Multiple Sclerosis

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Multiple sclerosis (MS) is the most common disabling neurological disease of young adults. While it most often appears between the ages of 20 and 40, it can also affect children and older people. MS is more common in colder climates and affects twice as many women as men. While MS may cause severe disability, most people with MS have a normal life expectancy.

Experts think there are currently 250,000 to 350,000 people diagnosed with MS in the US, and the rate of the disease has increased steadily over the past 50 years. MS is caused by damage to myelin, nerve fibers and neurons in the brain and spinal cord (central nervous system), but researchers do not know how and why this damage occurs.

Signs & Symptoms

Recognizing the initial symptoms of MS may be difficult because they range from mild to severe and may go away quickly or last for months. The first symptoms of MS often include:

  • blurred or double vision or pain in the eye
  • weak, stiff muscles, often with painful muscle spasms
  • tingling or numbness in the arms, legs, torso or face
  • clumsiness and balance problems when walking
  • bladder control problems
  • dizziness that doesn't go away

Later symptoms may include:

  • mental or physical fatigue
  • mood changes, such as depression or euphoria
  • changes in the ability to concentrate or to multi-task effectively
  • difficulty making decisions, planning, or prioritizing
  • muscle weakness in the hands and legs
  • muscle stiffness and spasms severe enough to affect walking or standing
  • tingling and burning sensations
  • numbness and loss of sensation
  • cognitive dysfunction (thinking, learning, memory and judgment difficulties)

Diagnosis

Magnetic Resonance Imaging (MRI)

Since MS is a neurological condition, it is usually diagnosed and treated by a neurologist. There are other disorders with symptoms that are similar to MS, so it is important for the neurologist to perform a thorough investigation before making a diagnosis. In addition to completing a medical history and conducting a physical exam and a detailed neurological examination, the doctor will order magnetic resonance imaging (MRI) of the head and spine. MRI is considered the best tool for diagnosing multiple sclerosis because it often detects lesions and abnormalities that would be missed by other imaging techniques.

Disease Progression

A key characteristic of MS is an exacerbation (also called a relapse, flare-up or attack), which is a sudden worsening of MS symptoms, or the appearance of new symptoms that lasts for at least 24 hours. An attack may be mild or severe enough to significantly interfere with life's daily activities. Most exacerbations last from several days to several weeks; when the symptoms of the attack subside, an individual with MS is said to be in remission.

Although it is difficult to predict how each person’s disease will progress, the course of MS generally follows one of two patterns:

  • Primary-progressive MS is characterized by a gradual physical decline with no noticeable remissions, although there may be temporary or minor relief from symptoms. This type of MS usually appears after age 40, and is just as common in men as in women.
  • Secondary-progressive MS begins with a relapsing-remitting course, followed by a later primary-progressive course. The majority of individuals with severe relapsing-remitting MS will develop secondary progressive MS if they are untreated.

Treatment

There is no cure for MS, but there are treatments for initial attacks, medications and therapies to improve symptoms and recently developed drugs to slow the worsening of the disease. These new drugs have been shown to reduce the number and severity of relapses and to delay the long term progression of MS.

MRI imaging plays a very important role in establishing an MS diagnosis, deciding when the disease should be treated and determining whether treatments work effectively or not. It also has been a valuable tool to test whether an experimental new therapy is effective at reducing exacerbations.

Research

Although researchers haven't been able to identify the cause of MS, there has been excellent progress in other areas of MS research. Scientists are exploring common factors that seem to be associated with developing MS, including:

  • Genetic susceptibility: Susceptibility to MS may be inherited.
  • Sunlight and vitamin D:  Studies suggest that people who spend more time in the sun and those with relatively high levels of vitamin D are less likely to develop MS.
  • Smoking: Studies have found that people who smoke are more likely to develop MS.
  • Infectious factors & viruses: The virus most consistently linked to the development of MS is Epstein Barr virus.

New discoveries are constantly changing treatment options and creating new and better therapies for MS. Clinical trials are available through the National Institute of Neurological Disorders and Stroke and other agencies.

Source: National Institute of Neurological Disorders and Stroke

  • Last updated: 02/18/2014
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