Definition of Multiple Sclerosis

Multiple sclerosis (MS) is a potentially debilitating disease in which your body's immune system eats away at the protective sheath that covers your nerves. This interferes with the communication between your brain and the rest of your body. Ultimately, this may result in deterioration of the nerves themselves, a process that's not reversible.

Symptoms vary widely, depending on the amount of damage and which particular nerves are affected. People with severe cases of multiple sclerosis may lose the ability to walk or speak. Multiple sclerosis can be difficult to diagnose early in the course of the disease, because symptoms often come and go — sometimes disappearing for months.

Although multiple sclerosis can occur at any age, it most often begins in people between the ages of 20 and 40. Women are more likely to develop multiple sclerosis than are men.

Symptoms of Multiple Sclerosis

Signs and symptoms of multiple sclerosis vary widely, depending on the location of affected nerve fibers. Multiple sclerosis signs and symptoms may include:

• Numbness or weakness in one or more limbs, which typically occurs on one side of your body at a time or the bottom half of your body
• Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement (optic neuritis)
• Double vision or blurring of vision
• Tingling or pain in parts of your body
• Electric-shock sensations that occur with certain head movements
• Tremor, lack of coordination or unsteady gait
• Fatigue
• Dizziness

Most people with multiple sclerosis, particularly in the beginning stages of the disease, experience relapses of symptoms, which are followed by periods of complete or partial remission. Signs and symptoms of multiple sclerosis often are triggered or worsened by an increase in body temperature.

Causes of Multiple Sclerosis

Multiple sclerosis is an autoimmune disease, where the body's immune system attacks its own tissues. In multiple sclerosis, this process destroys myelin — the fatty substance that coats and protects nerve fibers in the brain and spinal cord.

Myelin can be compared to the insulation on electrical wires. When myelin is damaged, the messages that travel along that nerve may be slowed or blocked.

Doctors and researchers don't understand exactly why multiple sclerosis occurs in some people and not others. A combination of factors, ranging from genetics to childhood infections, may play a role.

Risk factors for Multiple Sclerosis

These factors may increase your risk of developing multiple sclerosis:

Age
Although multiple sclerosis can occur at any age, it most commonly begins in people between the ages of 20 and 40.

Sex
Women are about twice as likely as men are to develop multiple sclerosis.

Heredity
The risk of multiple sclerosis is higher for people who have a family history of the disease. For example, if one of your parents or siblings has had multiple sclerosis, you have a 1 to 3 percent chance of developing the disease — as compared with the risk in the general population, which is just a tenth of 1 percent.

But the experiences of identical twins show that heredity can't be the only factor involved. If multiple sclerosis was determined solely by genetics, identical twins would have identical risks. But that's not what happens. An identical twin has only a 30 percent chance of developing multiple sclerosis if his or her twin already has the disease.

Infections
A variety of viruses have been linked to multiple sclerosis. Currently the greatest interest is in the association of multiple sclerosis with Epstein-Barr virus, the virus that causes infectious mononucleosis. How Epstein-Barr virus might result in a higher rate of MS remains to be clarified.

Race
White people, particularly those whose families originated in northern Europe, are at highest risk of developing multiple sclerosis. People of Asian, African or Native American descent have the lowest risk.

Geographical factors
Multiple sclerosis is far more common in countries with temperate climates, including Europe, southern Canada, northern United States, New Zealand and southeastern Australia. The risk seems to increase with latitude.

A child who moves from a high-risk area to a low-risk area, or vice versa, tends to have the risk level associated with his or her new home area. But if the move occurs after puberty, the young adult usually retains the risk level associated with his or her first home.

Other diseases
People are very slightly more likely to develop multiple sclerosis if they have one of the following autoimmune disorders:

• Thyroid disease
• Type 1 diabetes
• Inflammatory bowel disease

Complications of Multiple Sclerosis

In some cases, people with multiple sclerosis may also develop:

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

Preparing for your MS appointment

While you might first discuss your symptoms with your family doctor, he or she may refer you to a neurologist for further evaluation.

What you can do
Because appointments can be brief, plan ahead and write a list that includes:

• Detailed descriptions of your symptoms
• Information about medical problems you've had in the past
• Information about the medical problems of your parents or siblings
• All the medications and dietary supplements you take
• Questions you want to ask the doctor

What to expect from your doctor
In addition to a physical exam, your doctor may also check your neurological health by testing your:

• Reflexes
• Muscle strength
• Muscle tone
• Senses of touch and sight
• Coordination
• Balance

Tests and diagnosis of Multiple Sclerosis

There are no specific tests for multiple sclerosis. Ultimately, the diagnosis relies on ruling out other conditions that might produce similar symptoms. Your doctor may base a multiple sclerosis diagnosis on the following:

Blood tests
Analysis of your blood can help rule out some infectious or inflammatory diseases that have symptoms similar to multiple sclerosis.

