Definition

Multiple sclerosis (MS) is a chronic, disabling disease of the central nervous system. It causes injury to the sheath that covers nerve fibers, called myelin, in the brain, spinal cord, and optic nerves.

Nerve Fiber (Neuron)

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There are several types of MS:

• Relapsing-remitting MS —Symptoms suddenly reappear every few years, last for a few weeks or months, then go back into remission. Symptoms sometimes worsen with each occurrence.
• Primary progressive MS —Symptoms gradually worsen after symptoms first appear. Relapses and remissions usually do not occur.
• Secondary progressive MS —After years of relapses and remissions, symptoms suddenly begin to progressively worsen.
• Progressive relapsing MS —Symptoms gradually worsen after symptoms first appear. One or more relapses may also occur.

Causes

Malfunction of the body's immune system seems to be the cause of MS, but the exact cause of this malfunction is unknown.

The following conditions may contribute to MS:

• Viral or other infection
• Genetic factors (heredity)
• Environmental factors
• Degeneration of parts of the nervous system

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for MS include:

• Sex: female
• Age: 15-50 years old
• Being exposed to certain viruses
• Having family members who have MS
• 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 optic nerve
• Having low vitamin D levels (may be a risk factor)
• Smoking (may be a risk factor)

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
• Dizziness
• Muscle stiffness
• Muscle spasms
• Muscle weakness
• Incoordination or falling
• Trouble walking or maintaining balance
• Weakness in one or more limbs
• Bladder problems including:
  • Urgency
  • Hesitancy
  • Incomplete emptying
  • Incontinence
• Bowel problems, including constipation
• Sexual dysfunction
• Slurred speech
• Difficulty swallowing
• Forgetfulness, memory loss, and confusion
• Difficulty concentrating or solving problems
• Depression

Factors that may trigger or worsen symptoms include:

• Heat, including:
  • Hot weather
  • Hot baths or showers
  • Fever
• Overexertion
• Infection

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

• MRI scan —a test that uses magnetic waves to make pictures of structures inside the brain and spinal cord
• Sensory evoked potentials—a test that records the electrical responses evoked after a sensory stimulus
• Lumbar puncture (spinal tap)—removal of a small amount of fluid (CSF) from around the spinal cord to check for white blood cells, antibodies, and proteins
• Blood tests to rule out other diseases that may mimic MS (eg, B12 deficiency, Lyme disease, autoimmune disease)
• Visual evoked potential test —to look for problems in the brain that affect vision

Treatment

The goals of MS treatment are to relieve symptoms, prevent relapses, delay disability, and slow disease progression.

Treatments include:

Prevention

There are no guidelines for preventing MS because the cause is unknown.

To prevent flare-ups or worsening symptoms if you have MS:

• Take medications as prescribed.
• Avoid hot weather.
• Stay in air-conditioned places during periods of hot weather.
• Get adequate rest.
• Get regular, moderate exercise with your doctor's permission.
• Avoid hot showers or baths.
• Make sure to get enough fiber in your diet.
• To aid in stress reduction, consider getting regular massages.
• Try to avoid infection. You can do this by:
  • Practicing good hygiene
  • Staying away from people who are sick
  • Cooking food thoroughly
  • Practicing safe sex