Multiple sclerosis
MS; Demyelinating diseaseMultiple sclerosis (MS) is an autoimmune disease that affects the brain and spinal cord (central nervous system).
Autoimmune disease
An autoimmune disorder occurs when the body's immune system attacks and destroys healthy body tissue by mistake. There are more than 80 autoimmune d...
Read Article Now Book Mark ArticleBrain and spinal cord
The central nervous system is composed of the brain and spinal cord. Your brain and spinal cord serve as the main "processing center" for your entir...
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Causes
MS affects women more often than men. The disorder is most commonly diagnosed between ages 20 to 40, but it can be seen at any age.
MS is caused by damage to the myelin sheath. This sheath is the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow or stop.
The nerve damage is caused by inflammation. Inflammation occurs when the body's immune cells attack the nervous system. This can occur along any area of the brain, optic nerve, and spinal cord.
It is unknown what exactly causes MS. The most common thought is that it is caused by a virus, a gene defect, or both. Environmental factors may also play a role.
You are slightly more likely to develop this condition if you have a family history of MS or you live in a part of the world where MS is more common (areas further from the equator).
Symptoms
Symptoms vary because the location and severity of each attack can be different. Attacks can last for days, weeks, or months. Attacks are followed by remissions. These are periods of reduced symptoms or no symptoms. Fever, hot baths, sun exposure, and stress can trigger or worsen attacks.
Nerves in any part of the brain or spinal cord may be damaged. Because of this, MS symptoms can appear in many parts of the body.
Muscle symptoms:
- Loss of balance
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Muscle spasms
Muscle spasms
Muscle cramps are when a muscle gets tight (contracts) without you trying to tighten it, and it does not relax. Cramps may involve all or part of on...
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Numbness or abnormal sensation in any area
Numbness
Numbness and tingling are abnormal sensations that can occur anywhere in your body, but they are often felt in your fingers, hands, feet, arms, or le...
Read Article Now Book Mark Article - Problems moving arms or legs
- Problems walking
- Problems with coordination and making small movements
Coordination
Uncoordinated movement is due to a muscle control problem that causes an inability to coordinate movements. It leads to a jerky, unsteady, to-and-fr...
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Tremor in one or more arms or legs
Tremor
A tremor is a type of shaking movement. A tremor is most often noticed in the hands and arms. It may affect any body part, including the head, tong...
Read Article Now Book Mark Article - Weakness in one or more arms or legs
Bowel and bladder symptoms:
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Constipation and stool leakage
Constipation
Constipation in infants and children means they have hard stools or have problems passing stools. A child may have pain while passing stools or may ...
Read Article Now Book Mark Article - Difficulty beginning to urinate
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Frequent need to urinate
Frequent need to urinate
Frequent urination means needing to urinate more often than usual. Urgent urination is a sudden, strong need to urinate. This causes a discomfort i...
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Urine leakage (incontinence)
Urine leakage
Urinary (or bladder) incontinence occurs when you are not able to keep urine from leaking out of your urethra. The urethra is the tube that carries ...
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Eye symptoms:
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Double vision
Double vision
There are many types of eye problems and vision disturbances, such as: Halos Blurred vision (the loss of sharpness of vision and the inability to see...
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Eye discomfort
Eye discomfort
Pain in the eye may be described as a burning, throbbing, aching, or stabbing sensation in or around the eye. It may also feel like you have a forei...
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Uncontrollable eye movements
Uncontrollable eye movements
Nystagmus is a term to describe uncontrollable movements of the eyes that may be:Side to side (horizontal nystagmus)Up and down (vertical nystagmus)R...
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Vision loss (usually affects one eye at a time)
Vision loss
Blindness is a lack of vision. It may also refer to a loss of vision that cannot be corrected with glasses or contact lenses. Partial blindness mean...
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Numbness, tingling, or pain:
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Facial pain
Facial pain
Face pain may be dull and throbbing or an intense, stabbing discomfort in the face or forehead. It can occur in one or both sides.
Read Article Now Book Mark Article - Painful muscle spasms
Muscle spasms
Muscle cramps are when a muscle gets tight (contracts) without you trying to tighten it, and it does not relax. Cramps may involve all or part of on...
Read Article Now Book Mark Article - Tingling, crawling, or burning feeling in the arms and legs
Other brain and nerve symptoms:
- Decreased attention span, poor judgment, and memory loss
- Difficulty reasoning and solving problems
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Depression or feelings of sadness
Depression
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for shor...
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Dizziness and balance problems
Dizziness
Dizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...
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Hearing loss
Hearing loss
Hearing loss is being partly or totally unable to hear sound in one or both ears.
