What Is Multiple Sclerosis (MS)?

Multiple sclerosis (MS) is a lifelong, autoimmune disease of the central nervous system (CNS) that affects nearly 1 million Americans and 2.8 million people worldwide.

In MS, a person's immune system attacks the protective myelin sheath surrounding nerve fibers in the brain, spinal cord, and optic nerves (located in the eyes). As a result of myelin damage, nerve signaling is interrupted, leading to various symptoms like vision problems, numbness, weakness, and pain.

This article will review basic facts about MS, including symptoms, causes, diagnosis, treatment, and outlook. It will also provide insight into how to live well with MS.

What Are the Signs and Symptoms of Multiple Sclerosis?

No two people experience multiple sclerosis (MS) in the same way, and no single feature is unique to the disease. That said, some symptoms and signs are highly characteristic of the disease.

As an example, optic neuritis is a common first manifestation of MS. Optic neuritis in MS occurs when there is damage to the myelin covering the cranial nerve. This nerve relays messages to the brain about what the eye sees. Symptoms of optic neuritis include blurry vision, seeing colors less vividly, and pain with eye movements.

Other common MS symptoms include:

• Double vision (diplopia)
• Numbness and tingling (paresthesias)
• Fatigue
• Bladder problems
• Impaired balance and coordination
• Vertigo (sensation of spinning)
• Muscle weakness

Types of MS

MS is classified into four types:

• Clinically isolated syndrome (CIS): A person has their first episode of MS-related neurological symptoms. They may or may not go on to develop MS.
• Relapsing-remitting MS (RRMS): A person has acute attacks (relapses) of MS symptoms followed by periods of recovery in which the MS doesn’t progress. RRMS is the initial diagnosis for 85% to 90% of people with MS.
• Secondary progressive MS (SPMS): A person has worsening MS symptoms and disability over time. They may still experience occasional relapses.
• Primary progressive MS (PPMS): A person has MS symptoms and disability that worsen over time from the start of their disease. PPMS affects 10% to 15% of people with MS.
  

What Causes MS?

The cause of MS is unknown, although a person must be genetically vulnerable and exposed to specific environmental exposures to get MS.

The genetic component of MS can be best understood by examining some statistics. In the general population, a person has a 0.1% to 0.2% chance of developing MS. Their risk increases to 2% to 4% if they have a sibling with MS and to 30% if they have an identical twin with MS.

Besides a family history, environmental factors that may make a person more susceptible to developing MS include:

• Tobacco smoking
• Low vitamin D levels
• Having obesity in adolescence
• Prior infection with the Epstein-Barr virus (the most common cause of infectious mononucleosis, or mono)

How Is Multiple Sclerosis Diagnosed?

You may go to a primary healthcare provider when you have symptoms of MS. They may refer you to a neurologist, a physician who treats conditions affecting the nervous system. They diagnose MS using a formal set of criteria called the McDonald criteria.

To meet the McDonald criteria, a person must have evidence of damage in at least two parts of their CNS, which must have occurred at different times.

A medical history, neurological exam, and magnetic resonance imaging (MRI) of the brain and sometimes the spinal cord help determine if a person fulfills the McDonald criteria.

Other diagnostic tools used to confirm the diagnosis and rule out alternative diagnoses include:

• A spinal tap (lumbar puncture)
• Various blood tests, like a vitamin B12 level to rule out vitamin B12 deficiency or antinuclear antibodies (ANA) to check for other autoimmune diseases, like lupus

Treatment for Multiple Sclerosis

There is no cure for MS, but many therapies can help you manage the disease and optimize your quality of life and daily functioning.

Disease-Modifying Therapies (DMTs)

Disease-modifying therapies (DMTs) are "big-picture" drugs. They aim to improve the long-term outlook of MS by:

• Slowing the disease course
• Limiting the number of lesions (areas of inflammation) on imaging tests
• Reducing the number and severity of relapses

There are numerous approved DMTs, varying in their mode of action, side effects, level of effectiveness, and how they are delivered (e.g., by injection, mouth, or intravenous infusion).

Medications for Relieving Symptoms

DMTs do not treat individual relapses or relieve symptoms.

A moderate to severe MS relapse is typically treated with a corticosteroid, either Solumedrol (methylprednisolone) or prednisone.

