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    Multiple sclerosis

    MS; Demyelinating disease

    Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord (central nervous system).

    Causes

    Multiple sclerosis (MS) affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40, but can be seen at any age.

    MS is caused by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow down or stop.

    The nerve damage is caused by inflammation. Inflammation occurs when the body's own 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 this to happen. The most common thought is that a virus or gene defect, or both, are to blame. Environmental factors may play a role.

    You are slightly more likely to get this condition if you have a family history of MS or live in an part of the world where MS is more common.

    Symptoms

    Symptoms vary, because the location and severity of each attack can be different.Attacks can last for days, weeks, or months.Attacks are followed byperiods of reduced or no symptoms (remissions). Fever, hot baths, sun exposure, and stress can trigger or worsen attacks.

    It is common for the disease to return (relapse). However, the disease may continue to get worse without periods of remission.

    Nerves in any part of the brain or spinal cord may be damaged.Because of this, MSsymptoms can appear in many parts of the body.

    Muscle symptoms:

    • Loss of balance
    • Muscle spasms
    • Numbness or abnormal sensation in any area
    • Problems moving arms or legs
    • Problems walking
    • Problems with coordination and making small movements
    • Tremor in one or more arms or legs
    • Weakness in one or more arms or legs

    Bowel and bladder symptoms:

    • Constipation and stool leakage
    • Difficulty beginning to urinate
    • Frequent need to urinate
    • Strong urge to urinate
    • Urine leakage (incontinence)

    Eye symptoms:

    • Double vision
    • Eye discomfort
    • Uncontrollable rapid eye movements
    • Vision loss (usually affects one eye at a time)

    Numbness, tingling, or pain:

    • Facial pain
    • Painful muscle spasms
    • 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
    • Depression or feelings of sadness
    • Dizziness and balance problems
    • Hearing loss

    Sexual symptoms:

    • Problems with erections
    • Problems with vaginal lubrication

    Speech and swallowing symptoms:

    • Slurred or difficult-to-understand speech
    • Trouble chewing and swallowing

    Fatigue is a common and bothersome symptom as MS progresses. It is often worse in the late afternoon.

    Exams and Tests

    Symptoms of MS maybemimicthose of many other nervous system problems.MS is diagnosed by ruling out other conditions.

    People who have a form of MS called relapsing-remitting may have a history of at least two attacks, separated by a period of reduced or no symptoms.

    Thedoctor 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 nervoussystem may show reduced nerve function in one area of the body.Or it may bespread 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

    An eye examination may show:

    • Abnormal pupil responses
    • Changes in the visual fields or eye movements
    • Decreased visual acuity
    • Problems with the inside parts of the eye
    • Rapid eye movements triggered when the eye moves

    Tests to diagnose multiple sclerosis include:

    • Blood tests to rule out other conditions similar to MS
    • Lumbar puncture (spinal tap) for cerebrospinal fluid tests, including CSF oligoclonal banding
    • MRI scan of the brain and MRI scan of the spine are important to help diagnose and follow MS
    • Nerve function study (evoked potential test, such as brainstem auditory evoked response)

    Treatment

    There is no known cure for multiple sclerosis at this time. But, there are treatments that may slow the disease. The goal of treatment is to 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 may be used to decrease the severity of attacks
    • Medicines to control symptoms such as muscle spasms, urinary problems, fatigue or mood problems 

    The following may also be helpful for people with MS:

    • 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 disorder
    • 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 prevent falls
    • Social workers or other counseling services to help you cope with the disorder and get assistance
    • Vitamin D or other supplements (talk to your doctor first)

    Support Groups

    Living with MS may be a challenge. You can ease the stress of illness by joining an MS support group. Sharing with others who have common experiences and problems can help you not feel alone.

    Outlook (Prognosis)

    Outcome varies, and is hard to predict. Although the disorder is chronic and incurable, life expectancy can be normal or almost normal. Most people with MSare activeand function at work with littledisability.

    The following typically have the best outlook:

    • Females
    • People who were young (less than 30 years) 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. Slowly, there is greater loss of function with less improvement between attacks.

    • Depression
    • Difficulty swallowing
    • Difficulty thinking
    • Less and less ability to care for self
    • Need for indwelling catheter
    • Osteoporosis or thinning of the bones
    • Pressure sores
    • Side effects of medications used to treat the disorder
    • Urinary tract infections

    When to Contact a Medical Professional

    Call your health care provider if:

    • You develop any symptoms of MS
    • Symptoms get worse, even with treatment
    • The conditionworsens to the point when home care is no longer possible

    References

    Houtchens MK, Lublin FD, Miller AE, Khoury SJ. Multiple sclerosis and other inflammatory demyelinating diseases of the central nervous system. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 54.

    Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011;69:292–302.

    Rubin S. Management of multiple sclerosis: an overview. Disease-a-Month. 2013;59:253–260.

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    A Closer Look

    Self Care

      Tests for Multiple sclerosis

        Review Date: 9/25/2013

        Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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