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Sexual symptoms:
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Problems with erections
Problems with erections
An erection problem occurs when a man cannot get or keep an erection that is firm enough for intercourse. You may not be able to get an erection at ...
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Speech and swallowing symptoms:
- Slurred or difficult-to-understand speech
- Trouble chewing and swallowing
Fatigue is a common and bothersome symptom as MS progresses. It is often worse in the late afternoon.
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Read Article Now Book Mark ArticleExams and Tests
Symptoms of MS may mimic those of many other nervous system problems. MS is diagnosed by determining if there are signs of more than one attack on the brain or spinal cord and by ruling out other conditions.
People who have a form of MS called relapsing-remitting MS have evidence of at least two attacks separated by a remission.
In other people, the disease may slowly get worse in between clear attacks. This form is called secondary progressive MS. A form with gradual progression, but no clear attacks is called primary progressive MS.
Your health care provider may suspect MS if there are decreases in the function of two different parts of the central nervous system (such as abnormal reflexes) at two different times.
An exam of the nervous system may show reduced nerve function in one area of the body. Or the reduced nerve function may be spread over many parts of the body. This may include:
- Abnormal nerve reflexes
- Decreased ability to move a part of the body
- Decreased or abnormal sensation
- Other loss of nervous system functions, such as vision
An eye exam may show:
- Abnormal pupil responses
- Changes in the visual fields
Visual fields
The visual field refers to the total area in which objects can be seen in the side (peripheral) vision as you focus your eyes on a central point. Thi...
Read Article Now Book Mark Article - Changes in eye movements
- Damage to the nerve in the eye (optic nerve atrophy)
Optic nerve atrophy
Optic nerve atrophy is damage to the optic nerve. The optic nerve carries images of what the eye sees to the brain.
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Decreased visual acuity
Decreased visual acuity
The visual acuity test is used to determine the smallest letters you can read on a standardized chart (Snellen chart) or a card held 20 feet (6 meter...
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- Rapid eye movements triggered when the eye moves
Tests to diagnose MS include:
- Blood tests to check for other conditions that are similar to MS.
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Lumbar puncture (spinal tap) for cerebrospinal fluid (CSF) tests, including CSF oligoclonal banding may be needed.
Lumbar puncture
Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...
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MRI scan of the brain, or the spine, or both are important to help diagnose and follow MS.
MRI scan of the brain
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
Read Article Now Book Mark Article - Nerve function study (evoked potential test, such as visual evoked response) is less often used.
Treatment
There is no known cure for MS at this time, but there are treatments that may slow the disease. The goal of treatment is to stop progression, control symptoms, and help you maintain a normal quality of life.
Medicines are often taken long-term. These include:
- Medicines to slow the disease
- Steroids to decrease the severity of attacks
- Medicines to control symptoms such as muscle spasms, urinary problems, fatigue, or mood problems
Medicines are more effective for the relapsing-remitting form than for other forms of MS.
The following may also be helpful for people with MS:
Helpful for people with MS
Your health care provider has told you that you have multiple sclerosis (MS). This disease affects the brain and spinal cord (central nervous system...
Read Article Now Book Mark Article- Physical therapy, speech therapy, occupational therapy, and support groups
- Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars
- A planned exercise program early in the course of the disorder
- A healthy lifestyle, with good nutrition and enough rest and relaxation
- Avoiding fatigue, stress, temperature extremes, and illness
- Changes in what you eat or drink if there are swallowing problems
What you eat or drink if there are swal...
Difficulty with swallowing is the feeling that food or liquid is stuck in the throat or at any point before the food enters the stomach. This proble...
Read Article Now Book Mark Article - Making changes around the home to prevent falls
Prevent falls
Older adults and people with medical problems are at risk of falling or tripping. This can result in broken bones or more serious injuries. Use the ...
Read Article Now Book Mark Article - Social workers or other counseling services to help you cope with the disorder and get assistance
- Vitamin D or other supplements (talk to your provider first)
- Complementary and alternative approaches, such as acupuncture or cannabis, to help with muscle problems
- Spinal devices can reduce pain and spasticity in the legs
Support Groups
Living with MS may be a challenge. You can ease the stress of illness by joining an MS support group. Sharing with others who have common experiences and problems can help you not feel alone.
MS support group
The following organizations provide information on multiple sclerosis:Multiple Sclerosis Association of America -- mymsaa. orgMultiple Sclerosis Foun...
Read Article Now Book Mark ArticleOutlook (Prognosis)
The outcome varies, and is hard to predict. Although the disorder is life-long (chronic) and incurable, life expectancy can be normal or almost normal. Most people with MS are active and function at work with little disability.
Chronic
Chronic refers to something that continues over an extended period of time. A chronic condition is usually long-lasting and does not easily or quick...
