What is Multiple Sclerosis?

Introduction

Multiple sclerosis (MS) is a disease of the central nervous system (CNS), which consists of the brain, optic nerves, and spinal cord.
MS is an unpredictable disorder that can cause a variety of symptoms. For many, the symptoms of MS can flare up and then subside over the course of days, months, or even years.
With the process of MS, areas of the CNS become inflamed, damaging the protective covering (known as “myelin”) that surrounds and insulates the nerves (known as “axons”). This damage disrupts the smooth flow of nerve impulses. As a result, messages from the brain and spinal cord going to other parts of the body may be delayed and have trouble reaching their destination – causing the symptoms of MS.
MS is not contagious, and its causes are not yet fully understood. Researchers continue to search for answers on how MS is developed.
A number of long-term treatments, known as “disease-modifying therapies,” are available for the majority of individuals with MS. Although these treatments do not cure MS, they do work to slow disease activity and delay progression.
Additional treatment options are also available to reduce the severity of a relapse as well as to address the various symptoms of MS.

Symptoms of MS

While MS has the potential to cause several different symptoms, the specific symptoms each person experiences vary greatly.
Symptoms range from physical (bladder dysfunction and spasticity, for example), emotional and psychological (including cognitive changes, anxiety, and depression), plus “invisible” symptoms (such as fatigue and numbness).
Medications, different types of therapies, and other strategies are available to treat nearly all MS symptoms.
MS symptoms are often compounded by extreme fatigue, which may be worse in the afternoon and is sometimes related to a rise in body temperature.
When a family member is diagnosed with MS, loved ones may be affected in different ways, both emotionally and psychologically. Participating in some type of counseling program is often of benefit to everyone involved.

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Who Gets MS?

Nearly one million individuals are living with multiple sclerosis in the United States.
Most people with MS experience their first symptoms and are diagnosed between the ages of 15 and 50, although individuals of any age may be diagnosed with MS.
Three times as many women are diagnosed with the relapsing-remitting form of MS than men, while equal numbers of women and men are diagnosed with the primary-progressive form of MS.
The area where someone lives, as well as race and ethnic background, also helps to determine an individual’s risk of developing the disease.
While MS is not contagious or hereditary, genetic susceptibility does play a role, and one’s risk of MS is increased if a family member has MS.
Other factors linked to a higher risk of MS include insufficient exposure to sunlight contributing to a Vitamin D deficiency, cigarette smoking, and even cleaner environments lacking certain parasites.

Types of MS

Initially, most people with multiple sclerosis experience symptom flare-ups, which are also known as relapses, exacerbations, or attacks.
This type of MS is referred to as relapsing-remitting MS (RRMS), and approximately 85% of those diagnosed with MS start out with this form.
When experiencing a relapse, individuals may have new symptoms or an increase in existing symptoms. These usually persist for a short period of time followed by a remission.
Over time, RRMS may advance to secondary-progressive MS (SPMS). This form of MS does not have the dramatic variations in symptoms that RRMS does, but rather has a slow, steady progression, although some flare-ups may still occur.
Approximately 10 percent of the MS population is diagnosed with primary-progressive MS (PPMS), where individuals experience a steady worsening of symptoms from the start and do not have periodic relapses and remissions.
Other types of MS exist, but these are less common, and different terminology may be used.
Prior to an MS diagnosis, individuals with “possible MS” may often fall under the parameters of one of two syndromes: clinically isolated syndrome (CIS) and radiologically isolated syndrome (RIS). In such cases, an individual may show evidence of MS – either clinically or on magnetic resonance imaging (MRI), respectively – but a diagnosis cannot be confirmed at that time.

Possible Causes

Researchers have studied a variety of possible causes for multiple sclerosis, and a combination of factors appears to be involved.
Epstein-Barr virus (EBV) is a common virus that can remain dormant for many years and possibly develop into MS in genetically susceptible people. Recent studies often show an increased risk of MS for individuals who have been exposed to EBV.
Genes have some role in susceptibility to MS, but the exact mechanisms remain unclear.
A connection between MS and nutritional factors, including fat intake, as well as deficiencies in fish oil and Vitamin D, may play an important role.
Vitamin D is also derived from sunlight, and insufficient exposure to sunlight may be involved in the development of MS.
Lack of parasites in cleaner environments is another possible risk factor in the development of MS, as well as smoking cigarettes.

Diagnosis and Tests

Diagnosing multiple sclerosis and evaluating disease activity is most reliably done by neurologists through a neurological history and examination.
Lesions (areas of inflammation and myelin damage in the brain and/or spine) may be viewed on a magnetic resonance imaging (MRI) scan. This scan can confirm a diagnosis as well as evaluate ongoing disease activity.
A lumbar puncture, commonly known as a spinal tap, is sometimes used to help confirm a diagnosis. This procedure collects a small amount of cerebrospinal fluid (CSF), which is then evaluated for cellular and chemical abnormalities.
Evoked potential (EP) tests may also be used to help diagnose MS, if further support is needed. These measure the speed of the brain’s response to visual, auditory (sound), or sensory (feeling) stimuli, using electrodes taped to the patient’s head. Delayed responses can indicate possible damage to the nerve pathways.

Treatments for MS

Many effective medications and therapies are available for the treatment of multiple sclerosis in three different categories
- Slow MS activity and progression
- Reduce the severity and duration of a relapse
- Treat the symptoms of MS individually
Long-term treatments to slow MS activity and progression are also referred to as disease-modifying therapies (DMTs).
Presently, more than 25 brand-name and generic medications have been approved by the United States Food and Drug Administration (FDA) for relapsing forms of MS as well as for certain types of progressive MS.
Depending on the type of DMT selected, these are taken orally, via self-injection, or via intravenous (IV) infusion.

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Treating relapses helps to control the sudden flare up of symptoms, also referred to as exacerbations or attacks.
Symptom management is another important area in the overall treatment of MS. In addition to medications prescribed for a specific symptom, other treatment therapies – such as rehabilitation, counseling, and exercise, for example – may be recommended by one’s healthcare team to increase the effectiveness of managing certain symptoms.

Newly Diagnosed Information

For many, being newly diagnosed with MS finally gives a name to having some unexplained symptoms.
Symptoms such as visual problems, numbness, or weakness, are commonly experienced as the first sign of MS. Not knowing what is wrong and what might happen next is both worrisome and frightening.
People may actually feel a sense of relief in knowing the reason behind the different symptoms. From here, learning more about MS and its treatments will be of great help toward developing a positive plan for the future.
MSAA provides a wealth of information and support to assist individuals who are newly diagnosed as well as their family members, care partners, and friends.
Resources include MSAA’s website, educational programs, safety and mobility equipment, cooling vests, and MRI assistance, as well as publications, informational videos, webinars, podcasts, our online peer-to-peer community, mobile app, and more.
In addition, MSAA’s toll-free Helpline provides critically needed support, consultation, and encouragement to individuals who are newly diagnosed.
Our Helpline allows individuals with MS, family members, care partners, and friends to speak directly with one of MSAA’s experienced Client Services Specialists, all of whom have a social services or counseling background.

MSAA’s Helpline may be reached several ways:

Call (800) 532-7667, extension 154 for assistance in English and extension 131 for assistance in Spanish.
Helpline hours are Monday through Friday, 8:30 am to 8:00 pm, EST.
Email MSquestions@mymsaa.org
Chat live via your computer or mobile device through the online MS Chat feature.