Part 1 of 11: Symptoms
People with MS experience a wide range of symptoms. Due to the nature of the disease, it can vary widely from one person to another. The symptoms can change in severity from year to year, month to month, and even day to day.
Two of the most common symptoms are fatigue and difficulty walking.
About 80 percent of people with MS report having fatigue. Fatigue that occurs with MS is more than feeling tired. It can become debilitating, affecting your ability to work and perform everyday tasks.
Difficulty walking can occur with MS for a number of reasons:
- numbness of the legs or feet
- difficulty balancing
- muscle weakness
- muscle spasticity
Overwhelming fatigue can also contribute to the problem. Difficulty walking can lead to injuries due to falling.
Other fairly common symptoms of MS include:
- speech disorders
- cognitive issues involving concentration, memory, and problem-solving skills
- acute or chronic pain
Part 2 of 11: Overview
MS is a chronic illness involving the central nervous system. The immune system attacks myelin, which is the protective layer around nerve fibers. This causes inflammation and scar tissue, or lesions. This can make it hard for your brain to send signals to the rest of your body. Types of MS include:
Relapsing-remitting MS (RRMS)
RRMS involves clear relapses of disease activity followed by remissions. Symptoms are mild or absent during remission, and there’s no disease progression during the remission period. RRMS is the most common form of MS at onset.
Clinically isolated syndrome (CIS)
CIS involves one episode of symptoms that are due to demyelination in the central nervous system. This episode must last for at least 24 hours.
The two types of episodes are monofocal and multifocal. A monofocal episode means one lesion causes one symptom. A multifocal episode means you have more than one lesion and more than one symptom.
Although these episodes are characteristic of MS, they aren’t enough to prompt a diagnosis. If lesions similar to those that occur with MS are present, you’re more likely to receive a diagnosis of RRMS. If these lesions aren’t present, you’re less likely to develop MS.
Primary-progressive MS (PPMS)
Neurological function becomes progressively worse from the onset of your symptoms if you have PPMS. However, short periods of stability can still occur.
Progressive-relapsing MS was a term people previously used for progressive MS with clear relapses. People now call it PPMS. The words “active” and “not active” are used to describe disease activity.
Secondary-progressive MS (SPMS)
SPMS occurs when RRMS transitions into the progressive form. You may still have noticeable relapses, in addition to gradual worsening of function or disability.
Part 3 of 11: Treatments
No cure is available for MS, but multiple treatment options exist.
If you have relapsing-remitting MS (RRMS), you can choose one of the disease-modifying drugs. These medications are designed to slow disease progression and lower your relapse rate.
Self-injectable disease-modifying drugs include glatiramer (Copaxone, Glatopa) and beta interferons, such as:
Oral medications for RRMS include:
Intravenous infusion treatments for RRMS include:
Disease-modifying drugs aren’t effective in treating progressive MS.
Other treatments may ease your symptoms and improve your quality of life. Because the disease is different for everybody, treatment depends on your specific symptoms. For most people, a flexible approach is necessary.
Part 4 of 11: Signs
MS can develop all at once, or the symptoms can be so mild that you easily dismiss them. Any symptom can occur first. The following are three of the most common early symptoms of MS:
- Strange sensations, such as numbness and tingling of the arms, legs, or one side of your face can occur. It’s similar to that of feeling of pins and needles you get when your foot falls asleep, but it occurs for no apparent reason.
- Your balance may be a bit off, and your legs may feel week. You may find yourself tripping easily while walking or doing some other type of physical activity.
- A bout of double vision, blurry vision, or partial vision loss can be an early indicator of MS. You could also have some eye pain.
It isn’t uncommon for these early symptoms to go away only to return at a later date. You may go weeks, months, or even years between symptom flare-ups.
These symptoms can have many different causes. If you have these symptoms, it doesn’t necessarily mean that you have MS.
Part 5 of 11: Diagnosis
Your doctor will need to perform a neurological exam, a clinical history, and a series of other tests to determine if you have MS.
Diagnostic testing may include the following:
- MRI is the best imaging test for MS. Using a contrast dye allows the MRI to detect active and inactive lesions throughout the brain and spinal cord.
- Evoked potentials require stimulation of nerve pathways to analyze electrical activity in the brain. The three types of evoked potentials doctors use to help diagnose MS are visual, brainstem, and sensory.
- A spinal tap, or lumbar puncture, can help your doctor find abnormalities in your spinal fluid. It can help rule out infectious diseases.
- Doctors use blood tests to eliminate other conditions with similar symptoms.
The diagnosis of MS requires evidence of demyelination in more than one area of the brain, spinal cord, or optic nerves. That damage must have occurred at different times.
It also requires ruling out other conditions that have similar symptoms. This includes Lyme disease, lupus, and Sjogren's syndrome.
Part 6 of 11: Causes
If you have MS, the myelin in your body becomes damaged. Myelin is the protective layer that covers nerve fibers throughout the central nervous system.
