Multiple sclerosisMultiple sclerosis (MS) — Comprehensive overview covers symptoms, causes, diagnosis, treatment of this nerve condition.
Multiple sclerosis (MS) is a potentially debilitating disease in which your body's immune system eats away at the protective sheath that covers your nerves. This interferes with the communication between your brain and the rest of your body. Ultimately, this may result in deterioration of the nerves themselves, a process that's not reversible.
Symptoms vary widely, depending on the amount of damage and which nerves are affected. People with severe cases of multiple sclerosis may lose the ability to walk or speak. Multiple sclerosis can be difficult to diagnose early in the course of the disease because symptoms often come and go — sometimes disappearing for months.
There's no cure for multiple sclerosis. However treatments can help treat attacks, modify the course of the disease and treat symptoms.
Signs and symptoms of multiple sclerosis vary widely, depending on the location of affected nerve fibers. Multiple sclerosis signs and symptoms may include:
- Numbness or weakness in one or more limbs, which typically occurs on one side of your body at a time or the bottom half of your body
- Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement (optic neuritis)
- Double vision or blurring of vision
- Tingling or pain in parts of your body
- Electric-shock sensations that occur with certain head movements
- Tremor, lack of coordination or unsteady gait
Most people with multiple sclerosis, particularly in the beginning stages of the disease, experience relapses of symptoms, which are followed by periods of complete or partial remission. Signs and symptoms of multiple sclerosis often are triggered or worsened by an increase in body temperature.
The cause of multiple sclerosis is unknown. It's believed to be an autoimmune disease, in which the body's immune system attacks its own tissues. In multiple sclerosis, this process destroys myelin — the fatty substance that coats and protects nerve fibers in the brain and spinal cord.
Myelin can be compared to the insulation on electrical wires. When myelin is damaged, the messages that travel along that nerve may be slowed or blocked.
Doctors and researchers don't understand why multiple sclerosis develops in some people and not others. A combination of factors, ranging from genetics to childhood infections, may play a role.
These factors may increase your risk of developing multiple sclerosis:
- Being between the ages of 20 and 40. Multiple sclerosis can occur at any age, but most commonly affects people between these ages.
- Being female. Women are about twice as likely as men are to develop multiple sclerosis.
- Having a family history. If one of your parents or siblings has had multiple sclerosis, you have a 1 to 3 percent chance of developing the disease — as compared with the risk in the general population, which is just a tenth of 1 percent. But the experiences of identical twins show that heredity can't be the only factor involved. If multiple sclerosis was determined solely by genetics, identical twins would have identical risks. However, an identical twin has only a 30 percent chance of developing multiple sclerosis if his or her twin already has the disease.
- Having certain infections. A variety of viruses have been linked to multiple sclerosis. Currently the greatest interest is in the association of multiple sclerosis with Epstein-Barr virus, the virus that causes infectious mononucleosis. How Epstein-Barr virus might result in a higher rate of MS remains to be clarified.
- Being white. White people, particularly those whose families originated in northern Europe, are at highest risk of developing multiple sclerosis. People of Asian, African or Native American descent have the lowest risk.
Living in countries with temperate climes. Multiple sclerosis is far more common in Europe, southern Canada, northern United States, New Zealand and southeastern Australia. The risk seems to increase with latitude.
A child who moves from a high-risk area to a low-risk area, or vice versa, tends to have the risk level associated with his or her new home area. But if the move occurs after puberty, the young adult usually retains the risk level associated with his or her first home.
- Having certain other autoimmune diseases. You're very slightly more likely to develop multiple sclerosis if you have thyroid disease, type 1 diabetes or inflammatory bowel disease.
In some cases, people with multiple sclerosis may also develop:
- Muscle stiffness or spasms
- Paralysis, most typically in the legs
- Problems with bladder, bowel or sexual function
- Mental changes, such as forgetfulness or difficulties concentrating
Preparing for your appointment
Although you're likely to start by seeing your family doctor or general practitioner, he or she may refer you to a neurologist, a doctor who specializes in nervous system disorders. Here's some information to help you get ready for your appointment, and to know what to expect from your doctor.
