Multiple sclerosis (MS) is a chronic illness involving your central nervous system (CNS). 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.
People with MS experience a wide range of symptoms. Due to the nature of the disease, symptoms can vary widely from person to person.
They can also change in severity from year to year, month to month, and even day to day.
Around 80 percent of people with MS report having fatigue. Fatigue that occurs with MS can become debilitating, affecting your ability to work and perform everyday tasks.
Difficulty walking can occur with MS for a number of reasons:
- numbness in your legs or feet
- difficulty balancing
- muscle weakness
- muscle spasticity
- difficulty with vision
Difficulty walking can also lead to injuries due to falling.
Other fairly common symptoms of MS include:
- acute or chronic pain
- cognitive issues involving concentration, memory, and word-finding difficulty
The condition can also lead to speech disorders.
Your doctor will need to perform a neurological exam, request a clinical history, and order a series of other tests to determine if you have MS.
Diagnostic testing may include the following:
- Magnetic resonance imaging (MRI) scan. Using a contrast dye with the MRI allows your doctor to detect active and inactive lesions throughout your brain and spinal cord.
- Optical coherence tomography (OCT). OCT is a test that takes a picture of the nerve layers in the back of your eye and can assess thinning of the optic nerve.
- Spinal tap (lumbar puncture). Your doctor may order a spinal tap to find abnormalities in your spinal fluid. This test can help rule out infectious diseases and can also be used to look for oligoclonal bands (OCBs), which can be used to make an early diagnosis of MS.
- Blood tests. Doctors order blood tests to help eliminate other conditions with similar symptoms.
- Visual evoked potentials (VEP) test. This test requires the stimulation of nerve pathways to analyze electrical activity in your brain. In the past, brain stem auditory and sensory-evoked potential tests were also used to diagnose MS.
An MS diagnosis requires evidence of demyelination occurring at different times in more than one area of your brain, spinal cord, or optic nerves.
MS can develop all at once, or the symptoms can be so mild that you easily dismiss them. Three of the most common early symptoms of MS are:
- Numbness and tingling that affects the arms, legs, or one side of your face. These sensations are similar to the pins-and-needles feeling you get when your foot falls asleep. However, they occur for no apparent reason.
- Uneven balance and weak legs. You may find yourself tripping easily while walking or doing some other type of physical activity.
- Double vision, blurry vision in one eye, or partial vision loss. These can be an early indicator of MS. You may also have some eye pain.
It isn’t uncommon for these early symptoms to go away only to return later. You may go weeks, months, or even years between flare-ups.
These symptoms can have many different causes. Even if you have these symptoms, it doesn’t necessarily mean that you have MS.
RRMS is more common in women, whereas PPMS is equally common in women and men. Most experts believe that MS in men tends to be more aggressive and recovery from relapses is often incomplete.
If you have MS, the protective layer of myelin around your nerve fibers becomes damaged.
It’s thought that the damage is the result of an immune system attack. Researchers think there could be an environmental trigger, such as a virus or toxin, that sets off the immune system attack.
As your immune system attacks myelin, it causes inflammation. This leads to scar tissue, or lesions. The inflammation and scar tissue disrupt signals between your brain and other parts of your body.
MS isn’t hereditary, but having a parent or sibling with MS raises your risk slightly. Scientists have identified some genes that seem to increase susceptibility to developing MS.
Types of MS include:
Clinically isolated syndrome (CIS)
Although this episode is characteristic of MS, it’s not enough to prompt a diagnosis.
If there are more than one lesion or positive oligoclonal bands (OCB) in your spinal fluid at the time of a spinal tap, you’re more likely to receive a diagnosis of relapsing-remitting MS (RRMS).
If these lesions aren’t present, or your spinal fluid doesn’t show OCBs, you’re less likely to receive an MS diagnosis.
Relapsing-remitting MS (RRMS)
Relapsing-remitting MS (RRMS) involves clear relapses of disease activity followed by remissions. During remission periods, symptoms are mild or absent, and there’s no disease progression.
RRMS is the most common form of MS at onset and accounts for about 85 percent of all cases.
Primary progressive MS (PPMS)
If you have primary progressive MS (PPMS), neurological function becomes progressively worse from the onset of your symptoms.
However, short periods of stability can occur. The terms “active” and “not active” are used to describe disease activity with new or enhancing brain lesions.
Secondary progressive MS (SPMS)
Secondary progressive MS (SPMS) occurs when RRMS transitions into the progressive form. You may still have noticeable relapses in addition to disability or gradual worsening of function.
The bottom line
Your MS may change and evolve, for example, going from RRMS to SPMS.
You can only have one type of MS at a time, but knowing when you transition to a progressive form of MS may be difficult to pinpoint.
Life expectancy for people with MS is about 7.5 years shorter than expected. The good news is, life expectancy in those with MS is increasing.
