Multiple sclerosis

Multiple sclerosis is a disabling illness that affects the brain and spinal cord. It usually gets worse over time.

Nerve cells are surrounded by a layer of insulation called myelin. Myelin helps transmit nerve impulses. In multiple sclerosis, the myelin sheath becomes inflamed or damaged. This disrupts or slows nerve impulses and leaves areas of scarring along nerves. Multiple sclerosis can also damage nerve cells themselves, not just their myelin lining.

There are different types of multiple sclerosis, and they follow different patterns.

Relapsing-remitting multiple sclerosis. This is the most common type of multiple sclerosis. Relapsing means that symptoms come and go. Episodes during which symptoms suddenly get worse are called relapses, attacks, or flare-ups. Relapses can last for days to weeks. They are followed by remissions, or periods of recovery. During remissions, many people with MS feel close to normal.

Secondary progressive multiple sclerosis. About half of people with relapsing-remitting multiple sclerosis eventually enter a secondary phase. Brain and spinal cord damage gradually but steadily gets worse. As a result, symptoms gradually but steadily get worse.

Primary progressive multiple sclerosis. Symptoms worsen gradually and continuously from the start, without periods of relapse or remission.

Progressive relapsing multiple sclerosis. Symptoms steadily get worse, and there are also flare-ups.

Symptoms of multiple sclerosis

The first symptom of multiple sclerosis is often blurred or double vision. 

Other common symptoms include:

• Not everyone with multiple sclerosis will experience all of these symptoms. Most people only have a few of them.weak, stiff, or rigid muscles
• painful muscle spasms
• trouble walking
• tingling or numbness in the arms, legs, trunk, or face
• difficulty maintaining balance
• trouble with thinking and memory
• trouble speaking
• dizziness
• mental or physical fatigue
• tremor
• depression
• inappropriate laughing or crying, unrelated to mood
• problems controlling bladder or bowel movements
• erectile dysfunction.

Diagnosing multiple sclerosis

No one test can diagnose multiple sclerosis. If your symptoms suggest multiple sclerosis, you will probably need several tests to confirm if you have it or to rule it out as the cause of your symptoms.

Magnetic resonance imaging (MRI) is an imaging test that uses powerful magnets and radio waves to create pictures of the body. The damage caused by multiple sclerosis creates scars called lesions in the brain and spinal cord. An MRI can spot such lesions. Though MRI provides important information, it may not be enough to confirm that you have multiple sclerosis.

Other tests you may need to have include:

• evoked potentials. This test measures how quickly and accurately your nervous system responds to certain types of stimulation.
• lumbar puncture (spinal tap). Spinal fluid may contain proteins and inflammatory cells associated with multiple sclerosis.

Sometimes it's important for you and your doctor to see how your symptoms or test results change over time before making a diagnosis of multiple sclerosis.

Treating multiple sclerosis

Self-care

You can do several things to keep yourself feeling as well as possible.

Manage stress. Stress can intensify symptoms. Learn relaxation techniques such as meditation, progressive muscle relaxation, deep breathing, tai chi, or yoga.

Stay cool. People with multiple sclerosis often become more sensitive to heat. The smallest change in body temperature can aggravate symptoms. Take extra steps to keep cool:

• Turn on an air conditioner in your home or car.
• Take a cool shower or bath.
• Mist yourself with a spray bottle of water when you feel hot.
• Drink plenty of fluids to stay hydrated.
• Dress in light layers that you can remove if you feel warm.
• Buy a cooling vest or cooling packs that you can use on your wrists, neck and head.

Exercise. Regular exercise can help fend off fatigue and depression. It can help improve your strength, balance, coordination, and overall health and well-being. Ask your doctor how often you should exercise, and at what intensity. Your doctor may recommend that you work with a physical therapist to design an individualized exercise program. Exercise in the morning or evening, when temperatures are cooler.

Rest. Multiple sclerosis makes people tired. Try to get enough sleep.

Eat a healthy diet. A healthy diet can help keep you feeling your best. It should include plenty of:

• vegetables and fruits
• whole grains
• low-fat dairy products
• poultry
• fish
• nuts.

Go easy on red and processed meats; white rice, white, bread, and other sources of highly processed grains; and sugary foods and beverages.

Achieve and maintain a healthy weight. You can do this with a combination of diet and exercise.

Build a support network. Stay connected to family and friends. Join a support group. Surround yourself with people who will help you maintain a positive attitude.

Medical treatment

Although there is no cure for multiple sclerosis, a number of different treatments can manage flare-ups, slow the worsening of the disease, and ease symptoms.

Treating flare-ups. Corticosteroid drugs are the primary treatment for relapses. They shorten the length of flare-ups, but they do not change the course of the disease. Methylprednisone (Solu-Medrol, Depo-Medrol), given through a vein, is usually the first choice for severe attacks.   Another treatment, called plasmapheresis, is also sometimes used to treat flare-ups. In this procedure, blood is removed from the body, harmful substances are filtered out of the liquid portion of blood, and the remaining blood is transfused back into the body.

Disease-modifying therapy. Disease-modifying medications help slow the speed at which multiple sclerosis gets worse. Most of the drugs work by affecting the immune system.

• interferons. These are a type of protein. They reduce the frequency of relapses and reduce the duration and severity of attacks when they do occur. Interferons also slow the worsening of symptoms. Examples include interferon beta-1b (Betaseron), interferon beta-1a (Avonex, Rebif), and peginterferon beta-1a (Plegridy).
• glatiramer (Copaxone). This drug blocks cells that damage myelin. It may also reduce the frequency of relapses.
• monoclonal antibodies. These drugs reduce the frequency of attacks. One example of monoclonal antibodies is alemtuzumab (Campath).
• Nrf2 activators. This group of drugs decreases inflammation and prevents nerve damage that may cause symptoms of multiple sclerosis. One Nrf2 activator is dimethyl fumarate (Tecfidera).
• immunomodulators. As the name implies, these drugs affect the immune system. They decrease the action of immune cells that may cause nerve damage. One immunomodulator used to treat multiple sclerosis is teriflunomide (Aubagio).

Although they can be quite effective, these drugs can also have serious side effects.

Treating symptoms. You also can take medications to treat specific symptoms of multiple sclerosis including:

• Fatigue. Feelings of overwhelming exhaustion are common in people with multiple sclerosis.
• Spasticity. Muscle tightness and spasms can be disabling for multiple sclerosis patients with spinal cord damage.
• Bladder dysfunction. Bladder problems are common in patients with spinal cord damage from multiple sclerosis.
• Depression. This is a common problem for multiple sclerosis patients.
• Neurological symptoms. Anti-seizure medications decrease the risk of repeat seizures. They may also reduce other uncomfortable neurological symptoms that occur during attacks.