What you can do
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information you get during an appointment. Someone who accompanies you may remember something you missed or forgot.
- Write down questions to ask your doctor.
Preparing a list of questions for your doctor will help you make the most of your time together. For multiple sclerosis, some basic questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- Are there other possible causes for my symptoms?
- What kinds of tests do I need? Do these tests require any special preparation?
- Is my condition likely temporary or chronic?
- Will my condition progress?
- What treatments are available?
- What are the side effects of each treatment?
- What treatment do you feel would be best for me?
- What are the alternatives to the primary approach that you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there restrictions I need to follow?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
Don't hesitate to ask any other questions.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- When did you begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Does anyone in your family have multiple sclerosis?
Tests and diagnosis
There are no specific tests for multiple sclerosis. Ultimately, the diagnosis relies on ruling out other conditions that might produce similar symptoms. Your doctor may base a multiple sclerosis diagnosis on the following:
Analysis of your blood can help rule out some infectious or inflammatory diseases that have symptoms similar to multiple sclerosis.
Spinal tap (lumbar puncture)
In this procedure, a doctor or nurse removes a small sample of cerebrospinal fluid from within your spinal canal for laboratory analysis. This sample can show abnormalities associated with multiple sclerosis, such as abnormal levels of white blood cells or proteins. This procedure can also help rule out viral infections and other conditions that can cause neurological symptoms similar to those of multiple sclerosis.
This test uses a powerful magnetic field and radio waves to produce detailed images of internal organs. MRI can reveal lesions, indicative of the myelin loss on your brain and spinal cord. However, these types of lesions can also be caused by other conditions, such as lupus or Lyme disease, so the presence of these lesions isn't definitive proof that you have multiple sclerosis.
During an MRI test, you lie on a movable table that slides into a large, tube-shaped machine, which makes loud tapping or banging noises during the scans. Most MRIs take at least an hour. While the test is painless, some people feel claustrophobic inside the machine. Your doctor can arrange for a sedative if necessary.
You may also receive an intravenous dye that may help highlight "active" lesions. This helps doctors know whether your disease is in an active phase, even if no symptoms are present. Newer MRI techniques can provide even greater detail about the degree of nerve fiber injury or permanent myelin loss and recovery.
Newer MRI techniques may help with diagnosing multiple sclerosis. They include:
- Magnetic resonance spectroscopy (MRS). This provides information about the brain's biochemistry.
- Magnetization transfer imaging (MTI). MTI can detect abnormalities before lesions are visible on standard MRI scans.
- Diffusion tensor imaging (DTI). This technology provides 3-D images of demyelinated areas of the brain, which are useful in determining disease progression.
- Functional MRI (fMRI). This is used during cognitive performance tests.
Evoked potential test
This test measures the electrical signals sent by your brain in response to stimuli. An evoked potential test may use visual stimuli or electrical stimuli, in which short electrical impulses are applied to your legs or arms.
Treatments and drugs
There is no cure for multiple sclerosis. Treatment typically focuses on strategies to treat attacks, to modify the course of the disease and to treat symptoms. Some people have such mild symptoms that no treatment is necessary.
Strategies to treat attacks
- Corticosteroids. The most common treatment for multiple sclerosis, corticosteroids reduce the inflammation that spikes during a relapse. Examples include oral prednisone and intravenous methylprednisolone. Side effects may include increased blood pressure, mood swings and weight gain. Long-term use can lead to cataracts, high blood sugar and increased risk of infections.
- Plasma exchange (plasmapheresis). This procedure looks a little like dialysis as it mechanically separates your blood cells from your plasma, the liquid part of your blood. Plasma exchange is sometimes used to help combat severe symptoms of multiple sclerosis relapses in people who aren't responding to intravenous steroids.
