Multiple sclerosis: MedlinePlus Medical Encyclopedia
MS affects women more often than men. The disease is most commonly diagnosed between ages 20 to 40, but it can be seen at any age.
MS is caused by damage to the myelin sheath of nerves. This sheath is the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow or stop.
The nerve damage is caused by inflammation. Inflammation occurs when the body's immune cells attack the nervous system. This can occur along any area of the brain, optic nerve, and spinal cord.
It is unknown what exactly causes MS. The most common thought is that it is caused by a virus, a variant gene, or both. Environmental factors may also play a role.
You are slightly more likely to develop this condition if you have a family history of MS or you live in a part of the world where MS is more common (areas further from the equator).
Symptoms vary because the location and severity of each attack can be different. Attacks can last for days, weeks, or months. Attacks are followed by remissions. These are periods of reduced symptoms or no symptoms. Fever, hot baths, sun exposure, and stress can trigger or worsen attacks.
Nerves in any part of the brain or spinal cord may be damaged. Because of this, MS symptoms can appear in many parts of the body.
Muscle symptoms:
Loss of balance
or abnormal sensation in any area
Problems moving arms or legs
Problems walking
Problems with
and making small movements
in one or more arms or legs
in one or more arms or legs
Bowel and bladder symptoms:
and stool leakage
Difficulty beginning to urinate
Strong urge to urinate
(incontinence)
Eye symptoms:
(usually affects one eye at a time)
Numbness, tingling, or pain:
Painful
Tingling, crawling, or burning feeling in the arms and legs
Other brain and nerve symptoms:
Decreased attention span, poor judgment, and memory loss
Difficulty reasoning and solving problems
or feelings of sadness
and balance problems
Sexual symptoms:
Problems with vaginal lubrication
Speech and swallowing symptoms:
or difficult-to-understand speech
Trouble chewing and swallowing
is a common and bothersome symptom as MS progresses. It is often worse in the late afternoon.
Symptoms of MS may mimic those of many other nervous system problems. MS is diagnosed by determining if there are signs of more than one attack on the brain or spinal cord and by checking for other conditions.
People who have a form of MS called relapsing-remitting MS have evidence of at least two attacks separated by a remission.
In other people, the disease may slowly get worse in between clear attacks. This form is called secondary progressive MS. A form with gradual progression, but no clear attacks is called primary progressive MS.
Your health care provider may suspect MS if there are decreases in the function of two different parts of the central nervous system (such as abnormal reflexes) at two different times.
An exam of the nervous system may show reduced nerve function in one area of the body. Or the reduced nerve function may be spread over many parts of the body. This may include:
Abnormal nerve reflexes
Decreased ability to move a part of the body
Decreased or abnormal sensation
Other loss of nervous system functions, such as vision
An eye exam may show:
Abnormal pupil responses
Changes in the
Changes in eye movements
Damage to the nerve in the eye (
)
Problems with the inside parts of the eye
Rapid eye movements triggered when the eye moves
Tests to diagnose MS include:
Blood tests to check for other conditions that are similar to MS.
(spinal tap) for cerebrospinal fluid (CSF) tests, including CSF oligoclonal banding may be needed.
, or the spine, or both are important to help diagnose and follow the progress of MS.
Nerve function study (evoked potential test, such as visual evoked response) is less often used.
There is no known cure for MS at this time, but there are treatments that may slow the disease. The goal of treatment is to stop progression, control symptoms, and help you maintain a normal quality of life.
Medicines are often taken long-term. These include:
Medicines to slow the disease
Steroids to decrease the severity of attacks (more effective for relapsing-remitting form of MS than for other forms)
Other medicines are used to control symptoms such as muscle spasms, urinary problems, fatigue, or mood problems
The following may also be
:
Physical therapy, speech therapy, occupational therapy, and support groups
Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars
A planned exercise program early in the course of the disease
A healthy lifestyle, with good nutrition and enough rest and relaxation
Avoiding fatigue, stress, temperature extremes, and illness
Changes in
what you eat or drink if there are swallowing problems
Making changes around the home to
Social workers or other counseling services to help you cope with the disease and get assistance
Vitamin D or other supplements (talk to your provider first)
Complementary and alternative approaches, such as acupuncture or cannabis, to help with muscle problems
Spinal devices can reduce pain and spasticity in the legs
Living with MS may be a challenge. You can ease the stress of illness by joining an
. Sharing with others who have common experiences and problems can help you not feel alone.
The outcome varies, and is hard to predict. Although the disorder is life-long (
) and incurable, life expectancy can be normal or almost normal. Most people with MS are active and function at work with little disability.
Those who usually have the best outlook are:
Females
People who were young (less than 30 years old) when the disease started
People with infrequent attacks
People with a relapsing-remitting pattern
People who have limited disease on imaging studies
The amount of disability and discomfort depends on:
How often and severe the attacks are
The part of the central nervous system that is affected by each attack
Most people return to normal or near-normal function between attacks. Over time, there is greater loss of function with less improvement between attacks.
Contact your provider if:
You develop any symptoms of MS
Your symptoms get worse, even with treatment
The condition worsens to the point when home care is no longer possible
MS; Demyelinating disease
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Rae-Grant A, Day GS, Marrie RA, et al. Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90(17):777-788. PMID: 29686116
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.
Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.