoms can have social, work-related, and psychological effects such as:

  • The stress of dealing with MS may disrupt personal relationships.

  • A person who can’t walk or drive may lose his or her job.

  • People with MS often have depression.

MS symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.

How is MS diagnosed?

It can be difficult to diagnose MS. There is no single test that can tell for sure that you have the disease. And many conditions have symptoms that may seem like MS. But a likely diagnosis can be made. Your healthcare provider will follow a careful evaluation and testing process. He or she will look for any results that point to MS. Your provider will also rule out other possible causes and diseases.

Criteria for diagnosing MS

To make a diagnosis of MS, your healthcare provider must find all of the following:

  1. There is damage in at least 2 different areas of your central nervous system.

  2. You have had an MS symptom, or a worsening of an MS symptom, at 2 different times.

  3. Other possible conditions have been ruled out.

There is also another set of criteria that points to a likely MS diagnosis. This involves having 1 MS symptom, and an MRI that shows certain changes in brain tissue.

What does an MS evaluation include?

For an MS evaluation, your healthcare provider will take your full medical history and give you a neurological exam. This includes checking your:

  • Mental functions

  • Emotional functions

  • Language functions

  • Strength

  • Movement and coordination

  • Balance

  • Five senses and how they function

In some cases, the medical history and neurological exam are all that is needed to make a diagnosis. Other tests can be used to confirm the diagnosis. Or they may be used to find other possible causes for your symptoms.

Testing for MS

There are many illnesses with symptoms that may seem like MS. Your healthcare provider will do testing to rule out other possible conditions, or to help confirm a diagnosis. Sometimes repeat testing is needed. These tests may include:

  • MRI. This imaging test uses a combination of large magnets, radiofrequencies, and a computer to make detailed images of organs and structures in the body. It is used to check for scarring on your brain or spinal cord caused by MS.

  • Evoked potentials. These tests record the brain's electrical response to sight, sound, and touch. The tests can show if there is a slowing of messages in the different parts of the brain.

  • Spinal tap or lumbar puncture. Spinal fluid is removed from the spinal column and checked for problems linked with MS.

  • Blood tests. These are done to rule out other causes for neurological symptoms.

Treatment for MS

Once you have been diagnosed with MS, your healthcare provider will create a treatment plan for you based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • How well you handle certain medicines, treatments, or therapies

  • If your condition is expected to get worse

  • Your opinion or preference

  • Treatments for the conditions linked to MS may include:

  • Medicine

  • Clinical trials

  • Rehabilitation activities

  • Items or devices that help you to do everyday tasks (assistive technology)

  • Lifestyle changes including diet, exercise, not smoking, and stress management

There is no cure yet for MS. But there are ways to manage your symptoms, change the disease course, treat symptoms that return, and improve your function and mobility. Talk with your healthcare provider to learn more.

Rehabilitation for people with MS

The goal of rehabilitation is to help you to improve and keep function. Rehabilitation will vary depending on your symptoms. It may help you to:

  • Restore function needed for personal care, and for daily activities at home and work

  • Be as independent as possible

  • Get your family involved

  • Make the right decisions about your care

  • Learn about canes, braces, walkers, and other assistive devices

  • Begin an exercise program to improve muscle strength, endurance, and control

  • Improve your motor skills

  • Improve communication skills if you have trouble speaking

  • Manage bowel or bladder problems

  • Get cognitive retraining

  • Make changes in your home so that you can move around and function more easily and safely