Multiple Sclerosis

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Introduction

What is multiple sclerosis?

Multiple sclerosis is a progressive autoimmune disease and the most common neurological disease diagnosed in young adults. It is believed that multiple sclerosis occurs when the body’s own immune system attacks the central nervous system. Commonly called MS, the disease generally gets worse with time and can cause significant nerve damage.

The progression and severity of multiple sclerosis varies greatly among individuals. The severity of multiple sclerosis ranges from mild to severe and disabling, and it can result in muscle weakness, loss of balance, and difficulty walking.

In some cases, multiple sclerosis can lead to serious complications, such as choking and paralysis. Early diagnosis and medical care can help manage and control symptoms and minimize complications of multiple sclerosis.

Symptoms

What are the symptoms of multiple sclerosis?

The symptoms of multiple sclerosis result from inflammation, swelling, and lesions on the myelin, a fatty material that covers and insulates the nerve cells in the central nervous system. Myelin greatly improves the transmission speed of nerve impulses without decay of the nerve signal. Loss of myelin leads to abnormal transmission of electrical impulses through the central nervous system and difficulties with motor skills, cognition and sensation.

Symptoms of multiple sclerosis generally appear between the ages of 20 and 40 years. Symptoms are unpredictable and can vary greatly. In the early stages of the disease, symptoms come and go. People with multiple sclerosis can also experience periods of remission, in which symptoms disappear, and periods of relapse, in which symptoms reappear. Symptoms may worsen during relapses.

Symptoms of multiple sclerosis include:

  • Bowel and bladder problems, such as constipation and incontinence
  • Fatigue
  • Hearing and vision loss
  • Mental difficulties, such as problems with judgment, memory and concentration
  • Muscle spasms
  • Muscle weakness and difficulty moving arms and legs
  • Paralysis
  • Problems with balance, coordination and walking
  • Sexual dysfunction
  • Trembling or tremors
  • Worsening of symptoms with increased body temperature

Causes

What causes multiple sclerosis?

The causes of multiple sclerosis are not well understood. Researchers believe that the body’s immune system begins to attack the nervous system, specifically the myelin. The myelin is a fatty material that covers and insulates the nerve cells in the central nervous system. Healthy myelin is vital to the normal, rapid movement of electrical impulses through the nerve pathways.

In multiple sclerosis, patches of myelin in the brain and spinal cord become inflamed, swell and develop lesions. Myelin and nerve cells become damaged, which interferes with the normal transmission of electrical impulses and affects how your brain and body communicate.

It is believed that this process may be triggered by a combination of genetic factors and environmental elements, such as exposure to a virus. Sometimes it’s a case of biologic mistaken identity. This occurs when circulating antibodies meant to destroy viruses inaccurately target myelin because it has a similar molecular ‘fingerprint’.

What are the risk factors for multiple sclerosis?

A number of factors may be linked to an increased risk of developing multiple sclerosis. Some risk factors include:

  • Caucasian race

  • Female gender

  • Family history of multiple sclerosis

  • History of autoimmune disorders

  • History of infections such as Epstein-Barr virus and hepatitis B virus
    Treatments

    How is multiple sclerosis treated?

    There is no cure for multiple sclerosis. However, the disease can be managed and the symptoms controlled to various degrees of success with an individualized, multifaceted approach that includes medications and other therapies. You can help manage multiple sclerosis by consistently following your treatment plan.

    Treatment plans are geared toward managing your symptoms and suppressing the body’s autoimmune response, which is believed to be the root of multiple sclerosis.

    People with mild cases of multiple sclerosis may need or choose to have little or no treatment. However, all people with the disease are encouraged to keep their bodies as strong and healthy as possible by:

    • Avoiding excessive heat and exercise
    • Avoiding fatigue and stress
    • Eating a well-balanced diet
    • Engaging in regular, moderate exercise
    • Maintaining a healthy weight

      Medications for multiple sclerosis

      For people whose symptoms are moderate to severe, treatment may include any of the following medications:

      • Beta interferons, which can reduce the number of episodes of symptoms and slow progression of the disease
      • Intravenous biologic therapies, which can inhibit the abnormal immune response and reduce the rate of MS relapses
      • Corticosteroids, which can help minimize the intensity of symptoms
      • Muscle relaxers, which can reduce muscle spasms
      • Novantrone, which can be used for severe or advanced multiple sclerosis 

      Other treatments and therapies for multiple sclerosis

      • Equipment to help maintain independence, such as walkers, canes and braces
      • Exercise programs
      • Occupational therapy
      • Physical therapy
      • Speech therapy

      Complementary treatments
      Some complementary treatments may help some people to better deal with multiple sclerosis and its treatments. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

      Complementary treatments may include:

      • Acupuncture
      • Massage therapy
      • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products
      • Yoga

      What are the possible complications of multiple sclerosis?

      In some cases, complications of multiple sclerosis can be severely disabling. You can help lower the risk of serious complications, reduce symptoms, and delay disability by following the treatment plan you and your health care professional design specifically for you. Complications of multiple sclerosis include:

      • Adverse effects of multiple sclerosis treatment
      • Choking because of problems chewing and swallowing
      • Depression
      • Hearing loss
      • Incontinence
      • Loss of balance and falls
      • Painful muscle spasms
      • Paralysis
      • Permanent physical disability
      • Problems with memory and other mental functions
      • Seizures
      • Sexual dysfunction
      • Speech difficulties
      • Vision loss
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        Medical Reviewer: William C. Lloyd III, MD, FACS
        Last Review Date: 2018 Nov 18
        1. Multiple Sclerosis (MS). MedlinePlus. U.S. National Library of Medicine. https://medlineplus.gov/multiplesclerosis.html
        2. Cusick MF, Libbey JE, Fujinami RS. Multiple sclerosis: autoimmunity and viruses. Curr Opin Rheumatol 2013; 25:496
        3. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013
        4. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013
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