Spinal tap (lumbar puncture)
In this procedure, a doctor or nurse removes a small sample of cerebrospinal fluid from within your spinal canal for laboratory analysis. This sample can show abnormalities associated with multiple sclerosis, such as abnormal levels of white blood cells or proteins. This procedure can also help rule out viral infections and other conditions that can cause neurological symptoms similar to those of multiple sclerosis.

MRI
This test uses a powerful magnetic field and radio waves to produce detailed images of internal organs. MRI can reveal lesions, indicative of the myelin loss caused by multiple sclerosis, on your brain and spinal cord. However, these types of lesions can also be caused by other conditions, such as lupus or Lyme disease, so the presence of these lesions isn't definitive proof that you have multiple sclerosis.

During an MRI test, you lie on a movable table that slides into a large, tube-shaped machine, which makes loud tapping or banging noises during the scans. Most MRIs take at least an hour. While the test is painless, some people feel claustrophobic inside the machine. Your doctor can arrange for a sedative if necessary.

You may also receive an intravenous dye that may help highlight "active" lesions. This helps doctors know whether your disease is in an active phase, even if no symptoms are present. Newer MRI techniques can provide even greater detail about the degree of nerve fiber injury or permanent myelin loss and recovery.

Evoked potential test
This test measures the electrical signals sent by your brain in response to stimuli. An evoked potential test may use visual stimuli or electrical stimuli, in which short electrical impulses are applied to your legs or arms.

Treatments and drugs for Multiple Sclerosis

There is no cure for multiple sclerosis. Treatment typically focuses on combating the autoimmune response and managing the symptoms. Some people have such mild symptoms that no treatment is necessary.

Medications
Drugs that are commonly used for multiple sclerosis include:

• Corticosteroids. The most common treatment for multiple sclerosis, corticosteroids reduce the inflammation that spikes during a relapse. Examples include oral prednisone and intravenous methylprednisolone.
• Interferons. These types of drugs — such as Betaseron, Avonex and Rebif — appear to slow the rate at which multiple sclerosis symptoms worsen over time. But interferons can cause serious liver damage.
• Glatiramer (Copaxone). Doctors believe that Copaxone (glatiramer) works by blocking your immune system's attack on myelin. You must inject this drug subcutaneously once daily. Side effects may include flushing and shortness of breath after injection.
• Natalizumab (Tysabri). This drug is designed to work by interfering with the movement of potentially damaging immune cells from your bloodstream to your brain and spinal cord. Tysabri is generally reserved for people who see no results from or can't tolerate other types of treatments. This is because Tysabri increases the risk of progressive multifocal leukoencephalopathy — a brain infection that is usually fatal.
• Mitoxantrone (Novantrone). This immunosuppressant drug can be harmful to the heart, so it's usually used only in people who have advanced multiple sclerosis.

Therapies
A physical or occupational therapist can teach you stretching and strengthening exercises, and show you how to use devices that can make it easier to perform daily tasks.

Procedures
Plasma exchange (plasmapheresis) looks a little like dialysis as it mechanically separates your blood cells from your plasma, the liquid part of your blood. Plasma exchange is sometimes used to help combat severe symptoms of multiple sclerosis relapses, especially in people who are not responding to intravenous steroids.

Lifestyle and home remedies

These steps may help relieve some symptoms of multiple sclerosis:

• Get enough rest. Fatigue is a common symptom of multiple sclerosis, and getting your rest may make you feel less tired.
• Exercise. Regular aerobic exercise may offer some benefits if you have mild to moderate MS. Benefits include improved strength, muscle tone, balance and coordination, and help with depression. Swimming is a good option for people with MS who are bothered by heat.
• Be careful with heat. Extreme heat may cause extreme muscle weakness. Although some people with multiple sclerosis aren't bothered by heat and may enjoy warm baths and showers, be very careful before exposing yourself to extreme heat until you know how you'll react. Don't get into a hot tub or sauna unless there's someone nearby who can pull you out if necessary. If you do experience heat-related worsening of signs or symptoms, cooling down for a few hours usually will return you to your normal state.
• Cool down. Many people with multiple sclerosis experience heat-related worsening of MS symptoms. If you live in a hot and humid area, consider having air conditioning in your home. Tepid or cool baths also may provide some relief.
• Eat a well-balanced diet. Eating a healthy, well-balanced diet can help keep your immune system strong.

Coping and support for those with Multiple Sclerosis

As is true with other chronic diseases, living with multiple sclerosis can place you on a roller coaster of emotions. Here are some suggestions to help you even out the ups and downs:

• Maintain normal daily activities as best you can.
• Stay connected with friends and family.
• Continue to pursue hobbies that you enjoy and are able to do.

If multiple sclerosis impairs your ability to do things you enjoy, talk with your doctor about possible ways to get around the obstacles.

Remember that your physical health can directly impact your mental health. Counselors or therapists may help you put things in perspective. They can also teach you coping skills and relaxation techniques that may be helpful.

Sometimes, joining a support group, where you can share experiences and feelings with other people, is a good approach. Ask your doctor what support groups are available in your community.