An Overview of Multiple Sclerosis

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Multiple sclerosis is an autoimmune disease in which the immune system attacks and destroys the protective covering of nerve cells (myelin) of the brain, spinal cord, and/or eyes. As a result of this, nerve signaling is impaired, causing a wide variety of potential symptoms, such as muscle weakness, spasticity, pain, and cognitive issues.

The precise cause of MS is unknown. The disease is often diagnosed with the help of an MRI and/or spinal tap. Unfortunately, there's no cure. However, there are several treatment options and ways to cope that can help you manage your disease.

Timeline of MS research milestones
Verywell / Joyce Chan

Types

There are three main types of MS. They vary in their symptoms, disease course, and how they are treated.

  • Relapsing-remitting MS: About 85 to 90 percent of people with MS are first diagnosed with this form. During relapses, you'll experience neurological symptoms and functionality will decline. During remissions, symptoms may disappear or just become milder. Remission may last weeks or months.
  • Secondary-progressive MS: Some people with relapsing-remitting MS eventually develop secondary-progressive MS. It has a more progressive disease course in which symptoms become chronic and irreversible.
  • Primary-progressive MS: Symptoms slowly, but steadily get worse over time. Relapses don't occur, and the rate of worsening varies greatly. This is a less common type, accounting for about ten percent of cases. It tends to affect the spinal cord more than the brain.

You may also hear about clinically isolated syndrome (CIS). This is when a person has experienced a single episode that looks like an MS relapse but doesn't meet the criteria for a proper MS diagnosis. Some people with CIS go on to develop MS while others don't.

In the past, when specific treatments weren't available, the vast majority of patients with relapsing-remitting MS developed secondary progressive MS within 15 to 20 years of their diagnoses. However, since the development of disease-modifying medications, that has changed.

The prognosis for MS patients continues to improve.

Symptoms

In the central nervous system of a healthy person, nerve cells in the brain and spinal cord rapidly send signals to each other and to the rest of the body. But in a person with MS, this signaling is impaired due to damage to the myelin. Nerve impulses are either slow or not transmitted at all, and that causes a vast array of consequences.

Which MS symptoms each person with MS experiences is unique to them, but some are more common than others because the disease tends to affect certain locations within the central nervous system.

For example, because the brainstem and the nearby cerebellum are commonly affected, vertigo, speech problems, tremor, ataxia, and double vision often result.

Fatigue is also very common with MS as well as visual problems due to the involvement of the optic nerves.

Other common symptoms of MS include:

MS symptoms depend on the location and severity of the damage. Some people are inconvenienced by them, while others become seriously disabled.

In people who experience remission, symptoms might go away entirely. In others, they may become milder. Some people, however, have no periods of improvement.

Causes

Scientists are still scratching their heads about the exact cause of MS, but they've formed several theories.

Those with the most scientific backing include:

It's likely that a complicated interaction between your genes and your environment is what ultimately triggers MS. As with symptoms, causal factors can be different for different people.

Right now, there's no specific gene(s) that doctors can test to determine whether you'll develop MS, but certain risk factors may increase the odds of you have the disease. Some of these include:

  • Being between ages 20 and 50
  • Being female
  • Living in a northern climate
  • Smoking

Some dietary habits may increase or decrease risk as well, but there's no strong evidence to that end yet.

Diagnosis

Diagnosing MS can be difficult at times, and it's especially hard to confirm it based on symptoms alone given that they can come and go and be rather nebulous. A medical history, physical examination, tests such as blood tests and magnetic resonance imaging (MRI) of your brain and/or spinal cord are usually needed to determine if you do, in fact, have MS.

Since a lot of MS symptoms are common in other conditions, doctors need to rule them out during the diagnostic process. For instance, nerve pain, fatigue, and cognitive dysfunction are common in fibromyalgia and systemic lupus erythematosus. Numbness, tingling, and muscle weakness can stem from a vitamin B12 deficiency or herniated disc.

Before their diagnosis, it's fairly common for people with MS to say they first attributed their symptoms to a passing illness, like the flu. Doctors, too, sometimes miss MS because the symptoms are so subtle and transient. Some people go years without a diagnosis.

If you're having new symptoms that could point to MS, see your doctor. He or she will likely refer you to a neurologist if the disease is suspected.

Treatment

You've got a lot of treatment options for combatting MS. Disease-modifying medications include:

Most of them are for relapsing types of the disease, but evolving research on treatments for progressive MS are improving that picture. Ocrevus is the first FDA-approved treatment for both relapsing and primary-progressive MS.

An area getting a lot of attention is dietary changes, like supplementing with vitamin D and gut bacteria.

You also have a wide range of complementary therapies and management options, including physical or occupational therapy, assistive mobility devices, yoga, and reflexology. You may need to explore a number of treatment regimens before finding what works best for you.

Coping

Being diagnosed with any chronic condition is scary. You've probably been forced to make changes to your life and to accept the impact of MS on your body and your quality of life.

While adjustments are necessary, you can live well with this illness. Several approaches can help:

  • Learn all you can: Knowledge is power, and it can give you some control over the unpredictable nature of this condition.
  • Prepare for doctor's visits: It's a good idea to devise a list of questions prior to your appointment and/or bring someone along with you, so you're sure to get the answers that you need.
  • Commit to treatment: It's important for your peace of mind and MS care to establish an open, trusting relationship with your healthcare team. Ask them about proper ways to communicate and what constitutes an emergency. Stick to your medications and communicate all concerns, like negative side effects, to your doctor.
  • Consider changes: Healthy lifestyle habits like stress management, a healthy diet, regular exercise (that especially encourages balance and flexibility), smoking cessation, and sleep hygiene are beneficial with MS and for good overall health.
  • Give your brain a workout: Research suggests that brain training can improve your mental function with MS. Reading, playing games, doing puzzles, or actively trying to learn new skills can help keep your brain sharp.

A Word From Verywell

While there is no cure, it's important to understand that the vast majority of people with MS do not become severely disabled. It's rare for MS to be fatal, as well, and most related deaths are from very severe, rapidly progressing cases.

A lot of different factors affect how long you'll live with MS, including whether you're on disease-modifying drugs, what other medical problems you have, lifestyle factors such as diet, exercise, stress, and smoking, genetics, and much more.

As treatments get better, diagnoses come earlier, and researchers learn more about how lifestyle impacts the disease progression, the fact that the life expectancy for someone with MS is seven years less than average could very well change for the better.

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