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often called MS, is a disease that affects the
central nervous system—the brain and spinal cord. It
can cause problems with muscle control and strength, vision, balance, feeling,
Your nerve cells have a protective covering called
myelin. Without myelin, the brain and spinal cord can't communicate with the
nerves in the rest of the body. MS gradually destroys myelin in patches
throughout the brain and spinal cord, causing muscle weakness and other
symptoms. These patches of damage are called lesions.
different for each person. You may go through life with only minor problems. Or
you may become seriously disabled. Most people are somewhere in between.
Generally, MS follows one of four courses:
The exact cause is unknown, but
most experts believe that MS is an autoimmune disease. In this kind of disease, the
body's defenses, called the
immune system, mistakenly attack normal tissues. In
MS, the immune system attacks the central nervous system—the
brain and spinal cord.
Experts don't know why MS happens to some
people but not others. There may be a
genetic link, because the disease seems to run in
families. Where you grew up may also play a role. MS is more common in those
who grew up in colder regions that are farther away from the equator.
Symptoms depend on which
parts of the brain and spinal cord are damaged and how bad the damage is. Early
symptoms may include:
Diagnosing MS isn't always
easy. The first symptoms may be vague. And many of the symptoms can be caused
by problems other than MS.
MS is not
diagnosed unless a doctor can be sure that you have had at least two attacks affecting at least two different areas of your central nervous system.
The doctor will examine you, ask you questions about your symptoms, and do some
MRI is often used to confirm the diagnosis, because
the patches of damage (lesions) caused by MS attacks can be seen with this
Medicines are used to treat MS:
You may find it hard to decide when to start taking the drugs that slow the progression of MS. The drugs may not work for everyone, and they often have side
effects. You and your doctor will decide together when you should start any of these
There is no cure for MS. Treatment and self-care can
help you maintain your quality of life.
Physical therapy, occupational therapy, and
speech therapy can help you manage some physical problems caused by MS. You can
also help yourself at home by eating balanced meals, getting regular exercise and rest,
and learning to use your energy wisely.
Dealing with the physical
and emotional demands of MS isn't easy. If you feel overwhelmed, talk to your
doctor. You may be depressed, which can be treated. And finding a support group
where you can talk to other people who have MS can be very helpful.
Learning about multiple sclerosis:
Health Tools help you make wise health decisions or take action to improve your health.
The cause of multiple sclerosis (MS) is unknown. Because a person's
risk of MS is slightly higher in some families when a relative has MS, there may be a
genetic link. For more information, see What Increases Your Risk.
Some research suggests that where you lived as a child and viral illnesses you have had could be triggers for MS later in life. But these links have not been proved.
The symptoms of
multiple sclerosis (MS) vary from person to person
depending on which parts of the brain or spinal cord (central nervous system) are damaged. The
loss of myelin and scarring caused by MS can affect
any part of the central nervous system. Myelin is the insulating coating around a nerve.
Symptoms may come and go or become more or less severe from day to day or, in rare cases, from hour to hour.
Symptoms may become worse with increased body temperature or after a
Common early symptoms of MS
As MS progresses, symptoms may
become more severe and may include:
multiple sclerosis follows one of four courses:
MS is different for every person. You may go through life with only minor problems. Or you may become seriously disabled. Most people are somewhere in between.
The duration of the disease varies. Most people who get MS
live with it for decades.
MS usually progresses with a series of
relapses that occur over many years
(relapsing-remitting MS). In many people the first MS attack involves just a
single symptom. It may be weeks, months, or years before you have a relapse.
time goes by, symptoms may linger after each relapse so you lose the ability to
fully recover from the relapse. New symptoms often develop as the disease
damages other areas of the
brain or spinal cord.
Events that can mean you may have a more
severe type of MS include:
Some people have a few
mild attacks from which they recover entirely. This is called benign MS.
Although rare, a small number of people die within several years of the
onset of MS. This is called malignant or fulminant MS.
Because MS may affect your ability to move and walk, it
can place limits on your daily living, particularly as you age. If you or someone in
your family has MS, talk to your doctor about
how MS may affect daily living. Knowing what to expect will help you plan
for the future.
Complications that may result
from MS include:
Your risk for
multiple sclerosis (MS) increases with:
Some of the symptoms of
multiple sclerosis (MS) are similar to those of many
other illnesses. See your doctor if over a period of time you have more than
one symptom, such as:
If you have been diagnosed with MS, see your doctor
Milder MS-type symptoms can be caused by many
other conditions or may occur now and then in healthy people. For example, lots of
people have minor numbness in their fingers or a mild dizzy spell once in
a while. Stiffness and muscle weakness can result from being more active than
A wait-and-see approach (watchful waiting) is appropriate for these types of
everyday aches and pains, so long as they do not continue.
symptoms occur more often or don't go away, talk to your doctor.
