While there is no cure for MS, medications can help ease symptoms and slow progression of the disease. Symptoms of multiple sclerosis are numbness or abnormal sensations, difficulty with thinking and vision, and weakness in the legs or arms.
Most people with MS have a relapsing-remitting course of the disease. New symptoms occur in episodes called attacks, followed by periods of disease remission that may last weeks, months or years.
Symptoms
A person with MS may have many different symptoms, which vary from one person to another. These can include vision problems, such as double vision or trouble working with your hands; balance and coordination issues; numbness or tingling; bladder problems; and fatigue and depression. People who have the most common type of MS, relapsing-remitting multiple sclerosis, have attacks followed by periods without symptoms.
When someone has MS, their immune system mistakenly targets the protective sheath that surrounds and protects nerve fibers within the brain and spinal cord. This attack can cause them to stop working properly. Over time, this causes damage to the nervous system called a lesion. The lesions affect the way the brain sends electrical impulses to the rest of the body, resulting in the symptoms you experience.
Some of the most common symptoms in early MS are problems with thinking and memory. Your memory may be slow, and it can be hard to learn new things or find the right words for what you want to say. You might also have a tremor, which can make your hand shake or your whole body move in ways you can’t control.
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Other symptoms of MS are bladder and bowel problems, such as incontinence or problems emptying your bladder. Fatigue is a very common symptom and can be caused by direct nerve damage or by the strain of trying to manage your other symptoms. MS can cause muscle spasms, including in the legs, arms, abdomen, and chest. Some of these can be very painful.
Your doctor can diagnose MS by asking you about your past health problems and examining you. They will also order tests to check for key signs of damage to the brain and spinal cord, such as a magnetic resonance imaging (MRI) scan or a cerebral ultrasound. You may also have a spinal tap, which involves having a small tube inserted into your spine to test the fluid inside. The test looks for abnormal proteins called oligoclonal bands that can be a sign of MS. Blood tests may also be done to rule out other diseases that have similar symptoms.
Diagnosis
No one knows what causes multiple sclerosis, but it is believed to be an autoimmune disease. In this condition, your immune system mistakenly attacks healthy tissue in your body, causing inflammation and damaging the protective covering of nerve fibers in the brain and spinal cord (myelin). It’s like the insulation on an electrical wire—once it’s damaged, messages that travel along those nerve fibers are delayed or blocked. Symptoms of MS vary, and they can come and go. They also depend on which part of the central nervous system is affected.
The most common form of MS is relapsing-remitting MS, or RRMS. About 85% of people with the disease have this type. It’s the least severe form, and symptoms usually begin in young adults. It’s hard to predict how your symptoms will progress, but they tend to worsen over time during relapses and improve during remissions.
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A doctor will consider your symptoms and history of MS before diagnosing you. Then they’ll do a neurological exam, and order an MRI scan of your brain and spinal cord. The MRI can help identify damage to the brain and spinal cord, and it can find plaques or scarring that may be related to MS. Other tests, such as evoked potentials, can measure how fast information travels through your nerve pathways.
It’s important to tell your doctor about all of your symptoms, even those that seem unrelated to the reason you scheduled the appointment. Your doctor will need this information to make the best decision about your treatment plan. You can help by making a list of your key symptoms, including the times they occur and how long they last. Bring your medical records and any other relevant test results, including a list of all medications you take. You should also bring any clinical notes or scans you have from your primary care provider. If you are being referred to a specialist, such as a neurologist, be sure to bring that appointment information as well.
Treatment
There is no cure for multiple sclerosis, but there are a number of treatments to help manage MS symptoms. Medications can reduce inflammation that causes relapses, slow the progression of disease and improve quality of life. These medications are called disease modifying therapies (DMTs). The National Institute of Health’s website NIH RePORTER is an excellent source of information about ongoing research in various areas including the role of genes, environment and lifestyle in MS.
Medications used to treat MS can include glucocorticoids, which mimic the hormone cortisol and reduce inflammation during a flare-up. These drugs can be taken orally or injected under the skin, such as methylprednisolone. They are prescribed short-term to help with severe symptom attacks (called relapses), and they may speed recovery, but do not modify the long-term course of the disease.
Glatiramer acetate is an FDA-approved injection that decreases the relapse rate and may help prevent future damage to nerve fibers (axons). It works by binding to ligands for major histocompatibility complex molecules, reducing activation of immune cells and promoting regulatory cell induction. It also has neuroprotective properties and may help slow down the damage caused by inflammation.
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There are several other relapse management medications approved by the FDA. They include alendronate, azathioprine, and leflunomide, all of which are given by mouth or through a vein (intravenously). Interferons, such as relapidated interferon beta and glatiramer acetate, may reduce relapse rates and slow progression by altering the way the body processes proteins in the brain and spinal cord. They are given by mouth, and their doses vary.
Fatigue is a common symptom in many people with MS, and there are several medications that can help reduce it, such as cladribine, dimethyl fumarate, monomethyl fumarate, fingolimod, siponimod, ponesimod, and ozanimod. Behavioral treatment programs, stress management training, and joining an MS support group can also help.
There are other medications that are used to manage specific symptoms, such as tremors (drugs like primidone and carbidopa), muscle spasms (gabapentin or nortriptyline) and cognitive issues (medications like donepezil). Some patients find that they can benefit from using assistive devices for mobility, and some may be helped by physical or occupational therapy.
Prevention
While MS is a complex disease and cannot be prevented, there are steps that can help reduce the risk of developing it. People who are at higher risk for the disease include women, people between 20 and 40 years of age, those with a family history of MS, and those who have had certain infections. The Epstein-Barr virus, the same virus that causes infectious mononucleosis, has been linked to MS. Climate is also a factor; people in temperate regions are more likely to develop MS than those in warmer areas.
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Genetics is another major factor; it is more common for children to develop the disease if one or both of their parents have it. Race is also a factor; those of Northern European descent have the highest risk, while African, Asian and Native American people are at lower risks. Sex is another factor; it is more common for women to develop the disease than men. The presence of a certain autoimmune condition can also increase the chances of developing MS. These include thyroid disease, type 1 diabetes and inflammatory bowel diseases. Other conditions that may affect your chance of developing MS include past viral infections such as HHV-6 and EBV, which contain proteins that mimic myelin basic protein, causing the immune system to mistakenly attack myelin sheaths as foreign objects.
Lifestyle changes that can help decrease your risk of developing MS include eating a healthy diet, staying active and not smoking. It is recommended that you get enough vitamin D through sun exposure and through your diet, and avoid stress, which can trigger a flare-up. Talking to a mental health professional can help you learn how to manage stress and cope with it in healthier ways. Avoid high-heat environments, like saunas and hot yoga classes, as they can trigger a flare-up for some people with MS.
It is also important to take breaks when you’re feeling fatigued; pushing yourself too hard can cause symptoms to flare up. Make sure to drink enough water, and sleep when you’re tired; getting too little rest can also cause problems.
