What Is Multiple Sclerosis?

Multiple sclerosis (MS) is a neurological condition that affects the brain, optic nerves and spinal cord. It is an autoimmune disorder, meaning the immune system attacks the brain and spinal cord.

When someone has MS, their immune system attacks the protective covering of the nerve fibers, which is called myelin. This process, called demyelination, disrupts communication between the brain and the rest of the body. The immune system damaging myelin leaves scars known as lesions or plaques. Over time, this can cause permanent damage to the nerves.

MS affects people differently, depending on the location and extent of damage in the central nervous system. Some people may have mild symptoms with little disability, but others will experience worsening symptoms that lead to increased disability.

MS symptoms usually begin in young adults between the ages of 20 and 40. The disease affects about two and a half times as many women as men. MS is not a hereditary disorder, but having a parent or sibling with the condition increases the likelihood of someone getting MS.

Types of MS

Multiple sclerosis is different for each person. There are five described disease courses:

Clinically isolated syndrome: People experience symptoms from a single attack and then have a full or partial recovery. Damage may still exist in other places in the central nervous system. A single attack may allow diagnosis of MS.
Relapsing-remitting MS: Symptoms happen in recurring attacks with total or partial recovery. When the disease is inactive, it’s referred to as remission. People may go weeks, months, or even years between attacks. Treatment can decrease the frequency of attacks. Most people are initially diagnosed with this type of MS.
Secondary-progressive MS: Relapsing-remitting MS can turn into secondary-progressive MS. Attacks are less common but may still happen. People gradually develop regular symptoms that affect their functioning over time. Treatment can delay or stop relapsing-remitting MS from becoming secondary-progressive MS.
Primary-progressive MS: A less common form of the disease. Symptoms get progressively worse from the beginning. People with this form of MS may or may not have acute attacks.
Radiologically isolated syndrome: A person may have an abnormal MRI with typical MS lesions, but they don’t have any symptoms. Attacks or progression of symptoms may happen in the future.

Signs and Symptoms

Multiple sclerosis symptoms vary depending on the type and the person. Symptoms may change over time depending on which nerve fibers are affected.

Early signs of MS include:

Blurry vision
Dizziness
Fatigue
Numbness and tingling

Some common symptoms include:

Bladder control problems
Double vision
Electric-shock sensations with certain neck movements
Lack of coordination
Mood changes
Pain during eye movement
Partial or complete loss of vision
Slurred speech
Trouble with memory, thinking, and understanding information
Trouble walking or not being able to walk at all

Diagnosis

Diagnosing multiple sclerosis requires ruling out other conditions that may cause similar symptoms. Your doctor will start by taking your medical history and performing a physical exam.

Imaging Tests

Evoked potential tests: Record the electrical signals from the nervous system in response to stimuli. This test may use visual or electrical stimuli. Electrodes measure how quickly information travels through your nerve pathways.

Magnetic resonance imaging (MRI): Shows areas (lesions) of MS in the brain and spinal cord. Contrast dye is sometimes used to highlight lesions.

Optical coherence tomography: Uses light waves to create images of the eye. People with MS may also have a condition called optic neuritis, which causes changes in the retina.

Lab Tests

Blood tests: To look for markers of inflammation, and can help rule out other conditions with similar symptoms to MS.

Spinal tap: Removes a small sample of cerebrospinal fluid from the spinal canal. The sample can show changes in antibodies related to MS.

Treatment

There is no cure for multiple sclerosis, but treatment can decrease the number and severity of relapses. It may also delay the progression of the disease. Treatment is different for each person with MS. It will depend on the stage of the disease and symptoms.

Treatments for MS Attacks

Corticosteroids: Reduce nerve inflammation. Steroids may be oral or intravenous.
Plasma exchange: Removes liquid from part of the blood, called plasma, and separates it from blood cells. The blood cells are mixed with a protein solution and put back into your body. This treatment may be used if your symptoms are new or severe.