It’s thought that the damage is the result of an attack by the immune system. As your immune system attacks myelin, it causes inflammation. This leads to scar tissue, or lesions. All of that inflammation and scar tissue disrupts signals between the brain and other parts of your body.
It isn’t clear what may cause the immune system to attack.
Is MS hereditary?
MS isn’t hereditary, but having a parent or sibling with MS raises your risk slightly. Genetics may play a role. Scientists have identified some genes that seem to increase susceptibility to developing MS.
Researchers think there could be an environmental trigger such as a virus or toxin that sets off the immune system attack.
Part 7 of 11: Prognosis
It’s almost impossible to predict how MS will progress in any one person.
About 10 to 15 percent of people with MS have only rare attacks and minimal disability ten years after diagnosis. It’s not a medical diagnosis, but this is sometimes called “benign MS.”
Progressive MS generally advances faster than relapsing-remitting MS (RRMS). People with RRMS can be in remission for many years. A lack of disability after five years is usually a good indicator for the future.
The disease generally progresses faster in men than in women. It may also progress faster in those who receive a diagnosis after age 40 and in those who have a high relapse rate.
About half of people with MS use a cane or other form of assistance at 15 years after receiving an MS diagnosis. At 20 years, about 60 percent are still ambulatory and less than 15 percent need custodial care.
Your quality of life will depend on your symptoms and how well you respond to treatment. Most people with MS don’t become severely disabled and continue to lead full lives.
This unpredictable disease can change course without warning. It’s rarely fatal, and most people with MS have a lifespan that’s close to normal.
Part 8 of 11: Living with MS
Most people with MS find ways to manage their symptoms and function well. You’ll face unique challenges, and those can change over time. Many people with MS share their struggles and coping strategies through in-person or online support groups.
Having MS means you’ll need to see a doctor experienced in treating MS.
If you take one of the disease-modifying drugs, you’ll have to make sure you adhere to the recommended schedule. Your doctor may prescribe other medications to treat specific symptoms.
A well-balanced diet, low in empty calories and high in nutrients and fiber, will help you manage your overall health.
Regular exercise is important for physical and mental health, even if you have disabilities. If physical movement is difficult, swimming or exercising in a swimming pool can help. Yoga classes range from beginner to advanced levels, and some are designed just for people with MS.
Studies regarding the effectiveness of complementary therapies are scarce, but that doesn’t mean they can’t help in some way.
The following may help you feel less stressed and more relaxed:
- tai chi
- music therapy
MS is a lifelong condition. You should focus on communicating concerns with your doctor, learning all you can about MS, and discovering what things make you feel your best.
Part 9 of 11: Diet
Diet hasn’t been shown to impact the nature of the disease, but it can help with some of the challenges. If you have fatigue, for instance, a diet high in fats and simple carbohydrates won’t help.
The better your diet, the better your overall health. You’ll not only feel better in the short term, but you’ll be laying the foundation for a healthier future.
Your diet should consist mainly of:
- a variety of vegetables and fruits
- lean sources of protein, such as fish and skinless poultry
- whole grains and other sources of fiber
- low-fat dairy products
- adequate water and other fluids
You should limit or avoid:
- saturated fat
- trans fat
- red meats
- foods and beverages high in sugar
- foods high in sodium
- highly processed foods
Portion control can help you maintain a healthier weight. Read food labels. Foods that are high in calories but low in nutrients won’t help you feel better.
If you have coexisting conditions, ask your doctor if you should follow a special diet or take any dietary supplements.
Part 10 of 11: Statistics
MS is the most widespread neurological condition disabling young adults worldwide.
About 400,000 people in the United States have MS, though that’s only an estimate. Doctors in the United States aren’t required to report MS to any agency. According to the National MS Society, there hasn’t been a scientifically sound, national study on the prevalence of MS in the United States since 1975.
Most people are between the ages of 20 and 40 when their doctor diagnoses them with MS. Women develop MS 2 to 3 times more often than men, a difference that has grown steadily for five decades. MS is more common among Caucasians of northern European ancestry than other ethnic groups.
Rates of MS tend to be lower in places that are closer to the equator. The rates of MS are higher in places farther away from the equator. This may have to do with sunlight and vitamin D. People who relocate to a new location before age 15 generally acquire the risk factors associated with the new location.
Part 11 of 11: Effects of MS
The lesions from MS can appear anywhere in the central nervous system. This means they can affect any part of your body.
One of the most common symptoms of MS is fatigue, but it’s not uncommon for people with MS to also have:
- some degree of cognitive impairment
As you age, some disabilities from MS may become more pronounced. If you have mobility issues, you may be at an increased risk for bone fractures and breaks due to falls. Mobility issues can also lead to a lack of physical activity, which can lead to other health problems. Fatigue and mobility issues may also have an impact on sexual function. Having other conditions such as arthritis and osteoporosis can complicate matters.