Read Article Now Book Mark ArticleThose who usually have the best outlook are:
- Females
- People who were young (less than 30 years old) when the disease started
- People with infrequent attacks
- People with a relapsing-remitting pattern
- People who have limited disease on imaging studies
The amount of disability and discomfort depends on:
- How often and severe the attacks are
- The part of the central nervous system that is affected by each attack
Most people return to normal or near-normal function between attacks. Over time, there is greater loss of function with less improvement between attacks.
Possible Complications
MS may lead to the following:
- Depression
- Difficulty swallowing
- Difficulty thinking
- Less and less ability to care for self
- Need for indwelling urinary catheter
Indwelling urinary catheter
A urinary catheter is a tube placed in the body to drain and collect urine from the bladder.
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Osteoporosis or thinning of the bones
Osteoporosis
Osteoporosis is a disease in which bones become fragile and more likely to break (fracture).
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Pressure sores
Pressure sores
A pressure sore is an area of the skin that breaks down when something keeps rubbing or pressing against the skin.
Read Article Now Book Mark Article - Side effects of medicines used to treat the disorder
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Urinary tract infections
Urinary tract infections
A urinary tract infection, or UTI, is an infection of the urinary tract. The infection can occur at different points in the urinary tract, including...
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When to Contact a Medical Professional
Contact your provider if:
- You develop any symptoms of MS
- Your symptoms get worse, even with treatment
- The condition worsens to the point when home care is no longer possible
References
Calabresi PA, Multiple sclerosis and demyelinating conditions of the central nervous system. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 380.
Fabian MT, Krieger SC, Lublin FD. Multiple sclerosis and other inflammatory demyelinating diseases of the central nervous system. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 80.
Rae-Grant A, Day GS, Marrie RA, et al. Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90(17):777-788. PMID: 29686116 pubmed.ncbi.nlm.nih.gov/29686116/.
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Multiple sclerosis
Animation
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Multiple sclerosis - illustration
Multiple sclerosis is a central nervous system disorder marked by decreased nerve function with initial inflammation of the protective myelin nerve covering and eventual scarring. Symptoms and severity of symptoms vary widely and may progress into episodes of crisis alternating with episodes of remission.
Multiple sclerosis
illustration
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MRI of the brain - illustration
An MRI (magnetic resonance imaging) of the brain creates a detailed image of the complex structures in the brain. An MRI can give a three-dimensional depiction of the brain, making location of problems such as tumors or aneuryms more precise.
MRI of the brain
illustration
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Central nervous system and peripheral nervous system - illustration
The central nervous system comprises the brain and spinal cord. The peripheral nervous system includes nerves outside the brain and spinal cord.
Central nervous system and peripheral nervous system
illustration
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Myelin and nerve structure - illustration
Myelin is the layer that forms around nerve cells. Its purpose is to speed the transmission of impulses along nerve cells.
Myelin and nerve structure
illustration
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Nerve supply to the pelvis - illustration
The nerves that branch off the central nervous system (CNS) provide messages to the muscles and organs for normal function. When there is CNS damage, the function of these organs and tissues may be compromised. In multiple sclerosis, the demyelinization of nerve cells may lead to bowel incontinence, bladder problems and/or sexual dysfunction.
Nerve supply to the pelvis
illustration
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Multiple sclerosis - illustration
Multiple sclerosis is a central nervous system disorder marked by decreased nerve function with initial inflammation of the protective myelin nerve covering and eventual scarring. Symptoms and severity of symptoms vary widely and may progress into episodes of crisis alternating with episodes of remission.
Multiple sclerosis
illustration
-
MRI of the brain - illustration
An MRI (magnetic resonance imaging) of the brain creates a detailed image of the complex structures in the brain. An MRI can give a three-dimensional depiction of the brain, making location of problems such as tumors or aneuryms more precise.
MRI of the brain
illustration
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Central nervous system and peripheral nervous system - illustration
The central nervous system comprises the brain and spinal cord. The peripheral nervous system includes nerves outside the brain and spinal cord.
Central nervous system and peripheral nervous system
illustration
-
Myelin and nerve structure - illustration
Myelin is the layer that forms around nerve cells. Its purpose is to speed the transmission of impulses along nerve cells.
Myelin and nerve structure
illustration
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Nerve supply to the pelvis - illustration
The nerves that branch off the central nervous system (CNS) provide messages to the muscles and organs for normal function. When there is CNS damage, the function of these organs and tissues may be compromised. In multiple sclerosis, the demyelinization of nerve cells may lead to bowel incontinence, bladder problems and/or sexual dysfunction.
Nerve supply to the pelvis
illustration
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Multiple sclerosis
(Alt. Medicine)
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Multiple sclerosis - InDepth
(In-Depth)
Review Date: 3/31/2024
Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.