Talk to your doctor about
what to expect from the disease and from treatment. MS is an unpredictable
disease, but you probably can get some idea of what is "normal" and what
symptoms or problems are reasons for concern.
Some people who have MS
want active, regular support from their doctors. Others want to manage their
condition on their own as much as possible. Wherever you are in this range,
find out which signs or symptoms mean that you need to see your doctor. And
seek help when you need it.
Health professionals who may be involved in evaluating
symptoms of MS and treating the condition include:
Many university medical centers and large hospitals have
MS clinics or centers staffed by neurologists and other health professionals
who specialize in diagnosing and treating MS. They may be able to provide the
most thorough evaluation.
If you have been diagnosed with MS, at
some point you may need to seek the help of:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
multiple sclerosis (MS) isn't always easy and in some cases may take time.
Your medical history and
neurological exam can identify possible nervous
system problems and are often enough to strongly suggest a diagnosis of MS.
Tests may help confirm or rule out the diagnosis when your history and
exam do not provide clear evidence of the disease. MRI and neurological exam may help doctors predict which people
will develop MS after a first attack of symptoms.
MS is diagnosed when it is clear from neurological tests and a neurological exam that lesions
(damaged areas) are present in more than one area of the central nervous system (usually the brain, spinal cord, or the nerves to the
eyes). Tests will also clearly show that damage has occurred at more than one point in time.
Some people have had only one episode of a neurological symptom such as optic
neuritis, but MRI tests suggest they may have MS. This is known as a clinically
isolated syndrome. Many of these people go on to develop MS over time.
Urinary tract tests may be needed to help diagnose a
problem with bladder control in a person who has MS.
Neuropsychological tests may be needed to identify
thinking or emotional problems, which may be present without the person being
aware of them. Typically, these tests are in a question-and-answer
A blood test for JC virus antibodies may be done. This test can help you and your doctor understand your risk for getting a rare but serious brain infection called PML (progressive multifocal leukoencephalopathy).
Treatment can make living with
multiple sclerosis (MS) easier. Your type of treatment
will depend on how severe your symptoms are and whether your disease is active
or in remission. You may get medicines, physical therapy, and other treatment at home.
Medicines are used to treat relapses, control the course of the disease (disease-modifying drugs or DMDs), or treat symptoms.
The National Multiple
Sclerosis Society recommends that people with a definite diagnosis of MS and
who have active, relapsing disease start treatment with medicines. This group also recommends treatment with medicine after the first attack in some people who are at a high risk for MS.3
If you decide
not to try medicines at this time, meet with your doctor regularly to check whether the disease is progressing.
You and your doctor will set up a schedule
of periodic appointments to monitor and treat your symptoms and follow the
progress of your MS. Monitoring your condition helps your doctor find out
if you may need to try a different treatment.
occupational therapy, and nonmedical treatment done at
home may also help you manage symptoms and adjust to living and working
situations. To learn more, see Home Treatment.
In rare cases,
MS is life-threatening. If your
condition gets considerably worse, you may want to make a living will,
which allows your wishes to be carried out if you are not able to make
decisions for yourself. For more information, see the topic
Care at the End of Life.
In general, there is no way to prevent
multiple sclerosis (MS) or its attacks. For people
relapsing-remitting MS and secondary progressive MS, treatment with medicine may reduce the frequency of relapses and delay disability.
If you have
multiple sclerosis (MS), it is important to find ways
of coping with the practical and emotional demands of the disease. These are
different for everyone, so home treatment varies from person to person.
Home treatment may involve making it easier to get around your home,
depression, handling specific symptoms, and getting
support from your family and friends.
Ask your doctor about physical therapy and occupational therapy to help you manage at work and home.
Make all efforts to preserve your health. Proper diet,
rest, wise use of energy, and practical and emotional support from your family,
friends, and doctor can all be very helpful.
advice about coping with MS at home, contact the National Multiple Sclerosis
Society at www.nationalmssociety.org.
multiple sclerosis (MS) may be used:
These medicines can shorten a
sudden relapse and help you feel better sooner. They have not been shown
to affect the long-term course of the disease or to prevent disability.
Strong evidence suggests that MS is caused by the
immune system causing
inflammation and attacking nerve cells and myelin, which is the protective coating
surrounding the nerve fibers. Medicines that change the way the immune system works can reduce the number and severity of attacks that damage the nerves and myelin.
