In this section, you or a loved one can find out more about medical treatments and practical information about multiple sclerosis (MS). Read on to find answers to some of your questions as well as links to other information. Being informed is an important first step toward becoming an active decision-maker in your care plan.
It is a disease of the central nervous system that disrupts communication within the brain and spinal cord and with the rest of the body. In MS, the immune system attacks the substance called myelin that covers and insulates nerve fibers. MS causes damage to nerves and to the cells producing myelin and eventually can cause progressive deterioration leading to disability.
There are four clinical types of MS:
Clinically isolated syndrome: Clinically isolated syndrome (CIS) is a first episode of symptoms caused by inflammation and demyelination in the central nervous system. This MS attack or MS relapse results in loss of function and lasts for at least 24 hours or longer and is followed by a variable period of recovery, which may be complete or only partial. Loss of function can involve strength, sensation, vision, balance and coordination, and bladder and bowel function, and can occur alone or in combination. These attacks or relapses are associated with small injuries, or lesions, inside the brain or spinal cord and can be seen on an MRI. If the attack is associated only with fresh or new lesions on MRI, the individual does not yet have definite MS.
Relapsing remitting multiple sclerosis: Relapsing remitting MS (RRMS) represents the most common type of MS. All RRMS individuals start out with CIS and after a second relapse episode or subsequent new lesion on MRI are considered clinically definite RRMS. People with RRMS experience clearly defined episodes of new or increasing neurologic symptoms, often followed by periods of partial or complete recovery, called remission. Damage to the central nervous system varies so widely among people that no two individuals are likely to experience the exact same pattern in their clinical course. RRMS affects more women than men, with peak incidence of disease onset in the early 30s. Many cases of RRMS progress to become secondary progressive MS, with the progression typically taking 10 years or more.
Secondary progressive MS: An individual transitions to secondary progressive MS (SPMS) as disability progression occurs relatively independent of relapses, which also become fewer over time. All patients with SPMS must have had RRMS previously. SPMS is characterized by increasing nerve damage and loss, with increasing disability, but with less evidence of inflammation on MRI. Also, as with RRMS, symptoms of disability progression vary widely from person to person.
Primary progressive multiple sclerosis: A small percentage of MS cases are diagnosed as primary progressive MS (PPMS). PPMS affects men and women about equally. PPMS is characterized by progressively worsening neurological symptoms, without the early remissions typical of RRMS.
The cause of MS is not known. It is considered an autoimmune disease, meaning that a person's own immune system attacks the body. Symptoms, severity, and disease progression vary widely from person to person.
The effects of MS are many and varied, depending on the type of MS and the individual.
Multiple sclerosis can affect many parts of the body, and disease symptoms and progression are unique to each individual. Common symptoms include the following:
Bladder control problems
Cognitive problems including thinking and memory
Depression and other mood disorders
Dizziness and vertigo
Muscle stiffness or spasms
Numbness or tingling in the face, body or extremities
Multiple sclerosis is a complex disease, and many factors can affect an individual's health and the course of the disease.
Respiratory complications: People whose chest muscles and throat muscles have been severely weakened by MS may have trouble breathing and swallowing and may be more prone to develop pneumonia.
Speech complications: People with MS may slur their speech or not be able to speak loudly as the disease progresses.
Seizures: A very small percentage of MS patients may experience seizures as a result of abnormal electrical discharges in an injured or scarred area of the brain.
The type and severity of MS symptoms can differ widely from person to person, so treatment plans are usually tailored to an individual's unique circumstances. People with MS need to work closely with their medical professionals and families to create individualized treatment plans. A comprehensive care team may include a primary care physician, neurologist, urologist, mental health specialist, physiatrist, speech pathologist, nutritionist and physical and occupational therapists.
Interventions vary but people with MS may be treated with the following therapies:
For most people, regardless of having multiple sclerosis or not, exercise, healthy eating and good sleep habits are recommended. A healthy lifestyle can lead to enhanced quality of life. Talk to your doctor before making any lifestyle changes.
Maintain relationships with friends and family, even if it means making lifestyle adjustments such engaging in fewer physical activities, napping before events and leaving social engagements early to avoid fatigue.
Regular exercise helps reduce depression and fatigue, increases strength and balance, improves cardiovascular function and can improve bladder and bowel control. Walking on a treadmill, swimming, resistance training, yoga and tai chi are examples of exercises that can be gentle and yet effective. Remember, overheating can cause decompensation in neurological function. By working and exercising for shorter intervals, with intermittent resting intervals, an individual with MS can overcome the challenges of fatigue and overheating.
As with many chronic diseases, stress can worsen MS symptoms. It's especially important to get enough sleep, communicate honestly with your healthcare team, and enlist the support of friends, family, and professionals as needed.
Even though MS does not require a special diet, eating healthily is important for maintaining energy, avoiding extra stress on joints, and generally feeling well.
People with MS may eventually have trouble with daily activities. Devices and technology that assist with walking and driving can help MS patients remain independent and manage their lives as long as possible. Cooling vests and collars can help during hot summer days.
Sources: National Multiple Sclerosis Society - www.nationalmssociety.org
Mayo Clinic - www.mayoclinic.org