Slideshow: A Visual Guide to Multiple Sclerosis
MS is a chronic disease that damages the nerves in the spinal cord and brain, as well as the optic nerves. Sclerosis means scarring, and people with MS develop multiple areas of scar tissue in response to the nerve damage. Depending on where the damage occurs, symptoms may include problems with muscle control, balance, vision, or speech.
Nerve damage can cause:
These symptoms may lead to frequent tripping or difficulty walking.
More than half of people with MS experience a vision problem called optic neuritis. This inflammation of the optic nerve may cause blurred vision, loss of color vision, eye pain, or blindness, usually in one eye. The problem is usually temporary and tends to improve within a few weeks. In many cases, vision problems are the first sign of MS.
Although less common than vision problems, some people with MS develop slurred speech. This happens when MS damages the nerves that carry speech signals from the brain. Some people also have trouble swallowing.
MS can take a toll on mental sharpness. Some people may find it takes longer to solve problems. Others may have mild memory loss or trouble concentrating. Most people with MS also experience some loss of bladder control, because signals between the brain and bladder are interrupted. Finally, fatigue is a common problem. You may feel tired even after a good night’s sleep.
Confusion, slurred speech, and muscle weakness can be symptoms of MS, but they can also be signs of a stroke. Anyone who suddenly has trouble speaking or moving his or her limbs should be taken to the ER immediately. Treating a stroke within the first few hours provides the best odds of a successful recovery.
In people with MS, the body’s own immune system attacks the tissue surrounding the nerve fibers in the brain, spinal cord, and optic nerves. This covering is made of a fatty substance called myelin. It insulates the nerves and helps them send electrical signals that control movement, speech, and other functions. When myelin is destroyed, scar tissue forms, and nerve messages are not transmitted properly.
The roots of MS remain mysterious, but doctors see some surprising trends. It’s most common in regions far from the equator, including Scandinavia and other parts of Northern Europe. These areas get less sunlight, so some researchers believe that vitamin D (the “sunshine vitamin”) may be involved. Research suggests a possible link between vitamin D deficiency and autoimmune disorders, but studies are ongoing. Genetics appear to play a role, as well.
MS is at least twice as common in women as it is in men. While it can strike people of any race, Caucasians appear to be most at risk. The chances of developing the condition are highest between ages 20 and 50.
Tests are often used, along with a medical history and neurological exam, to diagnose MS and rule out other causes of symptoms. More than 90% of people with MS have scar tissue that shows up on an MRI scan. A spinal tap can check for abnormalities in the fluid that bathes the brain and spinal cord. Tests to look at electrical activity of nerves can also help with diagnosis. Lab tests can help rule out other autoimmune conditions or infections such as HIV or Lyme disease.
MS is different in every person. Doctors usually see four forms:
Relapsing-remitting: Symptoms flare during acute attacks, then improve nearly completely or “remit.” This is the most common form of MS.
Primary-progressive: MS slowly but steadily worsens.
Secondary-progressive: Begins as relapsing-remitting type, then becomes progressive.
Progressive-relapsing: The underlying disease steadily worsens. The patient has acute relapses, which may or may not remit. This is the least common form of MS.
Research suggests that the disease may be more active during the summer months. Heat and high humidity may also temporarily worsen symptoms. Very cold temperatures and sudden changes in temperature may aggravate symptoms, as well.
While there is no cure for MS, there are “disease-modifying drugs” that can reduce the frequency and severity of MS attacks. Use can result in less damage to the brain and spinal cord over time, slowing the progression of disability. When an attack does occur, high-dose corticosteroids can help cut it short. Many drugs are also available to manage troubling MS symptoms, such as muscle spasms, incontinence, and pain.
About half of people with MS develop some form of pain, either as a result of a short circuit in the nervous system or because of muscle spasms or strain. Doctors may prescribe antidepressants and anticonvulsant medications to ease nerve pain. Pain medicines and anti-spasm drugs may also be used. Muscle pain often responds well to massage and physical therapy. Be sure to discuss the options with your doctor if you find yourself in pain.
If MS affects balance, coordination, or muscle strength, you can learn to compensate. Physical therapy can help strengthen muscles, combat stiffness, and get around more easily. Occupational therapy can help retain coordination in your hands for dressing and writing. And if you’re having trouble speaking or swallowing, a speech therapist can help.
Many nontraditional therapies for MS have not been well studied. Some people say acupuncture relieves symptoms such as muscle spasms and pain, but research to confirm its value isn’t conclusive. Others have reported benefits from injections of bee venom, but a rigorous study, lasting 24 weeks, showed no improvements in disability, fatigue, or the number of MS attacks. It’s important to inform your doctor about any supplements, special diets, or other therapies you want to try.
Doctors generally agree that it’s safe for women with MS to get pregnant. Research suggests no increased risk of complications during pregnancy. In fact, many women have fewer MS symptoms during pregnancy. High levels of hormones and proteins may suppress the immune system, reducing the odds of a new attack. It’s best to talk with your doctors before pregnancy, as certain MS drugs should not be used while pregnant or nursing. In the early months after delivery, the odds for a relapse can rise.
The vast majority of people with MS are able to continue walking, though many benefit from some type of assistive device. Orthotic shoe inserts or leg braces can help increase stability. When one leg is stronger than the other, a cane can help. People with significant problems with their legs may need to use a walker. And a wheelchair or scooter may be best for those who are very unsteady or tire easily.
Making a few changes around the home can help you manage daily activities on your own. Install grab bars inside and outside the shower or tub. Use a non-slip mat. Add an elevated seat and safety rails to the toilet. Lower one of your kitchen counters so you can reach it from a sitting position. And get rid of any throw rugs, which are a tripping hazard.
Exercise can ease stiffness, fatigue, and other symptoms of MS. But overdoing it could make things worse. It’s best to start slowly. Try exercising for 10 minutes at a time, then gradually working your way up to a longer session. Before you begin, check with your doctor about what type of activity and level of intensity would be most appropriate. A few possibilities include water aerobics, swimming, tai chi, and yoga.
Most people with MS live a normal or near-normal lifespan. While the condition may make it more difficult to get around or complete certain tasks, it doesn’t always lead to severe disability. Thanks to effective medications, rehab therapies, and assistive devices, many people with MS remain active, stay in their jobs, and continue to enjoy their families and favorite activities.
Lava, MD on April 14, 2018
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George Kraft, director, Multiple Sclerosis Rehabilitation, Research, and Training Center and director, Western Multiple Sclerosis Center, University of Washington, Seattle.
FDA web site.
Francois Bethoux, MD, director of rehabilitation services, the Mellen Center for Multiple Sclerosis Treatment and Research, The Cleveland Clinic.
Franklin, G. Neurology, Nov. 18, 2009.
Kathleen Hawker, MD, assistant professor of neurology, University of Texas Southwestern Medical Center, Dallas.
Kelly, V. Neurology, Nov. 18, 2009.
Multiple Sclerosis Foundation web site.
National Multiple Sclerosis Society web site.
News release, American Academy of Neurology.
News release, FDA.
News release, Novartis.
Reviewed by Neil
Lava, MD on April 14, 2018
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