Medications to Slow MS Progression

Starting medication for relapsing-remitting MS as early as possible can decrease your relapse rate and slow the development of new lesions. Treatments can reduce the risk of worsening disability and improve quality of life.

Medical options for MS include infusions, injections, and oral medicines. These treatments may have serious side effects. Your health care team will account for how long you have had MS, what other treatments you have tried, and your other health issues when determining the most effective course of treatment.

Infusions:

Alemtuzumab: An antibody infusion that lowers relapse rates for those with aggressive MS. It targets a protein on immune cells and depletes white blood cells. This reduces relapses of MS by limiting nerve damage caused by white blood cells. The treatment may increase the risk of infections and autoimmune conditions.
Natalizumab: An antibody treatment that decreases relapse rates and slows the risk of disability. It blocks the movement of immune cells from the bloodstream to the brain and spinal cord.
Ocrelizumab: Treats both relapsing-remitting and primary-progressive MS. It’s an IV infusion and reduces the relapse rate and slows worsening disability.
Ublituximab: An antibody IV infusion for relapsing MS. It may be used for people who can’t take ocrelizumab.

Injectable treatments:

Glatiramer acetate: May help stop your immune system’s attack on myelin.
Interferon beta medicines: Interrupts diseases that attack the body, which can decrease inflammation and improve nerve growth. These treatments can reduce relapses and make them less severe.
Ofatumumab: Targets cells that damage the nervous system called B cells. It can lower the risk of new lesions and new or worsening symptoms.

Oral treatments:

Cladribine: A second-line treatment for relapsing-remitting MS. It can also be used for secondary-progressive MS. You take it in two two-week treatment courses over the course of two years.
Dimethyl fumarate: A twice-daily medication that reduces relapses. It may lower white blood cell count. It requires regular blood testing.
Diroximel fumarate: A twice-daily pill similar to dimethyl fumarate. It generally causes fewer side effects. It’s used for relapsing MS.
Fingolimod: A once-daily medicine that decreases relapse rate. Your heart rate and blood pressure are monitored for six hours after your first dose because the drug may slow your heart rate.
Monomethyl fumarate: A delayed release medicine that works steadily. The slow release may help decrease side effects.
Ozanimod: A once-daily medication that reduces the relapse rate of MS.
Ponesimod: A once-a-day medicine with a gradually increasing dosing schedule. It may cause respiratory infections, high blood pressure, and changes in heart rate.
Siponimod: A once-daily medication that slows progression and MS and decreases relapse rates in secondary-progressive MS. Some patients may need to have their heart rate and blood pressure monitored after the first dose.
Teriflunomide: Slows the rate of growth in the number of activated immune cells.

Physical Therapy for MS

Physical or occupational therapy can help you learn stretching and strengthening exercises. This makes walking and other daily tasks easier to perform with MS.

Lifestyle Management

MS is a complex condition that causes many symptoms that can interfere with daily activities. Many multiple sclerosis symptoms can be treated or managed. Your doctor may prescribe additional medications to improve other symptoms, such as muscle stiffness and depression linked to MS. Treating these symptoms can improve quality of life with MS.

Low levels of Vitamin D have been linked to relapses and new brain lesions in MS. Talk to your doctor about taking a Vitamin D supplement. Vitamin D levels should be monitored to avoid toxicity.

If you smoke, quitting is crucial for MS. Quitting smoking can slow disability progression and reduce symptom severity. Talk to your doctor for help with smoking cessation.

Fatigue is one of the most common symptoms of MS. It can interfere with your ability to function with daily activities. Tracking fatigue to gain a sense of patterns and planning breaks around energy-intensive activities can be helpful in managing fatigue.

Clinical Trials

Clinical trials help determine new treatment options for multiple sclerosis. Patients with MS have access to clinical trials at National Jewish Health. Speak with your doctor to find out if a clinical trial may be a good fit for you.

What Is Multiple Sclerosis?