Definition

Multiple sclerosis (MS) is a chronic, disabling disease of the central nervous system. The disease causes inflammation, destruction, and scarring of the sheath that covers nerve fibers, called myelin, in the brain and spinal cord. As a result, electrical signals from the brain are slowed or blocked from reaching the eyes, muscles, and other parts of the body.

Nerve Fiber (Neuron)

Myelin Sheath Damage

© 2009 Nucleus Medical Media, Inc.

There are several types of MS:

    
  • Relapsing-remitting MS—Symptoms suddenly reappear every few years, last for a few weeks or months, then go back into remission. Symptoms sometimes worsen with each occurrence.
  • Primary progressive MS—Symptoms gradually worsen after symptoms first appear. Relapses and remissions usually do not occur.
  • Secondary progressive MS—After years of relapses and remissions, symptoms suddenly begin to progressively worsen.
  • Progressive relapsing MS—Symptoms gradually worsen after symptoms first appear. One or more relapses may also occur.

    • Causes

    Malfunction of the body's immune system seems to be the cause of MS, but the exact cause of this malfunction is unknown.

    The following conditions may contribute to MS:

        
  • Viral or other infection
  • Genetic factors (heredity)
  • Environmental factors
  • Degeneration of parts of the nervous system

    • Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition. Risk factors for MS include:

        
  • Sex: female
  • Age: 15-50 years old
  • Being exposed to certain viruses
  • Having family members who have MS
  • Being of Northern European descent
  • Growing up in a colder climate, as opposed to a tropical climate
  • Having certain immune system genes
  • Having inflammation of the optic nerve
  • Having low vitamin D levels (may be a risk factor)
  • Smoking (may be a risk factor)

    • Symptoms

    Symptoms may range from mild to severe and may include:

        
  • Numbness or tingling in the face or limbs
  • Impaired vision in one or both eyes, including:     
  • Blurred vision
  • Double vision
  • Loss of vision
  • Eye pain
  • Fatigue
  • Dizziness
  • Muscle stiffness
  • Muscle spasms
  • Muscle weakness
  • Incoordination or falling
  • Trouble walking or maintaining balance
  • Weakness in one or more limbs
  • Bladder problems including:     
  • Urgency
  • Hesitancy
  • Incomplete emptying
  • Incontinence
  • Bowel problems, including constipation
  • Sexual dysfunction
  • Slurred speech
  • Difficulty swallowing
  • Forgetfulness, memory loss, and confusion
  • Difficulty concentrating or solving problems
  • Depression

    • Factors that may trigger or worsen symptoms include:

        
  • Heat including:     
  • Hot weather
  • Hot baths or showers
  • Fever
  • Overexertion
  • Infection

    • Diagnosis

    The doctor will ask about your symptoms and medical history, and perform a physical exam.

    Tests may include:

        
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the brain and spinal chord
  • Evoked potentials—a test that records the electrical responses evoked after a sensory stimulus
  • Lumbar puncture (spinal tap)—removal of a small amount of fluid from around the spinal cord to check for white blood cells, antibodies, and proteins
  • Blood tests to rule out other diseases that may mimic MS (eg, B12 deficiency , Lyme disease , autoimmune disease)
  • Visual evoked potential test —to look for problems in the brain that affect vision

    • Treatment

    The goals of MS treatment are to relieve symptoms, prevent relapses, delay disability, and slow disease progression.

    Treatments include:

    Medications

    Medications may include:

        
  • Corticosteroids—to reduce nerve tissue inflammation and shorten MS flare-ups
  • Interferon beta (Betaseron)—(a protein that naturally occurs in the body)—used to suppress the immune system
  • Glatiramer acetate —to help prevent MS relapses by modifying the function of the immune system
  • Other immunosuppressive drugs, such as:     
  • Intravenous immunoglobulin
  • Cyclophosphamide (Cytoxan)
  • Mitoxantrone (Novantrone)
  • Azathioprine (Imuran, Azasan)
  • Methotrexate (Rheumatrex, Trexall)
  • Intravenous immunoglobulin
  • Natalizumab (Tysabri)—for relapsing MS (This medication is under a mandatory registration program.)
  • Muscle relaxants—to treat muscle spasms or stiffness
  • Other drugs to treat:     
  • Fatigue
  • Depression
  • Pain
  • Bladder or bowel problems

    • Physical Therapies and Lifestyle Changes

    Therapies and changes may include:

        
  • Regular moderate exercise with your doctor's permission (Swimming is especially beneficial.)
  • Physical therapy to help maintain muscle strength and tone, dexterity, and walking ability
  • Massage
  • High fiber diet to prevent constipation
  • Stress reduction techniques
  • Quitting smoking —Smoking may worsen MS, possibly causing the condition to progress to a more severe form.

    • Psychological Therapies

    Individual or group therapy will help you learn coping strategies for physical symptoms and emotional stress.

    If you are diagnosed with MS, follow your doctor's instructions .

    Prevention

    There are no guidelines for preventing MS because the cause is unknown.

    To prevent flare-ups or worsening symptoms if you have MS:

        
  • Take medications as prescribed.
  • Avoid hot weather.
  • Stay in air-conditioned places during periods of hot weather.
  • Get adequate rest.
  • Get regular, moderate exercise with your doctor's permission.
  • Avoid hot showers or baths.
  • Make sure to get enough fiber in your diet.
  • To aid in stress reduction, consider getting regular massages.
  • Try to avoid infection. You can do this by:     
  • Practicing good hygiene
  • Staying away from people who are sick
  • Cooking food thoroughly
  • Practicing safe sex