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 10 years after diagnosis. It’s generally presumed they’re not on treatment or injectables. This is sometimes called benign MS.
With the development of disease-modifying therapies (DMTs), studies show promising results that the progression of the disease can be slowed.
Progressive MS generally advances faster than RRMS. People with RRMS can be in remission for many years. A lack of disability after 5 years is usually a good indicator for the future.
Age and sex
The disease tends to be more severe and debilitating in men and older adults. The same prognosis is also seen in African Americans and those who have a high relapse rate.
The bottom line
Your quality of life with MS will depend on your symptoms and how well you respond to treatment. This rarely fatal, but unpredictable, disease can change course without warning.
Most people with MS don’t become severely disabled and continue to lead full lives.
No cure is currently available for MS, but multiple treatment options exist.
Disease-modifying therapies (DMTs)
Disease-modifying therapies (DMTs) are designed to slow disease progression and lower your relapse rate.
Self-injectable disease-modifying medications for RRMS include glatiramer acetate (Copaxone) and beta interferons, such as:
Oral medications for RRMS include:
- dimethyl fumarate (Tecfidera)
- fingolimod (Gilenya)
- teriflunomide (Aubagio)
- cladribine (Mavenclad)
- diroximel fumarate (Vumerity)
- siponimod (Mayzent)
Intravenous infusion treatments for RRMS include:
- alemtuzumab (Lemtrada)
- natalizumab (Tysabri)
- mitoxantrone (Novantrone)
- Ocrelizumab (Ocrevus)
In 2017, the Food and Drug Administration (FDA) approved the first DMT for people with PPMS. This infusion drug is called ocrelizumab (Ocrevus), and it can also be used to treat RRMS.
Another drug, ozanimod (Zeposia), has recently been approved for treating CIS, RRMS, and SPMS, but it isn’t yet marketed due to the COVID-19 pandemic.
Not all MS drugs will be available or appropriate for every person. Talk to your doctor about which drugs are most appropriate for you and the risks and benefits of each one.
Other treatments may also ease your symptoms and improve your quality of life.
Because MS is different for everyone, treatment depends on your specific symptoms. For most, a flexible approach is necessary.
Most people with MS find ways to manage their symptoms and function well.
Having MS means you’ll need to see a doctor experienced in treating MS.
If you take one of the DMTs, you’ll need to adhere to the recommended schedule. Your doctor may prescribe other medications to treat specific symptoms.
Diet and exercise
Regular exercise is important for physical and mental health, even if you have disabilities.
Your diet should mainly consist of:
- a variety of fruits and vegetables
- lean sources of protein, such as fish and skinless poultry
- whole grains and other sources of fiber
- low-fat dairy products
- adequate amounts of water and other fluids
The better your diet, the better your overall health. You’ll not only feel better in the short term, but you’ll also be laying the foundation for a healthier future.
You should limit or avoid:
- saturated fat
- trans fat
- red meats
- foods and beverages high in sugar
- foods high in sodium
- highly processed foods
If you have other medical conditions, ask your doctor if you should follow a special diet or take any dietary supplements.
Read food labels. Foods that are high in calories but low in nutrients won’t help you feel better or maintain a healthy weight.
Other complementary therapies
Studies regarding the effectiveness of complementary therapies are scarce, but that doesn’t mean they can’t help in some way.
The following therapies may help you feel less stressed and more relaxed:
According to the National Multiple Sclerosis Society, there hasn’t been a scientifically sound national study on the prevalence of MS in the United States since 1975.
In a 2017 study, however, the Society estimated that around 1 million Americans have MS.
Other things you should know:
- MS is
the most widespreadneurological condition disabling young adults worldwide.
- Most people diagnosed with RRMS are between ages 20 and 50 at the time of their diagnosis.
- Overall, MS is more common in women than men. According to the National Multiple Sclerosis Society, RRMS is two to three times more common in women than men. PPMS rates in women and men are roughly equal.
- Rates of MS tend to be lower in places that are closer to the equator. This may have to do with sunlight and vitamin D exposure. People who relocate to a new location before age 15 generally acquire the risk factors associated with the new location.
- Data from 1999 to 2008 showed that direct and indirect costs of MS were between $8,528 and $54,244 per year. Current DMTs for RRMS can cost up to $60,000 a year. Ocrelizumab (Ocrevus) costs $65,000 a year.
Canadians have the highest rate of MS in the world.
The lesions MS causes can appear anywhere in your CNS and affect any part of your body.
As you age, some disabilities MS causes may become more pronounced.
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
The bottom line
Mobility issues can lead to a lack of physical activity, which can cause other health problems. Fatigue and mobility issues may also have an effect on sexual function.
MS is a lifelong condition. You’ll face unique challenges that can change over time.
You should focus on communicating concerns with your doctor, learning all you can about MS, and discovering what makes you feel your best.
Many people with MS even choose to share their challenges and coping strategies through in-person or online support groups.