Multiple Sclerosis

What is multiple sclerosis?

Multiple sclerosis (MS) is a disease of the central nervous system (the brain and spinal cord). Many people with multiple sclerosis are only mildly affected by the disease and continue to lead their lives much as they did before their diagnosis. However, other people who have multiple sclerosis experience severe loss of coordination and muscle control.

There are 2 different patterns of MS symptoms.

• The more common pattern is episodes of symptoms for days or weeks followed by periods of no symptoms for weeks or months. This type of MS is called relapsing-remitting disease.
• Symptoms that keep getting worse after the first signs of illness are the less common pattern of symptoms. This form of the disease is called primary progressive disease.

How does it occur?

A fatty substance called myelin covers nerve fibers. The myelin normally insulates the nerve fibers. It helps nerve messages move to and from the brain. When you have multiple sclerosis, some of the myelin is damaged. The damaged areas are called plaques. The damage can keep nerves from sending signals to the body.

What causes damage to the myelin is not well understood. Currently, most scientists think that the loss of myelin is caused by an autoimmune process. This means that the body mistakenly reacts to some part of itself as foreign and attacks it. In the case of MS, the body attacks and destroys areas of its own myelin.

What are the symptoms?

Common first symptoms of MS are:

• vague feelings of weakness, clumsiness, or exhaustion
• blurred vision
• one or more areas of skin that feel numb or tingly

Other possible symptoms include:

• double vision
• weakness in the arms or legs
• stiff muscles
• dizziness
• loss of bladder control
• depression
• memory loss

Usually the symptoms come and go unpredictably. The times when you are having symptoms are called episodes. The episodes may last a few days or weeks at a time. The times when you are not having symptoms are called remissions. Many people with MS are able to function quite normally during remissions.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. Your provider will pay special attention to your nervous system.

The best test for MS is MRI (magnetic resonance imaging). MRI gives X-ray-like images that are better than other types of scans for looking at the central nervous system. MRI can show areas of damaged myelin.

If the diagnosis is still uncertain after MRI, your healthcare provider may do a test to measure how fast your nerves conduct impulses. A sample of fluid from your spine may be analyzed for changes that are often found in people who have MS.

You may have more than 1 MRI over time. Several MRIs may show plaques appearing in different parts of the central nervous system at different times. This confirms the diagnosis of multiple sclerosis.

How is it treated?

There is not yet a cure for MS. However, treatment with medicine can help shorten episodes of symptoms and increase the time between episodes.

The goals of long-term treatment are:

• to help lengthen the time between episodes of symptoms
• to prevent damage to the nerves.

Drugs that prevent the immune system from attacking the myelin are used to prevent episodes. The drugs most commonly used for this purpose are:

• a type of medicine called an interferon, which is given as a shot
• glatiramer acetate, which is given as daily shots under the skin, much like insulin shots
• mitoxantrone, which is given into the vein
• natalizumab, which is given into the vein

Steroid medicine may help symptoms be less severe during an episode as well as shorten the time an episode lasts. Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.

There are medicines that can help control specific symptoms of MS, such as depression, tiredness, urinary symptoms, and tremors or spasms. Ask your healthcare provider about medicines to help with these symptoms.

It’s important to get enough rest when you have MS. Always try to get plenty of rest, especially when you are having symptoms.

Much research is being done to find better ways to prevent MS symptoms and long-term nerve damage. Keep your follow-up appointments with your healthcare provider to be sure you are up to date on the latest treatments.

How long do the effects last?

You may have many episodes and remissions. Some people never have more than a few mild, infrequent symptoms. However, with time, the episodes may become more frequent or last longer. Some loss of function may continue between episodes. In some cases the disease eventually results in severe disability.

What kind of ongoing care do I need?

The most important aspect of care is emotional support. You may feel anxiety, anger, and fear. A mental health professional or other counselor may be able to help with the depression that often comes with MS.

Caring for someone with active MS requires a team approach. The doctors treating you may include a neurologist and a rehab specialist. Nurses, counselors, a physical therapist, an occupational therapist, and a social worker may all be part of your healthcare team. For example, a physical therapist can help you keep some strength, coordination, balance, and stamina. The goal is to enable you to be as independent as possible while also helping you cope with all of the consequences of having a disease that can become disabling.

What can be done to help prevent multiple sclerosis?

Because the cause of MS is not known, doctors don’t yet know how to prevent it.

For more information, call or write:

National Multiple Sclerosis Society
Phone: 800-FIGHT-MS (344-4867)
Web site: http://www.nmss.org.