MULTIPLE SCLEROSIS

Multiple sclerosis (MS) is a condition wherein the immune system attacks the myelin sheath (protective cover of the nerve cells), and eventually can cause the nerves to deteriorate or be damaged. Although the exact case is unknown, multiple sclerosis is considered to be an autoimmune disease.

These factors may increase your risk of developing multiple sclerosis:

  • Age. MS can occur at any age, but most commonly affects people between the ages of 15 and 60.
  • Sex. Women are about twice as likely as men are to develop MS.
  • Family history. If one of your parents or siblings has had MS, you are at higher risk of developing the disease.
  • Certain infections. A variety of viruses have been linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis.
  • Race. White people, particularly those of Northern European descent, are at highest risk of developing MS. People of Asian, African or Native American descent have the lowest risk.
  • Climate. MS is far more common in countries with temperate climates, including Canada, the northern United States, New Zealand, southeastern Australia and Europe.
  • Certain autoimmune diseases. You have a slightly higher risk of developing MS if you have thyroid disease, type 1 diabetes or inflammatory bowel disease.
  • Smoking. Smokers who experience an initial event of symptoms that may signal MS are more likely than nonsmokers to develop a second event that confirms relapsing-remitting MS.

People with multiple sclerosis also may develop:

  • Muscle stiffness or spasms
  • Paralysis, typically in the legs
  • Problems with bladder, bowel or sexual function
  • Mental changes, such as forgetfulness or mood swings
  • Depression
  • Epilepsy

Doctors have identified a few major types of MS. The categories are important, because they help predict how severe the disease can be and how well treatment will work.

Relapsing-Remitting Multiple Sclerosis

Most people with multiple sclerosis — around 85% — have this type. They usually have their first signs of the disease in their early 20s. After that, they have attacks of symptoms (called relapses) from time to time, followed by weeks, months, or years of recovery (called remissions).

Primary Progressive Multiple Sclerosis

In primary progressive multiple sclerosis, the disease gradually gets worse over time. There are no well-defined attacks of symptoms, and there is little or no recovery. In addition, MS treatments don’t work as well with this type of MS. About 10% of people with MS have this type.

Secondary Progressive Multiple Sclerosis

After living with relapsing-remitting MS for many years, most people will get secondary progressive MS. In this type, symptoms begin a steady march without relapses or remissions. (In this way, it’s like primary progressive MS.) The change typically happens between 10 and 20 years after you’re diagnosed with relapsing-remitting MS.

This type is rare enough that doctors don’t know much about it. Probably around 5% of people with multiple sclerosis have this form. In many ways, it seems similar to primary progressive MS.

Multiple sclerosis signs and symptoms may differ greatly from person to person and over the course of the disease depending on the location of affected nerve fibers. They may include:

  • Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or the legs and trunk
  • Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
  • Prolonged double vision
  • Tingling or pain in parts of your body
  • Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign)
  • Tremor, lack of coordination or unsteady gait
  • Slurred speech
  • Fatigue
  • Dizziness
  • Problems with bowel and bladder function

DIAGNOSIS

It can be a challenge for doctors to diagnose multiple sclerosis (MS). There’s no one test that can definitely show if someone has it. And there are many conditions with symptoms that can seem like MS.

There are no specific tests for MS. Instead, a diagnosis of multiple sclerosis often relies on ruling out other conditions that might produce similar signs and symptoms, known as a differential diagnosis

Your doctor will start by asking you about your medical history and your symptoms. She’ll also do a few tests to see if your brain and spinal cord are working as they should. These include:

  • Imaging tests, like an MRI, to take a closer look at your brain
  • Spinal taps, also called lumbar punctures, to check the fluid that runs through your spinal column
  • Electrical tests, called evoked potentials, to see if MS has affected your nerve pathways
  • Blood tests

 

RECOMMENDED MEDICATIONS

There is no cure for multiple sclerosis. Treatment typically focuses on speeding recovery from attacks, slowing the progression of the disease and managing MS symptoms. Some people have such mild symptoms that no treatment is necessary.

Controlling a relapse

These medicines can shorten a sudden relapse and help you feel better sooner. They have not been shown to affect the long-term course of the disease or to prevent disability.

  • Corticosteroids (such as methylprednisolone)
  • ACTH (adrenocorticotropic hormone)
  • Intravenous immunoglobulin (IVIG)
  • Plasma exchange

Disease-modifying treatment

The most commonly used disease-modifying therapies are:

  • Interferon beta (such as Betaseron), for clinically isolated syndrome (first MS attack), relapsing-remitting MS, and secondary progressive MS.
  • Glatiramer (Copaxone), for clinically isolated syndrome and relapsing-remitting MS.
  • Dimethyl fumarate (Tecfidera).
  • Fingolimod (Gilenya).
  • Mitoxantrone (Novantrone).
  • Natalizumab (Tysabri).
  • Teriflunomide (Aubagio).

 Relieving symptoms

Treating specific symptoms can be effective, even if it doesn’t stop the progression of the disease. Symptoms that can often be controlled or relieved with medicine include:

  • Fatigue
  • Muscle stiffness (spasticity).
  • Urinary problems.
  • Constipation
  • Pain and abnormal sensations.
  • Depression

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