Multiple sclerosis (MS) is a chronic condition involving your central nervous system (CNS). With MS, your immune system attacks myelin, which is the protective layer around nerve fibers.
MS causes inflammation and temporary lesions. It can also lead to lasting lesions caused by scar tissue, which can make it hard for your brain to send signals to the rest of your body.
There’s no cure for MS, but it’s possible to manage symptoms. Learn more about the causes of MS, how it’s treated, and more.
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.
Here are some of the most common symptoms associated with MS.
Around 80 percent of people with MS report having fatigue, according to the National Multiple Sclerosis Society (NMSS). Fatigue that occurs with MS can make it harder for you to go about your everyday tasks.
Difficulty walking can occur with MS due to:
- numbness in your legs or feet
- difficulty balancing
- muscle weakness
- muscle spasticity
- difficulty with vision
Difficulty walking can also lead to injuries if you fall.
Vision problems are often some of the first symptoms for many people with MS. Vision problems may affect one or both eyes. These issues may come and go, or get worse over time. They can also resolve entirely.
Some common vision problems associated with MS include:
- optic neuritis, which can cause pain or blurry vision in one eye
- diplopia, or double vision
- nystagmus, or involuntary movement of the eyes
MS causes lesions in the brain that can affect speech. These speech issues, also known as dysarthria, can range from mild to severe.
Symptoms of dysarthria can include the following:
- slurred speech
- “scanning” speech, where there are long pauses between words or syllables
- changes in volume of speech
Other fairly common symptoms of MS include:
- acute or chronic pain
- cognitive issues involving concentration, memory, and word-finding
- difficulty chewing and swallowing
- sleep issues
- problems with bladder control.
A healthcare professional, often a neurologist, will need to perform a neurological exam. They will also talk with you about your clinical history and order a series of other tests to determine if you have MS.
Diagnostic testing may include the following:
- 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). In this test, a picture is taken of the nerve layers in the back of your eye to check for thinning around 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. It can also be used to look for oligoclonal bands (OCBs), which can be used to diagnose MS.
- Blood tests. Doctors order blood tests to help eliminate the possibility of other conditions that have 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-evoked 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. Demyelination is a process that prevents nerves from efficiently sending signals.
Types of MS include:
Clinically isolated syndrome (CIS)
CIS is a pre-MS condition involving 1 episode of symptoms lasting at least 24 hours. These symptoms are due to demyelination in your CNS.
Although this episode is characteristic of MS, it’s not enough to prompt a diagnosis.
If there’s more than one lesion or positive oligoclonal band (OCB) in your spinal fluid at the time of a spinal tap, you’re more likely to receive a diagnosis of 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 mild to moderate disease progression.
RRMS is the most common form of MS at onset and accounts for about 85 percent of all cases, according to NMSS.
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 sometimes 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.
No cure is currently available for MS, but treatment options exist that can help you manage your symptoms and improve your quality of life.
Disease-modifying therapies (DMTs)
DMTs are designed to slow the progression of MS and lower your relapse rate.
Self-injectable disease-modifying medications for RRMS include glatiramer acetate (Copaxone) and beta interferons, such as:
In 2020 the FDA approved Kesimpta for treatment. Kesimpta is an injectable monoclonal antibody treatment that can be self-administered.
Oral medications for RRMS include:
- dimethyl fumarate (Tecfidera)
- fingolimod (Gilenya)
- teriflunomide (Aubagio)
- cladribine (Mavenclad)
- diroximel fumarate (Vumerity)
- siponimod (Mayzent)
- ozanimod (Zeposia)
- monomethyl fumerate (Bafiertam)
- ponesimod (Ponvory)
Intravenous (IV) 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 COVID-19.
Not all MS medications will be available or appropriate for every person. Talk with your doctor about which drugs are most appropriate for you and the risks and benefits of each one.
Other treatments may also be targeted at easing specific symptoms to help improve your quality of life.
Because MS is different for everyone, treatment depends on your specific symptoms. For most, a flexible approach is necessary.
If you have MS, the protective layer of myelin around some of the nerve fibers of your brain, optic nerve, and spinal cord become 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 demyelination. This can go into remission as new layers of myelin form, but chronic inflammation can lead to scar tissue, which can result in lasting neurological impairment.
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, according to a review of studies published in 2011.
It’s almost impossible to predict how MS will progress in any one person. Life expectancy in those with MS is increasing, according to NMSS.
About 10 to 15 percent of people with MS have only rare attacks and minimal disability 10 years after diagnosis, according to NMSS. It’s generally presumed they’re not on treatment or injectable medications. This is sometimes called benign MS.
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.
The disease tends to be more severe and debilitating in men, according to a 2018 review of studies.
The bottom line
Your quality of life with MS will depend on your symptoms and how well you respond to treatment. But even though this unpredictable disease can change course without warning, it’s rarely fatal.
Most people with MS don’t become severely disabled, and continue to lead full lives.
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 without a trigger.
- 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 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.
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.
If physical movement is difficult, swimming or exercising in a swimming pool can help. Some yoga classes are designed just for people with MS.
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 healthier 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 try to 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.
It’s helpful to learn how to properly read food labels. Foods that are high in calories but low in nutrients won’t help you feel better or maintain a weight that works for you.
Other complementary therapies
Studies regarding the effectiveness of complementary therapies are scarce, but that doesn’t mean these methods can’t help in some way.
The following therapies may help you feel less stressed and more relaxed:
The exact cause of MS is still unknown. However, there are several risk factors for developing MS.
These risk factors include:
The lesions MS causes can appear anywhere in your CNS and have wide-ranging effects.
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.
According to NMSS, 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 that causes young adults to live with disabilities 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 NMSS, 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 MS risk factors associated with the new location, compared with after age 15. Canadians experience the highest rate of MS in the world.
- 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.
MS is a lifelong condition. You’ll face unique challenges that can change over time.
You should focus on communicating your 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.