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Multiple Sclerosis—Adult

(MS—Adult)

Definition

Multiple sclerosis (MS) is a disease of the brain and spinal cord. It is a long term condition that causes damage to the brain and spinal cord. There are several types of MS:
  • Relapsing-remitting MS —New symptoms occur and worsen over a few days and weeks. This is called relapse. They last for a few weeks or months. This is followed by a period of no symptoms called remission. Symptoms may get worse with each occurrence.
  • Primary progressive MS —Symptoms gradually worsen after they first appear. Relapses and remissions usually do not occur.
  • Secondary progressive MS —Symptoms occur in relapses and remissions for years. Then symptoms suddenly begin to worsen.

Causes

MS is caused by a problem with the immune system. Parts of the immune system attack nerve fibers in the brain, spinal cord, and nerves to the eyes. The exact reason for these abnormal immune actions is not known. Things that may play a role in development of MS include:
  • Issue with genes (can be passed down in families)
  • Viral or other infection
  • Environmental factors
Abnormal Immune Responses Cause Nerve Damage
Myelin Sheath Damage
Copyright © Nucleus Medical Media, Inc.

Risk Factors

MS is more common in women. It often first appears in people aged 15 to 50 years old. Other things that may increase your chance of MS include:
  • Family members who have MS or other autoimmune disorders, such as systemic lupus erythematosus
  • Being of Northern European descent
  • Growing up in a colder climate, as opposed to a tropical climate
  • Having certain immune system genes
  • Having inflammation of the nerve to the eye
  • Having low vitamin D levels
  • Smoking

Symptoms

Symptoms may range from mild to severe and may include:
  • Numbness or tingling in the face or limbs
  • Impaired vision in one or both eyes, including:
    • Blurred vision
    • Double vision
    • Loss of vision
  • Eye pain
  • Fatigue
  • Lightheadedness
  • Muscle stiffness
  • Muscle spasms
  • Muscle weakness
  • Incoordination or falling
  • Trouble walking or maintaining balance
  • Weakness in one or more limbs
  • Bladder problems including:
  • Bowel problems, including constipation
  • Sexual dysfunction
  • Slurred speech
  • Difficulty swallowing
  • Forgetfulness, memory loss, and confusion
  • Difficulty concentrating or solving problems
  • Depression
Symptoms may worsen with:
  • Heat, including:
    • Hot weather
    • Hot baths or showers
    • Fever
  • Overexertion—intense physical activity
  • Infection

Diagnosis

You will be asked about your symptoms and past health. A physical exam will be done. There is no test to confirm MS. Instead the doctor will rule out other conditions that cause similar problems. Tests may include:
  • Blood tests—to rule out other diseases that may mimic MS
  • MRI scan
  • Lumbar puncture—sample and test of fluid around the brain and spinal cord
  • Sensory evoked potentials—check how you respond to stimulus
  • Visual evoked potential test —test the brain's response to what you see
  • Optical coherence tomography (OCT)—to look at the eye and nerve to the eye

Treatment

There is no cure for MS. Treatment can help to ease symptoms and prevent or slow them from happening again. For primary and secondary progressive MS, treatment can also slow the progress of the disease. It may delay disability. Talk with your doctor about the best treatment plan for you. Options include:

Medicine

Medicine can help to slow MS. It may also help to manage symptoms. Types of medicine that can slow the progression of MS or prevent damage to nerve fibers include:
  • Interferon betas
  • Glatiramer acetate
  • Immunomodulators
  • Immunosuppressives
Corticosteroids may be given during active phases. It can help to reduce inflammation. It may lessen damage to the nerve fibers and shorten the length of relapses.
Symptoms may be managed with:
  • Muscle relaxants—to reduce muscle spasms
  • Potassium channel blockers—to help improve vision, motor skills, and relieve fatigue
  • Botox injections —to reduce tremor and muscle tone
  • Pain relievers
  • Antidepressants
  • Medicine to help with bladder or bowel problems

Supportive Therapies

MS can impact different areas of health and wellness. Supportive therapy include:
  • Regular moderate exercise—swimming may be especially helpful
  • Physical therapy—to help maintain muscle strength and tone, movement, and walking ability
  • Occupational therapy—to help with daily living activities
  • Speech and/or swallowing therapy
  • Cognitive therapy—to address mental health changes
  • Stress reduction tools
Some alternative therapies that have shown some benefits include:
Alternative therapies should only be used along with a medical plan. Care team can help to coordinate plan.

Psychological Therapies

Long term health issues and changes in ability can be stressful. Individual or group therapy can help to develop coping skills. It may help to ease stress and anxiety and improve quality of life.

Avoiding Periods of Relapse

Some MS have periods of time with no symptoms. Certain steps may help to delay or avoid relapses. It may also prevent a worsening of symptoms. Steps include:
  • Stick to the treatment plan you worked out with your doctor
  • Get enough rest—adjust as needed
  • Avoid hot weather
  • Stay in air-conditioned places during periods of hot weather
  • Avoid hot showers or baths
  • Avoid overexertion and stress
  • Avoid infection by:
    • Using proper hygiene, especially when washing your hands
    • Staying away from people who are sick
    • Thoroughly cooking food
    • Practicing safe sex
  • Quitting smoking —smoking may worsen MS

Prevention

There are no current guidelines to prevent MS.

RESOURCES

Multiple Sclerosis Association of America
http://www.mymsaa.org
National Multiple Sclerosis Society
http://www.nationalmssociety.org

CANADIAN RESOURCES

Health Canada
https://www.canada.ca
Multiple Sclerosis Society of Canada
http://mssociety.ca

References

Multiple sclerosis. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/multiple-sclerosis-ms/ . Updated September 5, 2019. Accessed September 13, 2019.
NINDS multiple sclerosis information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Multiple-Sclerosis-Information-Page. August 5, 2013. Accessed September 13, 2019.
What is MS? National Multiple Sclerosis Society website. Available at: http://www.nationalmssociety.org/What-is-MS. Accessed September 13, 2019.
4/25/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T905969/Treatment-of-specific-impairments-in-multiple-sclerosis : Rosti-Otajärvi EM, Hämäläinen PI. Neuropsychological rehabilitation for multiple sclerosis. Cochrane Database Syst Rev. 2014;2:CD009131.
4/25/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116285/Multiple-sclerosis-MS : Yadav V, Bever C Jr, Bowen J, et al. Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2014;82(12):1083-1092.
11/9/2015 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116285/Multiple-sclerosis-MS : Kuo CF, Grainge MJ, Valdes AM, et al. Familial aggregation of systemic lupus erythematosus and coaggregation of autoimmune diseases in affected families. JAMA Intern Med. 2015;175(9):1518-1526.

Revision Information

  • Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
  • Review Date: 09/2019
  • Update Date: 09/13/2019
Article written by Alan R