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Multiple sclerosis MS; Demyelinating disease Last reviewed: September 26, 2011.

Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord (central nervous system).

Causes, incidence, and risk factors Multiple sclerosis (MS) affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40, but can be seen at any age.

MS is caused by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow down or stop.

The nerve damage is caused by inflammation. Inflammation occurs when the body's own 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 this to happen. The most common thought is that a virus or gene defect, or both, are to blame. Environmental factors may play a role.

You are slightly more likely to get this condition if you have a family history of MS or live in an part of the world where MS is more common.

Symptoms Symptoms vary, because the location and severity of each attack can be different. Episodes can last for days, weeks, or months. These episodes alternate with periods of reduced or no symptoms (remissions).

Fever, hot baths, sun exposure, and stress can trigger or worsen attacks.

It is common for the disease to return (relapse). However, the disease may continue to get worse without periods of remission.

Because nerves in any part of the brain or spinal cord may be damaged, patients with multiple sclerosis can have symptoms in many parts of the body.

Muscle symptoms:

Loss of balance

Muscle spasms

Numbness or abnormal sensation in any area

Problems moving arms or legs

Problems walking

Problems with coordination and making small movements

Tremor in one or more arms or legs

Weakness in one or more arms or legs

Bowel and bladder symptoms:

Constipation and stool leakage

Difficulty beginning to urinate

Frequent need to urinate

Strong urge to urinate

Urine leakage (incontinence)

Eye symptoms:

Double vision

Eye discomfort

Uncontrollable rapid eye movements

Vision loss (usually affects one eye at a time)

Numbness, tingling, or pain

Facial pain

Painful muscle spasms

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

Depression or feelings of sadness

Dizziness and balance problems

Hearing loss

Sexual symptoms:

Problems with erections

Problems with vaginal lubrication

Speech and swallowing symptoms:

Slurred or difficult-to-understand speech

Trouble chewing and swallowing

Fatigue is a common and bothersome symptoms as MS progresses. It is often worse in the late afternoon.

Signs and tests Symptoms of MS may mimic those of many other nervous system disorders. The disease is diagnosed by ruling out other conditions.

People who have a form of MS called relapsing-remitting may have a history of at least two attacks, separated by a period of reduced or no symptoms.

The 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.

A neurological exam may show reduced nerve function in one area of the body, or 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

An eye examination may show:

Abnormal pupil responses

Changes in the visual fields or eye movements

Decreased visual acuity

Problems with the inside parts of the eye

Rapid eye movements triggered when the eye moves

Tests to diagnose multiple sclerosis include:

Lumbar puncture (spinal tap) for cerebrospinal fluid tests, including CSF oligoclonal banding

MRI scan of the brain and MRI scan of the spine are important to help diagnose and follow MS

Nerve function study (evoked potential test)

Treatment There is no known cure for multiple sclerosis at this time. However, there are therapies that may slow the disease. The goal of treatment is to control symptoms and help you maintain a normal quality of life.

Medications used to slow the progression of multiple sclerosis are taken on a long-term basis, they include:

Interferons (Avonex, Betaseron, or Rebif), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), and natalizumab (Tysabri)

Fingolimod (Gilenya )

Methotrexate, azathioprine (Imuran), intravenous immunoglobulin (IVIg) and cyclophosphamide (Cytoxan) may also be used if the above drugs are not working well

Steroids may be used to decrease the severity of attacks.

Medications to control symptoms may include:

Medicines to reduce muscle spasms such as Lioresal (Baclofen), tizanidine (Zanaflex), or a benzodiazepine

Cholinergic medications to reduce urinary problems

Antidepressants for mood or behavior symptoms

Amantadine for fatigue

For more information see:

Neurogenic bladder

Bowel retraining

The following may also be helpful for people with MS:

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

Making changes around the home to prevent falls

Social workers or other counseling services to help you cope with the disorder and get assistance (such as Meals-on-Wheels)

For more information about living with MS, see: Multiple sclerosis - at home

Household changes to ensure safety and ease in moving around the home are often needed.

Support Groups For additional information, see multiple sclerosis resources.

Expectations (prognosis) The outcome varies, and is hard to predict. Although the disorder is chronic and incurable, life expectancy can be normal or almost normal. Most people with MS continue to walk and function at work with minimal disability for 20 or more years.

The following typically have the best outlook:

Females

People who were young (less than 30 years) 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 you have attacks

How severe they 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. Slowly, there is greater loss of function with less improvement between attacks. Over time, many require a wheelchair to get around and have a more difficult time transferring out of the wheelchair.

Those with a support system are often able to remain in their home.

Complications Depression

Difficulty swallowing

Difficulty thinking

Less and less ability to care for self

Need for indwelling catheter

Osteoporosis or thinning of the bones

Pressure sores

Side effects of medications used to treat the disorder

Urinary tract infections

Calling your health care provider Call your health care provider if:

You develop any symptoms of MS

Symptoms get worse, even with treatment

The condition deteriorates to the point where home care is no longer possible

References 1.Calabresi P. Multiple sclerosis and demyelinating conditions of the central nervous system. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 436. 2.Carroll WM. Oral therapy for multiple sclerosis--sea change or incremental step? N Engl J Med. 2010 Feb 4;362(5):456-8. Epub 2010 Jan 20. [PubMed: 15635109] 3.Goodin DS, Cohen BA, O'Connor P, et al. Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment: the use of natalizumab (Tysabri) for the treatment of multiple sclerosis (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2008:71(10):766-73. [PubMed: 18765653] 4.Farinotti M, Simi S, Di Pietrantonj C, McDowell N, Brait L, Lupo D, Filippini G. Dietary interventions for multiple sclerosis. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004192. [PubMed: 17253500]

5.Kappos L, Freedman MS, Polman CH, et al. Effect of early versus delayed interferon beta-1b treatment on disability after a first clinical event suggestive of multiple sclerosis: a 3-year follow-up analysis of the BENEFIT study. Lancet. 2007:370(9585):389-97. [PubMed: 17679016] 6.Miller DH, Leary SM. Primary-progressive multiple sclerosis. Lancet Neurol. 2007;6:903-912. [PubMed: 17884680] 7.Marriott JJ, Miyasaki JM, Gronseth G, O'Connor PW; Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Evidence Report: The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010 May 4;74(18):1463-70. [PubMed: 18765653] Review Date: 9/26/2011. ------------------------------------------

Central nervous system and peripheral nervous system

The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves. Review Date: 11/14/2011. Reviewed by: Chad Haldeman-Englert, MD, Wake Forest School of Medicine, Department of Pediatrics, Section on Medical Genetics, Winston-Salem, NC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.