Multiple sclerosis (MS) is a disease in which the immune system, which normally protects your body, instead attacks the covering (myelin sheath) surrounding the nerves in your brain and spinal cord. These nerves send information from your brain and spinal cord to other nerves in your body, and myelin helps make this transmission efficient.
People with MS can typically experience one of four disease courses, each of which might be mild, moderate, or severe.
- Relapsing-Remitting MS. People with this type of MS experience clearly defined attacks of worsening neurologic function. These attacks – which are also called relapses, flare-ups, or exacerbations – are followed by partial or complete recovery periods, during which no disease progression occurs. Approximately 85% of people are initially diagnosed with relapsing-remitting MS.
- Primary-Progressive MS. This disease course is characterized by slowly worsening neurologic function from the beginning – with no distinct relapses or remissions. The rate of progression may vary over time, with occasional plateaus and temporary minor improvements. Approximately 10% of people are diagnosed with primary-progressive MS.
- Secondary-Progressive MS. Following an initial period of relapsing-remitting MS, many people develop a secondary-progressive disease course in which the disease worsens more steadily, with or without occasional flare-ups, minor recoveries (remissions), or plateaus. Before the disease-modifying medications became available, approximately 50% of people with relapsing-remitting MS developed this form of the disease within 10 years.
- Progressive-Relapsing MS. In this relatively rare course of MS (5%), people experience steadily worsening disease from the beginning, but with clear attacks of worsening neurologic function along the way. They may or may not experience some recovery following these relapses, but the disease continues to progress without remissions.
MS is caused by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow down or stop. The nerve damage is caused by inflammation. Inflammation occurs when the body’s own immune cells attack the nervous system. This can occur along any area of the brain, optic nerve, and spinal cord.
It is unknown what exactly causes this to happen. The most common thought is that virus or gene defects, or both, are to blame. Environmentally factors may play a role also. You are slightly more likely to get this condition if you have a family history of MS or live in a part of the world where MS is more common.
Some studies have suggested that many viruses such as Epstein-Barr (mononucleosis), varicella zoster, and the hepatitis vaccine may be the cause of MS. To date, however, this belief has not been proven.
In MS, damage to the myelin in the central nervous system, and to the nerve fibers themselves, interferes with the transmission of nerve signals between the brain and spinal cord and other parts of the body. This disruption of nerve signals produces the primary symptoms of MS, which vary depending on where the damage has occurred.
Some symptoms of MS are much more common than others.
Most common symptoms include:
- Walking, balance & coordination problems
- Bladder dysfunction
- Bowel dysfunction
- Vision problems
- Dizziness and Vertigo
- Sexual dysfunction
- Emotional changes
Less common symptoms include:
- Speech disorders
- Swallowing problems
- Hearing loss
- Respiration/breathing problems
At this time, there are no symptoms, physical findings or laboratory tests that can, by themselves, determine if a person has MS. The doctor uses several strategies to determine if a person meets the long-established criteria for a diagnosis of MS and to rule out other possible causes of whatever symptoms the person is experiencing.
These strategies include:
- Medical history
- Neurologic exam
- Magnetic resonance imaging (MRI)
- Evoked potentials (EP)
- Spinal fluid analysis
In order to make a diagnosis of MS, the physician must:
- Find evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves AND
- Find evidence that the damage occurred at least one month apart AND
- Rule out all other possible diagnoses
Multiple sclerosis (MS) has no cure. Treatment usually focuses on strategies to treat MS attacks, manage symptoms and reduce the progress of the disease. Some people have such mild symptoms that no treatment is necessary.
Strategies to treat attacks:
- Corticosteroids. Corticosteroids are mainly used to reduce the inflammation that spikes during a relapse. Examples include oral prednisone and intravenous methylprednisolone (Solu-Medrol). Side effects may include mood swings, seizures, weight gain and an increased risk of infections.
- Plasma exchange (plasmapheresis). This procedure removes some blood from your body and mechanically separates your blood cells from your plasma, the liquid part of your blood. Doctors then mix your blood cells with a replacement solution and return the blood to your body.
- Difficulty swallowing
- Less and less ability to care for self
- Need to indwelling catheter
- Osteoporosis or thinning of the bones
- Pressure sores
- Urinary tract infections