Facts and Definition of Multiple Sclerosis (MS)
Multiple sclerosis is caused by damage to tissues surrounding nerve fibers.
- Multiple sclerosis (MS) is a condition that results from damage to myelin, the tissues surrounding nerves of the brain and spinal cord.
- Damage to the myelin is a result of an autoimmune disease in which the body produces an immune response against its own tissues.
- Multiple sclerosis is more common in women than in men.
- Symptoms and signs of MS are extremely variable and range from mild to severe, and may include:
- Some people with MS may have no symptoms to mild symptoms; about 30% of those affected will have significant disability after 20-25 years with the condition.
- The average age of onset for MS is about 34 years of age; but children and teens also get the condition.
- There is no cure for MS, but disease-modifying drugs can reduce the symptoms, delay disability, and reduce progression of the condition as seen on MRI.
What Is Multiple Sclerosis (MS)?
Multiple sclerosis (MS) can be thought of as an immune-mediated inflammatory process involving different areas of the central nervous system (CNS) at various points in time. As the name suggests, the condition affects many areas of the central nervous system or CNS. Normal nerves are surrounded by a myelin sheath to insulate and protect them from damage. This sheath also allows effects how fast nerve signals get from the brain or spinal cord (CNS) to the affected body part. As this sheath is destroyed, the nerve conduction to that body area or part decreases or is interrupted completely. The destruction is caused by the body's immune system attacking the myelin sheath. The reason that the body's immune system attacks the sheath is not understood fully, but it is believed to be related to a combination of a genetic predisposition and acquired or environmental influences.
Multiple Sclerosis (MS) Symptoms and Treatment
What Are the Signs and Symptoms of Multiple Sclerosis?
- The signs and symptoms of MS in adults, children, and teens are similar; however, children and teens with the disease (pediatric MS) also may have seizures and complete lack of energy that adults with MS do not experience.
- Moreover, symptoms in people with multiple sclerosis differ from person to person. Visual, sensory, and motor signs and symptoms are all part of MS; however, there is a wide range of symptoms that can appear. Some people have mild cases of MS with little or no disability over the years.
- Others have more severe types of MS, requiring confinement to a wheelchair or bed.
- Over 30% of those affected with MS will have a significant disability after 20 to 25 years.
- Still, others may live their entire lives symptom-free (some individuals without multiple sclerosis symptoms are found incidentally to have multiple sclerosis lesions by MRI or individuals in whom an examination of their brain after death unexpectedly reveals that they were affected by the disease).
- This variability makes it difficult in some cases to diagnose multiple sclerosis. Often the signs and symptoms are mistaken as being psychiatric in origin.
5 Early Warning Signs and Symptoms of Multiple Sclerosis
The early first signs and symptoms of multiple sclerosis are often visual changes.
- Large number of people with multiple sclerosis develop optic neuritis (inflammation of the optic nerve, which is an extension of the central nervous system), described as a painful vision loss. If a patient is diagnosed with optic neuritis early, treatment could change the course of the disease.
- Before the actual loss of vision, the patient may have visual changes described by many people as blurred or hazy vision, flashing lights, or alterations in color.
- The tissues around the eye and moving the eye may be painful.
- Most people recover over several months. Others are left with permanent visual defects.
- Double vision occurs when the eyes move in different directions and is another common symptom of multiple sclerosis.
What Are the Common Signs and Symptoms of Multiple Sclerosis?
Multiple sclerosis commonly affects the cerebellum, the portion of the brain responsible for balance and fine motor coordination. Consequently, people with multiple sclerosis often have difficulty maintaining their balance when walking and performing delicate tasks with their hands. The unexplained dropping of a cup or other objects, or unusual weakness can occur.
Other signs and symptoms of MS may include:
- Facial pain
- Hearing loss
- Painful muscle spasms
- Weakness in one or more of the arms or legs
- Tingling or numbness
- Electrical-type pain sensations in the chest, abdomen, arms, or legs
- Urinary retention
- A constant state of tiredness or fatigue
There appears to be a relationship between multiple sclerosis, higher temperatures, and the worsening of symptoms. Seizures occur in about 5% of people with multiple sclerosis. Those with MS may complain of sleep disturbances, depression, or may feel that they are experiencing changes in attention span or memory.
Many symptoms of multiple sclerosis lead to other complications, such as infections of the bladder (urinary infections), kidney, or blood. Any area of the body can be involved, making this disease difficult to distinguish from other nervous system disorders.
What Are the Signs and Symptoms of Multiple Sclerosis in Children and Teens (Pediatric MS)?
- The signs and symptoms of multiple sclerosis in children and teens are similar to those experienced by adults; however, they also may have seizures and extreme fatigue or lethargy.
- Children with MS are considered to have the form of MS known as relapsing-remitting multiple sclerosis.
What Causes Mulitple Sclerosis?
The central nervous system is made up of the brain and spinal cord. They process information from our environment and control voluntary muscle movements to allow the body to do certain things.
- When you touch something hot, for example, signals are sent from sensory nerve endings in your hand up long nerves in your arm, eventually reaching the spinal cord.
- From there, the signal is transferred up your spinal cord to your brain, where the information is processed. Your brain then sends a signal back down the spinal cord to the nerves in your arm.
- These nerves cause the muscles in your arm to contract, pulling your hand away from the heat.
