Overview
Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system).
In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause permanent damage or deterioration of the nerves.
Signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently or at all, while others may experience long periods of remission without any new symptoms.
There's no cure for multiple sclerosis. However, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms.
Symptoms
Multiple sclerosis signs and symptoms may differ greatly from person to person and over the course of the disease depending on the location of affected nerve fibers. Symptoms often affect movement, such as:
- Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or the legs and trunk
- Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign)
- Tremor, lack of coordination or unsteady gait
Vision problems are also common, including:
- Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
- Prolonged double vision
- Blurry vision
Multiple sclerosis symptoms may also include:
- Slurred speech
- Fatigue
- Dizziness
- Tingling or pain in parts of your body
- Problems with sexual, bowel and bladder function
When to see a doctor
See a doctor if you experience any of the above symptoms for unknown reasons.
Disease course
Most people with MS have a relapsing-remitting disease course. They experience periods of new symptoms or relapses that develop over days or weeks and usually improve partially or completely. These relapses are followed by quiet periods of disease remission that can last months or even years.
Small increases in body temperature can temporarily worsen signs and symptoms of MS, but these aren't considered disease relapses.
About 60 to 70 percent of people with relapsing-remitting MS eventually develop a steady progression of symptoms, with or without periods of remission, known as secondary-progressive MS.
The worsening of symptoms usually includes problems with mobility and gait. The rate of disease progression varies greatly among people with secondary-progressive MS.
Some people with MS experience a gradual onset and steady progression of signs and symptoms without any relapses. This is known as primary-progressive MS.
Causes
The cause of multiple sclerosis is unknown. It's considered an autoimmune disease in which the body's immune system attacks its own tissues. In the case of MS, this immune system malfunction destroys the fatty substance that coats and protects nerve fibers in the brain and spinal cord (myelin).
Myelin can be compared to the insulation coating on electrical wires. When the protective myelin is damaged and nerve fiber is exposed, the messages that travel along that nerve may be slowed or blocked. The nerve may also become damaged itself.
It isn't clear why MS develops in some people and not others. A combination of genetics and environmental factors appears to be responsible.
Risk Factors
These factors may increase your risk of developing multiple sclerosis:
- Age. MS can occur at any age, but usually affects people somewhere between the ages of 16 and 55.
- Sex. Women are more than two to three times as likely as men are to have relapsing-remitting MS.
- Family history. If one of your parents or siblings has had MS, you are at higher risk of developing the disease.
- Certain infections. A variety of viruses have been linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis.
- Race. White people, particularly those of Northern European descent, are at highest risk of developing MS. People of Asian, African or Native American descent have the lowest risk.
- Climate. MS is far more common in countries with temperate climates, including Canada, the northern United States, New Zealand, southeastern Australia and Europe.
- Vitamin D. Having low levels of vitamin D and low exposure to sunlight is associated with a greater risk of MS.
- Certain autoimmune diseases. You have a slightly higher risk of developing MS if you have thyroid disease, type 1 diabetes or inflammatory bowel disease.
- Smoking. Smokers who experience an initial event of symptoms that may signal MS are more likely than nonsmokers to develop a second event that confirms relapsing-remitting MS.
Complications
People with multiple sclerosis may also develop:
- Muscle stiffness or spasms
- Paralysis, typically in the legs
- Problems with bladder, bowel or sexual function
- Mental changes, such as forgetfulness or mood swings
- Depression
- Epilepsy
Treatments for MS signs and symptoms
Physical therapy. A physical or occupational therapist can teach you stretching and strengthening exercises and show you how to use devices to make it easier to perform daily tasks.
Physical therapy along with the use of a mobility aid when necessary can also help manage leg weakness and other gait problems often associated with MS.
- Muscle relaxants. You may experience painful or uncontrollable muscle stiffness or spasms, particularly in your legs. Muscle relaxants such as baclofen (Lioresal) and tizanidine (Zanaflex) may help.
- Medications to reduce fatigue. Amantadine (Gocovri, Oxmolex), modafinil (Provigil) and methylphenidate (Ritalin) may be helpful in reducing MS-related fatigue. Some drugs used to treat depression, including selective serotonin reuptake inhibitors, may be recommended.
- Medication to increase walking speed. Dalfampridine (Ampyra) may help to slightly increase walking speed in some people. People with a history of seizures or kidney dysfunction should not take this medication.
- Other medications. Medications also may be prescribed for depression, pain, sexual dysfunction, insomnia, and bladder or bowel control problems that are associated with MSClinical trials
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
Lifestyle and home remedies
To help relieve the signs and symptoms of MS, try to:
- Get plenty of rest. Look at your sleep habits to make sure you're getting the best possible sleep. To make sure you're getting enough sleep, you may need to be evaluated — and possibly treated — for sleep disorders such as obstructive sleep apnea.
- Exercise. If you have mild to moderate MS, regular exercise can help improve your strength, muscle tone, balance and coordination. Swimming or other water exercises are good options if you're bothered by heat. Other types of mild to moderate exercise recommended for people with MS include walking, stretching, low-impact aerobics, stationary bicycling, yoga and tai chi.
- Cool down. MS symptoms often worsen when the body temperature rises in some people with MS. Avoiding exposure to heat and using devices such as cooling scarves or vests can be helpful.
- Eat a balanced diet. Since there's little evidence to support a particular diet, experts recommend a generally healthy diet. Some research suggests that vitamin D may have potential benefit for people with MS.
- Relieve stress. Stress may trigger or worsen your signs and symptoms. Yoga, tai chi, massage, meditation or deep breathing may help.
Many people with MS use a variety of alternative or complementary treatments or both to help manage their symptoms, such as fatigue and muscle pain.
Activities such as exercise, meditation, yoga, massage, eating a healthier diet, acupuncture and relaxation techniques may help boost overall mental and physical well-being, but there are few studies to back up their use in managing symptoms of MS.
Guidelines from the American Academy of Neurology recommend the use of oral cannabis extract for muscle spasticity and pain, but do not recommend cannabis in any other form for other MS symptoms due to a lack of evidence.
The guidelines also do not recommend the use of herbal supplements such as Ginkgo biloba and bee venom or magnetic therapy for MS symptoms.
Coping and support
Living with any chronic illness can be difficult. To manage the stress of living with MS, consider these suggestions:
- Maintain normal daily activities as best you can.
- Stay connected to friends and family.
- Continue to pursue hobbies that you enjoy and are able to do.
- Contact a support group, for yourself or for family members.
- Discuss your feelings and concerns about living with MS with your doctor or a counselor.
Preparing for your appointment
You may be referred to a doctor who specializes in disorders of the brain and nervous system (neurologist).
What you can do
- Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
- Make a list of all your medications, vitamins and supplements.
- Bring any clinical notes, scans, laboratory test results or other information from your primary care provider to your neurologist.
- Write down your key medical information, including other conditions.
- Write down key personal information, including any recent changes or stressors in your life.
- Write down questions to ask your doctor.
- Ask a relative or friend to accompany you, to help you remember what the doctor says.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. You may be asked:
- When did you begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Does anyone in your family have multiple sclerosis?
Questions to ask your doctor
- What's the most likely cause of my symptoms?
- What kinds of tests do I need? Do they require any special preparation?
- Is my condition likely temporary or chronic?
- Will my condition progress?
- What treatments are available?
- I have these other health conditions. How can I best manage them together?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.
