Multiple Sclerosis (MS)

What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is an autoimmune disease. With these conditions, your immune system mistakenly attacks healthy cells. In people with MS, the immune system attacks cells in the myelin, the protective sheath that surrounds nerves in the brain and spinal cord.

Damage to the myelin sheath interrupts nerve signals from your brain to other parts of your body. The damage can lead to symptoms affecting your brain, spinal cord and eyes.

There are four types of multiple sclerosis:

• Clinically isolated syndrome (CIS): When someone has a first episode of MS symptoms, healthcare providers often categorize it as CIS. Not everyone who has CIS goes on to develop multiple sclerosis.
• Relapsing-remitting MS (RRMS): This is the most common form of multiple sclerosis. People with RRMS have flare-ups -- also called relapse or exacerbation -- of new or worsening symptoms. Periods of remission follow (when symptoms stabilize or go away).
• Primary progressive MS (PPMS): People diagnosed with PPMS have symptoms that slowly and gradually worsen without any periods of relapse or remission.
• Secondary progressive MS (SPMS): In many cases, people originally diagnosed with RRMS eventually progress to SPMS. With secondary-progressive multiple sclerosis, you continue to accumulate nerve damage. Your symptoms progressively worsen. While you may still experience some relapses or flares (when symptoms increase), you no longer have periods of remission afterward (when symptoms stabilize or go away).

How common is multiple sclerosis (MS)?

Nearly 1 million adults in the U.S. are living with multiple sclerosis. MS commonly affects more women than men. Most people with MS receive a diagnosis between the ages of 20 and 40.

What causes multiple sclerosis (MS)?

Experts still don’t know for sure what causes multiple sclerosis. Research is ongoing to help identify what causes the disease. Factors that may trigger MS include:

• Exposure to certain viruses or bacteria: Some research suggests that being exposed to certain infections (such as Epstein-Barr virus) can trigger MS later in life.
• Where you live: Your environment may play a role in your risk for developing MS. Certain parts of the world have significantly higher rates of the disease than others. Areas farther from the equator have higher rates of MS. That may be because these regions receive less intense sun. People who get less sun have lower levels of vitamin D, a risk factor for developing MS.
• How your immune system functions: Multiple sclerosis is an autoimmune disease. Researchers are working to figure out what causes some people’s immune cells to mistakenly attack healthy cells.
• Gene mutations: Having a family member with MS does increase your risk of the disease. But it’s still unclear exactly how and which genes play a role in triggering multiple sclerosis.

What are the symptoms of multiple sclerosis?

Vision problems — such as optic neuritis (blurriness and pain in one eye) — are often one of the first signs of multiple sclerosis. Other common symptoms include:

• Changes in gait.
• Fatigue.
• Loss of balance or coordination.
• Muscle spasms.
• Muscle weakness.
• Tingling or numbness, especially in your legs or arms.

What are the complications of multiple sclerosis?

If MS progresses, worsening symptoms may lead to complications such as:

• Difficulty walking that may result in needing a cane, walker or wheelchair.
• Loss of bowel or bladder control.
• Memory problems.
• Sexual difficulties.

Who diagnoses multiple sclerosis (MS)?

Many conditions could cause similar neurological symptoms. Getting an accurate diagnosis is sometimes difficult. Some people see multiple providers over years before receiving a diagnosis. While the search can be frustrating, it’s important to keep looking for answers. Identifying and treating MS as soon as possible can help slow the disease’s progression.

If your primary care provider suspects you may have MS, you will need to see a neurologist. A neurologist is a doctor who specializes in treating conditions that affect the nervous system, which includes your brain and spinal cord.

How is multiple sclerosis diagnosed?

No one test can provide a definitive MS diagnosis. To understand what’s causing symptoms, your healthcare provider will do a physical exam. You may also have blood tests and imaging tests, such as MRI. An MRI looks for evidence of lesions (areas of damage) in the brain or spinal cord that indicate multiple sclerosis. Lesions develop as a result of damage to the myelin sheath surrounding the nerves. A spinal tap (lumbar puncture) may also need to be done.

If these tests don’t provide a clear answer, your neurologist may recommend an evoked potentials test. This test checks your nerve function by measuring electrical activity in the brain and spinal cord.

How is multiple sclerosis (MS) managed or treated?