For people who have
relapsing-remitting MS, disease-modifying therapy can reduce
the number and severity of relapses. It may also delay disability in some people. Some of these medicines may also delay
disease progression and reduce relapses in some people who have
secondary progressive MS.
The most commonly used disease-modifying therapies are:
Other disease-modifying medicines may also be used for relapsing-remitting MS. These medicines are available as pills that you take by mouth. They include:
And other disease-modifying medicines may be used if the medicines above haven't worked or when MS is getting worse. They include:
There is no effective disease-modifying treatment for
primary progressive MS.
Some people have
only one episode of a neurological symptom such as
optic neuritis. Yet
MRI or other tests suggest that these people have MS. This is known
as a clinically isolated syndrome. Many of these people go on to develop MS
over time. In most cases, doctors will prescribe medicine for people who have had a clinically isolated syndrome.
These medicines, when taken early or even before you have been diagnosed with
MS, may keep the disease from getting worse or extend your time without
Treating specific symptoms can
be effective, even if it doesn't stop the progression of the disease. Symptoms
that can often be controlled or relieved with medicine include:
Medicines can also help with sexual problems, emotional problems, and walking problems. Sildenafil (Viagra) can help with sexual problems in both men and women. Yohimbine and clomipramine may also
be given to improve
erectile dysfunction. Dextromethorphan and quinidine (Nuedexta) is a medicine that can be used for uncontrollable outbursts of crying or laughing at strange or inappropriate times. Dalfampridine (Ampyra) is a medicine that can be used to help with walking problems.
Medicine may be used only some of the time or regularly, depending
on how severe or constant a certain symptom is. Changes in diet, schedule,
exercise, and other habits can also help manage some of these symptoms. See Home Treatment.
A variety of
other medicines and biological chemicals have been tried or are being studied as
therapy for MS. None of them have been clearly proved as beneficial, and none have
been approved for treatment of MS.
Several medicines are being tested in
clinical trials. People with MS who have not responded
to standard therapy sometimes choose to take part in these trials. To learn
more about clinical trials, talk to your doctor or contact the National
Multiple Sclerosis Society at www.nationalmssociety.org.
The National Multiple Sclerosis Society recommends that people with a definite diagnosis of MS and active, relapsing
disease start treatment with interferon beta or glatiramer. Most neurologists support this recommendation and now
agree that permanent damage to the nervous system may occur early on, even while symptoms are still quite mild.
Early treatment may help prevent or delay some of this damage. In general, treatment is recommended until it no
longer provides a clear benefit.
The National MS Society also says that treatment with medicine may be considered after the first attack in some
people who are at a high risk for MS (before MS is definitely diagnosed).
Despite the recommendation, some people find it hard to decide whether to begin disease-modifying therapy,
especially when their symptoms have been fairly mild. Some may not want to bear the risks and side effects of
medicine when they are not sure they need it. Some may want to see whether their disease gets worse before they
start therapy. A small percentage of people diagnosed with MS may never have more than a few mild episodes and
may never develop any disability, but the disease is unpredictable.
The need and desire for medicine vary. If your symptoms are mild, you may choose to manage
them without any medicine. If you have specific symptoms that are causing
problems, certain medicines may help you keep them under control. Or you may
want to use medicine only during a relapse.
You may also want to
Also keep in mind that it can be hard to tell if
medicine is helping. Multiple sclerosis is a disease with spontaneous
remissions. This means that your condition can improve on its own, without any
treatment. Just because your symptoms improve after treatment doesn't mean
that a treatment is working.
multiple sclerosis (MS) who have severe
tremor (shakiness) affecting movement may be helped by
surgery. People with severe
spasticity (muscle stiffness) may be helped by
insertion of a spinal pump to deliver medicines when oral medicines
Surgery options include:
The unpredictability and
variety of symptoms caused by
multiple sclerosis (MS) make it a disease that people
have tried to treat in many different ways.
Many complementary therapies have been proposed as
treatments for MS. None of these treatments have been shown to modify the
course of the disease. Some of those most commonly used are:
Although clinical research has not shown any of these
complementary therapies to be effective, a person with MS may benefit from safe
nontraditional therapies along with conventional medical treatment. Some
complementary therapies may help relieve
stress, depression, fatigue, and muscle tension. And some may improve your overall
well-being and quality of life. Talk to your doctor if you are
interested in trying any of these complementary therapies or alternative medical approaches to MS treatment.