This system works efficiently, unless there is a disease process affecting the nerve pathways in the spinal cord and brain. MS is one of the diseases that can affect these pathways. The nerves in the body are covered by a fatty substance called myelin (myelin sheath). The myelin sheath insulates the nerves and allows them to transmit information to and from the brain in a fraction of a second. If the myelin is disrupted in any way, the transmitted information is not only delayed, but it may also be misinterpreted by the brain. This autoimmune destruction of the myelin sheath leads to areas of demyelination (also known as plaques) in the brain and spinal cord. These plaques disrupt the transmission of information by nerves in the CNS and lead to the symptoms seen in MS.
At What Age Can Multiple Sclerosis Start? Who Has MS?
- MS is more common in individuals of northern European descent.
- Women are more than twice as likely to develop multiple sclerosis as men.
- Multiple sclerosis usually affects people between the ages of 20 and 50 years, and the average age of onset is approximately 34 years.
- Multiple sclerosis can affect children and teens (pediatric MS). It has been estimated that 2%-5% of people with MS develop symptoms prior to age 18.
What kind of disease is multiple sclerosis?
Is There A Test to Diagnose Multiple Sclerosis?
Diagnosing multiple sclerosis is difficult. The vague and nonspecific nature of this disease mimics many other diseases. Doctors combine history, physical exam, laboratory work, and sophisticated medical imaging techniques to arrive at a diagnosis. More often than not, a neurology specialist is required to make a diagnosis. Examples of tests and procedures used to diagnose MS include:
- A complete blood count (CBC), blood chemistry, urinalysis, and often spinal fluid evaluation (lumbar puncture or “spinal tap”) are all routine laboratory tests used to rule out other conditions and help confirm the diagnosis of multiple sclerosis.
- An MRI, which creates an image of the brain or the spinal cord, is used to search for changes within the brain or spinal cord that are unique to multiple sclerosis.
What Medications Are Used for the Treatment of Multiple Sclerosis?
There are several treatment options for multiple sclerosis. Listed examples below are US FDA-approved drugs to treat multiple sclerosis. These are known as disease-modifying therapies for MS. Disease-modifying therapies have been found through clinical trials to reduce the number of relapses, delay the progression of disability, and limit new disease activity that is observed on MRI. Examples of drugs used to treat MS include:
Mitoxantrone (Novantrone) is a chemotherapy agent that has been approved by the FDA to treat multiple sclerosis. Treatment with mitoxantrone requires monitoring of cardiac function, and there is a fixed limit to the dose that can be administered to patients. It also carries the long-term risk of leukemia. For these reasons, Novantrone is typically reserved for patients with more aggressive forms of multiple sclerosis.
New research and treatment methods are currently being investigated and are expected to offer some hope to people with multiple sclerosis. In particular, new research studies have shown that skin patches containing myelin peptides may be a promising therapy.
Consult your healthcare team for multiple sclerosis treatment options.
What Drug Therapies Are Used for the Treatment and Symptoms of Multiple Sclerosis?
In addition to drugs that target the disease process, other medications used to relieve certain symptoms of MS.
- Corticosteroid medications, for example,
- methylprednisolone (Solu-Medrol, Depo-Medrol)
- dexamethasone (Bayacardron)
- prednisone (Steraped)
- Tricyclic antidepressants
- Muscle relaxants, for example, baclofen (Lioresal)
- Selective serotonin reuptake inhibitor (SSRIs) antidepressants
- The oral phosphodiesterase type 5 inhibitors, for example, sildenafil (Viagra), tadalafil (Cialis, Adcirca), and vardenafil) (Levitra, Staxyn ODT)
What Is the Prognosis and Life Expectancy for MS in Adults, Teens, and Children? Is It Fatal?
- Most people with the relapsing-remitting form of MS progress to a stage where relapses become much less frequent, but they continue to accumulate disabling symptoms. This new phase of the disease is termed secondary progressive multiple sclerosis. Symptoms of this type of MS are intermittent and worsen neurologic symptoms, which can last several days or weeks before returning to their original state of health. Some people, however, are left with residual deficits (residual disability) after some attacks.
- A few people have a relapsing-progressive form of MS. In this type, people have relapses superimposed on a pattern of continuous progression of disability.
- Rarely, people with multiple sclerosis have a pure progressive (primary progressive multiple sclerosis) forms of the disease. Their disability progresses in the absence of attacks over time.
Most people with MS usually die from diseases such as pneumonia or heart attacks, especially in those who are bedridden.
Currently, there is no cure for multiple sclerosis.
How Can I Prevent Multiple Sclerosis?
As of yet, no true way of preventing multiple sclerosis has been found.
When Should You Seek Medical Care for Multiple Sclerosis?
The symptoms of multiple sclerosis are very variable and differ from patient to patient. They can also be confused with symptoms of many other conditions. You should talk with your physician if you or someone you know has any of the signs and symptoms associated with multiple sclerosis or if you have any concerning symptoms. Several of the symptoms of multiple sclerosis may be severe enough to send the patient to a hospital's emergency department. Go to the nearest Emergency Department if you have any of the following symptoms:
- Visual changes and painful eye movements. Optic neuritis, one of the most common early signs of multiple sclerosis, causes these symptoms.
- If you experience personality changes or sudden loss of strength in the arms and legs. These symptoms are common with multiple sclerosis, but they can also be signs of other serious diseases that require urgent treatment such as stroke, infection, or chemical imbalances.
Reviewed on 10/10/2019
Luzzio, C., MD. "Multiple Sclerosis." Medscape. Updated Jan 27, 2016.
National Instututes of Neurological Disorders and Stroke. Multiple Sclerosis Information Page.
National MS Society. "What Is MS?"