Strategies to modify the course of the disease
- Beta interferons. These types of drugs — such as Avonex, Betaseron, Extavia and Rebif — appear to slow the rate at which multiple sclerosis symptoms worsen over time. Interferons can cause side effects, including liver damage, so you'll need blood tests to monitor your liver enzymes.
- Glatiramer (Copaxone). Doctors believe that glatiramer works by blocking your immune system's attack on myelin. You must inject this drug subcutaneously once daily. Side effects may include flushing and shortness of breath after injection.
- Fingolimod (Gilenya). An oral medication given once daily, this works by trapping immune cells in lymph nodes. It reduces attacks of MS and short-term disability. To take this drug, you'll need to have your heart rate monitored for six hours after the first dose because the first dose can slow your heartbeat (bradycardia). You'll also need to be immune to the chickenpox virus (varicella-zoster virus). Other side effects include high blood pressure and visual blurring.
- Natalizumab (Tysabri). This drug is designed to work by interfering with the movement of potentially damaging immune cells from your bloodstream to your brain and spinal cord. Tysabri is generally reserved for people who see no results from or can't tolerate other types of treatments. This is because Tysabri increases the risk of progressive multifocal leukoencephalopathy — a brain infection that is usually fatal.
- Mitoxantrone (Novantrone). This immunosuppressant drug can be harmful to the heart, and it's associated with development of blood cancers like leukemia, so it's usually used only to treat severe, advanced multiple sclerosis.
Strategies to treat symptoms
- Physical therapy. A physical or occupational therapist can teach you stretching and strengthening exercises, and show you how to use devices that can make it easier to perform daily tasks.
- Muscle relaxants. If you have multiple sclerosis, you may experience painful or uncontrollable muscle stiffness or spasms, particularly in your legs. Muscle relaxants such as baclofen (Lioresal) and tizanidine (Zanaflex) may improve muscle spasticity. Baclofen may increase weakness in the legs. Tizanidine may cause drowsiness or a dry mouth.
- Medications to reduce fatigue. Drugs such as amantadine (Symmetrel) may help reduce fatigue.
- Other medications. Medications may also be prescribed for depression, pain and bladder or bowel control problems that may be associated with multiple sclerosis.
A number of other drugs and procedures such as stem cell transplantation to treat multiple sclerosis are under investigation.
Lifestyle and home remedies
These steps may help relieve some symptoms of multiple sclerosis:
- Get plenty of rest. Fatigue is a common symptom of multiple sclerosis, and although it's generally unrelated to your activity level, resting may make you feel less tired.
- Exercise. Regular aerobic exercise may offer some benefits if you have mild to moderate multiple sclerosis. Benefits include improved strength, muscle tone, balance and coordination, and help with depression. Swimming is a good option for people who are bothered by heat.
- Cool down. Multiple sclerosis symptoms often worsen when your body temperature increases. Cool baths can reduce your core temperature, especially if you submerge your upper torso.
- Eat a balanced diet. Eating a healthy, balanced diet can help keep your immune system strong.
- Relieve stress. Because stress may trigger or worsen signs and symptoms, try to learn to relax. Activities such as yoga, tai chi, massage, meditation or deep breathing — or just listening to music — might help.
Coping and support
As is true with other chronic diseases, living with multiple sclerosis can place you on a roller coaster of emotions. Here are some suggestions to help you even out the ups and downs:
- Maintain normal daily activities as best you can.
- Stay connected to friends and family.
- Continue to pursue hobbies that you enjoy and are able to do.
If multiple sclerosis impairs your ability to do things you enjoy, talk with your doctor about possible ways to get around the obstacles.
Remember that your physical health can affect your mental health. A counselor or therapist may help you put things in perspective, as well as teach you coping skills and relaxation techniques that may be helpful.
Sometimes, joining a support group, where you can share experiences and feelings with other people who have similar concerns, is a good approach. Ask your doctor what support groups are available in your community.
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