There is currently no cure for MS. Treatment focuses on managing symptoms, reducing relapses (periods when symptoms worsen) and slowing the disease’s progression. Your comprehensive treatment plan may include:

• Disease-modifying therapies (DMTs): Several medications have FDA approval for long-term MS treatment. These drugs help reduce relapses (also called flare-ups or attacks). They slow down the disease’s progression. And they can prevent new lesions from forming on the brain and spinal cord.
• Relapse management medications: If you have a severe attack, your neurologist may recommend a high dose of corticosteroids. The medication can quickly reduce inflammation. They slow damage to the myelin sheath surrounding your nerve cells.
• Physical rehabilitation: Multiple sclerosis can affect your physical function. Staying physically fit and strong will help you maintain your mobility.
• Mental health counseling: Coping with a chronic condition can be emotionally challenging. And MS can sometimes affect your mood and memory. Working with a neuropsychologist or getting other emotional support is an essential part of managing the disease.

How can I prevent a multiple sclerosis flare-up?

Disease-modifying therapies are the most effective way to reduce the number of flare-ups (also called relapses or attacks) you experience. Leading a healthy lifestyle is also important. The choices you make can help slow disease progression. Good care can also lessen your symptoms and improve your quality of life.

Lifestyle changes that can improve your condition include:

• Eating a healthy diet: There is no magic MS diet. Experts recommend a balanced diet that includes lots of fruit and vegetables, whole grains, healthy fats and lean protein. You should also limit your intake of added sugars, unhealthy fats and processed foods.
• Getting regular exercise: Multiple sclerosis can cause muscle weakness, loss of balance and difficulty walking. Aerobic exercise, flexibility and strength training are essential to help keep muscles strong and maintain physical function.
• Managing stress: Stress can take a physical and emotional toll. It can also interfere with sleep, which can worsen MS-related fatigue. It’s important to find ways to manage stress — such as yoga, meditation, exercise, and working with a mental health provider.
• Not smoking and limiting alcohol intake: Smoking and alcohol are linked to worsening MS symptoms and could speed the disease's progression. Quitting smoking will support your health.

What is the prognosis (outlook) for people with multiple sclerosis (MS)?

In some cases, multiple sclerosis does lead to disability and loss of some physical or mental function. But thanks to advances in treatment, most people with MS will continue to lead full, active and productive lives. Taking steps to manage your health and lifestyle can help improve your long-term outcome.

Is it common for people with multiple sclerosis (MS) to experience depression?

Depression is very common in people with multiple sclerosis (MS). In fact, symptoms of depression severe enough to require medical intervention affect up to half of all people with MS at some point during their illness.

Depression may be the result of a difficult situation or stress. It is easy to understand how having MS, with its potential for progressing to permanent disability, can bring on depression.

Depression might be actually caused by MS. MS may affect the insulating myelin that surrounds nerves which transmit signals affecting mood.

Depression is also a side effect of some drugs used to treat MS, such as steroids or interferon.

How does heat or humidity impact people with multiple sclerosis (MS)?

Heat or high humidity can cause many people with MS to experience a temporary worsening of their symptoms. Doctors believe that this occurs because heat causes nerves (whose myelin covering has been removed by MS) to conduct electrical signals even less efficiently.

For reasons that are not well understood, extremely cold temperatures and changes in temperature can also cause MS symptoms, usually spasticity (muscle stiffness), to flare.

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When should I call the doctor?

You should call your healthcare provider if you experience:

• Feeling overly sensitive to heat.
• Feeling unsteady or off balance.
• Memory problems.
• Numbness or tingling, especially in your arms or legs.
• Sudden vision changes.
• Weakness in your arms or legs.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

• How do we know for sure that I have multiple sclerosis and not another neurological condition?
• Do I need to start taking disease-modifying therapy medication?
• What are the benefits and risks of various DMTs?
• Will I need to stay on medication for the rest of my life?
• What lifestyle changes can I make to help manage MS?

A note from Cleveland Clinic

Multiple sclerosis is a disease that affects the central nervous system (brain, spinal cord and optic nerves). It is an autoimmune disease that causes your immune cells to mistakenly attack your healthy nerve cells. These attacks lead to inflammation and damage to the myelin sheath that covers and protects your nerve cells. This damage causes neurological symptoms — such as loss of balance, vision problems and muscle weakness. Several effective treatments exist for MS. These medications reduce relapses and help slow the progression of the disease. Most people with MS are able to manage their symptoms and lead full, active lives.