Health Library

Multiple Sclerosis—Adult

(MS—Adult)

by Rick Alan

En Español (Spanish Version)
More InDepth Information on This Condition

Definition

Multiple sclerosis (MS) is a disease of the central nervous system. It is a chronic condition that can be disabling.

There are several types of MS:

Relapsing-remitting MS—Symptoms suddenly reappear periodically. They last for a few weeks or months, then go back into remission (a period with no symptoms). Symptoms may get worse 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.

Nerve Fiber (Neuron)

Causes

The immune system normally attacks viruses or bacteria that should not be in the body. With MS, a problem with the immune system causes it to attack healthy nerves. In particular, MS attacks the nerve fibers in the brain, spinal cord, and the nerves of the eye. The exact cause of these immune problems is unknown.

The following may contribute to the development of MS:

Viral or other infection
Genetic factors (heredity)
Environmental factors
Breaking down of parts of the nervous system

Risk Factors

Factors that increase your chance of MS include:

Sex: female
Age: 15-50 years old
Being exposed to certain viruses
Having family members who have MS or other autoimmune disorders
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

Other factors that may play a role include:

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

Incoordination or falling

Trouble walking or maintaining balance

Weakness in one or more limbs

Bladder problems including:
- Incontinence
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

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 cerebrospinal 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 (such as, 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:

Medicines may include:

Interferon beta (such as Betaseron, Avonex, Rebif)—(a protein that naturally occurs in the body)—used to suppress the immune system
Glatiramer acetate (Copaxone)—to help prevent MS relapses by modifying the function of the immune system
Other immunosuppressive drugs, such as:
- IV immunoglobulin (IVIG)
- Cyclophosphamide (Cytoxan)
- Mitoxantrone (Novantrone)
- Azathioprine (Imuran, Azasan)
- Methotrexate (Rheumatrex, Trexall)
Natalizumab (Tysabri)—for relapsing-remitting MS (This medicine is under a mandatory registration program.)
Muscle relaxants—to treat muscle spasms or stiffness
Fingolimod (Gilenya)—a new oral medicine to reduce relapses and slow the progression of MS

Other medications may also be given to treat symptoms:

Corticosteroids—to reduce nerve tissue inflammation and shorten MS flare-ups

Dalfampridine (Ampyra)—a medicine to improve walking in patients with MS

Botox injections may be used to treat spasticity in the arms and legs
Other drugs to treat:
- Fatigue
- Depression
- Pain
- Bladder or bowel problems

Therapies and changes may include:

Regular moderate exercise with your doctor's permission—Swimming may be especially beneficial.

Physical therapy to help maintain muscle strength and tone, dexterity, and walking ability

Massage
High-fiber diet to prevent constipation
Stress reduction techniques
Quitting smoking—Smoking may worsen MS, causing the condition to progress to a more severe form.

Individual or group therapy will help you learn coping strategies for physical symptoms and emotional stress.

If you are diagnosed with MS, follow your doctor's instructions.

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

Multiple Sclerosis Association of America

http://www.mymsaa.org

National Multiple Sclerosis Society

http://www.nationalmssociety.org

Health Canada

http://www.hc-sc.gc.ca

Multiple Sclerosis Society of Canada

http://mssociety.ca

About MS. National Multiple Sclerosis Society website. Available at: http://nationalmssociety.org/about-multiple-sclerosis/index.aspx. Accessed August 31, 2012.

Ascherio A, et al. Vitamin D and multiple sclerosis. Lancet Neurol. 2010;9(6):599-612.

Berkow R. The Merck Manual of Medical Information. New York, NY. Simon and Schuster, Inc; 2000.

Bradley WG, Daroff RB, et al. Neurology in Clinical Practice e-dition. 4th ed. Butterworth Heinemann; 2003. Neurology in Clinical Practice website. Available at: http://www.nicp.com/content/default.cfm. Accessed October 25, 2007.

FDA approves Ampyra to improve walking in adults with multiple sclerosis. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm198463.htm. Published January 22, 2010. Accessed August 30, 2012.

International Multiple Sclerosis Genetics Consortium. Risk alleles for multiple sclerosis identified by a genomewide study. NEJM. 2007;357(9):851-862.

Kasper DL, Braunwald E, et al. Harrison’s Principles of Internal Medicine. 16th ed. The McGraw-Hill Companies; 2006.

Multiple sclerosis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 10, 2012. Accessed August 31, 2012.

Multiple Sclerosis Society. News item. Multiple Sclerosis Society website. Available at: http://www.nationalmssociety.org/news/news-detail/index.aspx?nid=2568. Accessed August 31, 2012.

Multiple Sclerosis. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htm. Accessed August 31, 2012.

Rose JW, Carlson NG. Pathogenesis of multiple sclerosis. Continuum Lifelong Learning Neurol. 2007;13:35-62.

Van der Mae IA, et al. Individual and joint action of environmental risk factors and MS. Neurol Clin. 2011;29:233-55.

1/4/2011 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Healy B, Ali E, Guttmann C, et al. Smoking and disease progression in multiple sclerosis. Arch Neurol. 2009;66(7):858-864.

1/4/2011 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: FDA approves Botox to treat spasticity in flexor muscles of the elbow, wrist and fingers. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm203776.htm. Updated March 9, 2010. Accessed March 19, 2010.

1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: US Food and Drug Administration. FDA approves first oral drug to reduce MS relapses. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm226755.htm. Published September 22, 2010. Accessed September 24, 2010.

1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Kang JH, Sheu JJ, Kao S, Lin HC. Increased risk of multiple sclerosis following herpes zoster: a nationwide, population-based study. J Infect Dis. 2011;204(2):188-92.

Last reviewed September 2012 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.