Other medications, along with lifestyle and rehabilitation interventions, are used to ease the everyday symptoms of MS.

A few examples of medications for MS symptoms include:

• A muscle relaxant like Lyvispah (baclofen) for spasticity (muscle tightness)
• A stimulant like Ritalin (methylphenidate) for fatigue
• An antidepressant like Cymbalta (duloxetine) or an anti-seizure drug like Neurontin (gabapentin) for neuropathic pain (nerve-related pain)
  

Complementary Therapies

Various complementary therapies may also ease MS symptoms.

Exercise, under the guidance of your healthcare provider or physical therapist, can have a particularly positive impact on MS. Research suggests that exercise helps decrease MS-related fatigue and improve bladder function, balance, muscle strength, and cognition in MS.

Mind-body therapies can also reduce physical symptoms and improve stress management and well-being. Two popular therapies in MS care include:

• Massage: Massage is the practice of kneading various muscles and soft tissues in the body. In MS, massage has been found to relieve pain and fatigue.
• Acupuncture: Acupuncture is a traditional Chinese practice in which thin needles are inserted into the skin at specific points to allow for the free flow of energy. In MS, acupuncture has been found to improve fatigue, bladder problems, pain, and walking difficulties.

Lifestyle Changes

Healthy lifestyle behaviors are also paramount to optimizing how a person feels, wit their MS and overall. These behaviors include:

• Establishing a regular sleep schedule
• Eating a well-balanced diet and staying as active as possible
• Avoiding smoking
• Visiting your primary healthcare provider for general checkups and updated vaccinations (e.g., the COVID-19 vaccine and the flu shot)
  
• Practicing daily rituals that help you de-stress (e.g., yoga, meditation, music)
• Engaging in meaningful, pleasurable hobbies or activities

Living With MS

Living with a chronic, often debilitating, and highly unpredictable disease like MS can be challenging on many levels—physically, emotionally, financially, mentally, and logistically.

Nevertheless, you can achieve a fulfilling life with MS, and most people do. Still, it takes inner resiliency, social support, and the proper lifestyle and healthcare interventions.

How MS Affects Mental Health

If you or a loved one has MS, it's normal to experience a range of negative emotions, such as sadness, irritability, frustration, fear, and anger.

Grief, too, is a normal reaction in MS as you cope with losing physical or cognitive skills or even a job or a life once imagined.

While expected, when these emotions become overwhelming or affect your ability to function, it's time to talk with your primary care provider or neurologist. They may signify something more serious, like depression or other mental health conditions.

As you navigate MS and mental health, consider these steps or strategies:

• Prioritize your energy and emotional/physical needs.
• Set and defend your boundaries.
• Practice self-compassion.
• Ensure social support or join an MS support group.
• Consider professional counseling, especially when dealing with sensitive issues like intimacy or talking to your children about MS.

Caring for Someone With MS

Caring for someone with a disabling and unpredictable disease like MS can be an energy-consuming and challenging experience.

In addition to managing physical demands, you may have to schedule healthcare provider appointments, pick up medication from the pharmacy, and manage various household tasks like cleaning, doing laundry, and paying bills.

As a caregiver, try to be mindful of your physical and mental needs to prevent burnout. This might mean:

• Seeing a healthcare provider and dentist for regular checkups
• Carving out time each day to exercise
• Connecting with others or joining a caregiver support group

Also, remember to take short and long breaks, like a coffee outing with a friend or an overnight stay in a hotel, so you can relax and recharge. During this time, ask a friend or family member to help you, or seek respite care from a home health agency that provides trained caregivers. 

Outlook for Multiple Sclerosis

While MS is incurable and a chronic condition that may affect all aspects of a person's life, including relationships, career, and family decisions, the good news is that most people can live well with the right support and care.

In fact, MS is generally not considered fatal. If a person dies from MS, it's usually related to a complication of the disease, like a urinary tract infection (UTI), pneumonia (lung infection), or a pressure sore. These complications tend to occur when a person's MS is advanced.

Another positive outlook feature is that the life expectancy of people diagnosed with MS has increased over the past two decades.

The increased and now near-normal life span of those living with MS is likely due to the remarkable discovery of several disease-modifying therapies. Lifestyle changes and broader knowledge about MS leading to earlier diagnosis and treatment may also play a role.