Clinical research also has been
unable to show that treatments such as "liberation" angioplasty for chronic cerebrospinal venous insufficiency (CCSVI), bee venom therapy, Prokarin (a caffeine
and histamine combination),
removal of mercury fillings (dental amalgams), and
hyperbaric oxygen therapy have any benefits for people
who have MS. Some of these therapies may be harmful as well as expensive and are not recommended by most experts.
treatments for MS involve reducing the activity of the
immune system. This may be done with
medicines and biological chemicals or through methods such as
total lymphoid irradiation, in which the entire lymph
node system is exposed to radiation. While these methods have been used with success in
the treatment of certain other medical conditions, they have failed to produce
significant benefits when tested in controlled clinical trials. They remain
experimental treatments for MS.
Stem cell transplant, which uses immature cells from the bone marrow, has been studied. Early results suggest that stem cell transplant may delay disability, especially in people with relapsing-remitting MS.4 Stem cell transplant may be an option for people who have very aggressive or malignant forms of MS.5 It remains unproved and isn't recommended for treating relapsing-remitting MS.
There is no cure for MS. So far, the only treatments proved
to affect the course of the disease are approved disease-modifying therapies. Other types of treatment should not replace these medicines if you are a candidate for
treatment with them.
Some people who have MS report that complementary therapies have worked for them. This may be in part due to the
placebo effect. The placebo effect means that you feel better after getting treatment, even though the treatment has not been proved to work. And even if some complementary
therapies don't treat the disease itself, they may affect a person's sense of well-being and help the person feel better and healthier.
If you are
thinking about trying a complementary treatment, get the facts first. Discuss these questions with your doctor:
With a hard-to-treat disease like MS, it can be tempting
to jump at the promise of an effective treatment. Be cautious about trying
Tremlett H, et al. (2010). New perspectives in the natural history of multiple sclerosis. Neurology, 74(24): 2004–2015.
Ropper AH, Samuels MA (2009). Multiple sclerosis and
allied demyelinative diseases. In Adams and Victor's Principles of Neurology, 9th ed., pp. 874–903. New York:
National Clinical Advisory Board of the National Multiple Sclerosis Society (2008). Disease Management Consensus Statement. New York: National Multiple Sclerosis Society. Available online: http://www.nationalmssociety.org/for-professionals/healthcare-professionals/publications/expert-opinion-papers/index.aspx.
Burt RK, et al. (2009). Autologous non-myeloablative haemopoietic stem cell transplantation in relapsing-remitting multiple sclerosis: A phase I/II study. Lancet Neurology, 8(3): 244–253.
Fassas A, et al. (2011). Long-term results of stem cell transplantation for MS: A single-center experience. Neurology, 76(12): 1066–1070.
Other Works Consulted
Burton JM, et al. (2009). Oral versus intravenous steroids for treatment of relapses in multiple sclerosis. Cochrane Database of Systematic Reviews (3).
Cortese I, et al. (2011). Evidence-based guideline update: Plasmapheresis in neurologic disorders: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 76(3): 294–300.
Courtney AM, et al. (2009). Multiple sclerosis. Medical Clinics of North America, 93(2): 451–476.
Fox RJ, Arnold DL (2009). Seeing injectable MS therapies differently: They are more similar than different. Neurology, 72(23): 1972–1973.
Giesser B (2010). Reproductive Issues in Persons With Multiple Sclerosis. Clinical Bulletin: Information Health Professionals. Available online: http://www.nationalmssociety.org/for-professionals/healthcare-professionals/publications/clinical-bulletins/index.aspx.
Goodin DS, et al. (2008, reaffirmed 2010). Neutralizing antibodies to interferon beta: Assessment of their clinical and radiographic impact: An evidence report: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 68(13): 977–984.
Grossman P, et al. (2010). MS quality of life, depression, and fatigue improve after mindfulness training: A randomized trial. Neurology, 75(13): 1141–1149.
Kelly VM, et al. (2009). Obstetric outcomes in women with multiple sclerosis and epilepsy. Neurology, 73(22): 1831–1836.
Marriott JJ, et al. (2010). Evidence report: The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 74(18): 1463–1470.
McDonald WI, et al. (2001). Recommended diagnostic
criteria for multiple sclerosis: Guidelines from the International Panel on the
Diagnosis of Multiple Sclerosis. Annals of Neurology,
Polman CH, et al. (2005). Diagnostic criteria for
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Polman CH, et al. (2006). A randomized,
placebo-controlled trial of natalizumab for relapsing multiple sclerosis.
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October 15, 2013
Adam Husney, MD - Family Medicine & Anne C. Poinier, MD - Internal Medicine & Barrie J. Hurwitz, MD - Neurology
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