Multiple Sclerosis: Frequently Asked Questions

The Multiple Sclerosis Foundation estimates between 300,000 and 400,000 people in the U.S. are living with multiple sclerosis, with 200 new cases diagnosed each week. If you have been diagnosed with MS, or if you’re concerned about your risk for developing this disease, you may have more questions than answers. With MS, being informed is key to noticing symptoms before they progress. Seeking treatment early can help you or a loved one get relief and manage daily life before the condition worsens.

What is multiple sclerosis?

MS is a chronic, neurological immune-mediated disease that affects your central nervous system, which is made up of your brain, spinal cord and optic nerves. Within your central nervous system, nerve fibers called axons are protected by myelin, a fatty layer of insulation. This myelin is responsible for allowing nerve signals to travel properly throughout your nervous system.

When you have multiple sclerosis, your immune system attacks this myelin, causing inflammation and eventual destruction of the myelin and damage to the axons. When myelin is destroyed, lesions can form on your exposed nerve tissues, causing hardened scar tissue (called sclerosis) to develop at the site of the lesions. When this sclerosis occurs in multiple locations throughout your nervous system, it is called multiple sclerosis.

The scarring on your nerve fibers disrupts normal transmission of signals sent by your brain to your spinal cord and other parts of your body. Without these signals, your body struggles to perform desired actions, leading to a wide variety of disabling symptoms that can make performing everyday tasks extremely difficult.

What causes multiple sclerosis?

There is no known direct cause of multiple sclerosis. Researchers believe the disease is caused by several combined factors including genetics, environment, immune system reactions and other viral agents.

Genetics

MS is not considered a hereditary disease, although having a parent or sibling with MS has been shown to slightly increase a person’s likelihood of developing the condition. Identical twins have a 30 percent chance of developing MS if one of the twins has already been diagnosed with the disease.

Environment

Studies have shown children born in geographic locations with higher incidences of MS are more likely to develop MS. Exposure to certain environmental factors in these locations prior to puberty may have a causal relationship with developing the disease.

Sunlight and vitamin D exposure may also have an impact on a person’s likelihood of developing MS. Vitamin D is important in supporting immune function. Those who live farther away from the equator and are exposed to less sunlight have been found to have higher incidences of MS.

Immune system

MS is an immune-mediated disease, meaning the immune system, which is designed to protect you from disease, mistakenly attacks certain structures and cells within the nervous system, leading to the destruction of myelin. Researchers have identified certain immune cells that trigger MS attacks, providing further proof that the immune system is somehow involved in causing multiple sclerosis.

Viral agents

Some MS studies suggest that viruses, such as the Epstein-Barr virus, the flu, herpes and measles may be linked with the disease. There is no solid evidence linking these viruses with MS, but a link may exist between catching these viruses at an early age and developing MS as an adult. 

Who is most at risk for multiple sclerosis?

Multiple sclerosis is a disease that does not discriminate. It can affect people from all age groups, genders and ethnic backgrounds, but some people do have higher risks of developing the disease.

The following factors have been linked to higher risks of MS.

·         Age: MS can be diagnosed at any age, but it most commonly affects people between the ages of 20 and 40.

·         Gender: MS is three times more common in women than it is in men.

·         Family history: Those who have a parent or sibling with MS have a slightly higher risk of being diagnosed. 

·         Race: Caucasians are diagnosed with MS more frequently than Hispanics or African Americans. The disease is even rarer among Asians and other ethnic groups.

·         Climate: MS is more common in climates that are situated farther away from the equator due to the lack of sunlight and natural vitamin D.

·         Smoking: Smokers who experience initial symptoms consistent with MS are more likely than nonsmokers to experience worsening symptoms and be diagnosed with MS.

·         Autoimmune diseases: Those with certain autoimmune diseases such as thyroid disease, type 1 diabetes and inflammatory bowel disease have a slightly higher risk of developing MS.

·         Infections: Certain viruses such as the flu, measles, herpes and the Epstein-Barr virus, which causes mononucleosis, have been linked to MS diagnoses. 

What are the common symptoms of multiple sclerosis?

Symptoms of MS vary greatly from person to person. Symptoms may also present differently based on the progression of the disease and the location of the affected nerves. The first warning signs may happen suddenly in full force or they may be so mild that you don’t even realize you’re experiencing them. If you experience any of the following signs and symptoms, it is best to seek help from a physician.

·         Partial (blurry) or complete loss of vision, most often in one eye at a time and accompanied by pain

·         Numbness or weakness in the arms and legs that affects one side of the body at a time

·         Issues with balance and coordination

·         Heat sensitivity

·         Prolonged double vision

·         Tingling or pain throughout the body

·         Slurred speech

·         Fatigue

·         Dizziness

·         Bowel and bladder function issues

·         Electric-shock sensations that occur with certain neck movements, such as bending the neck forward

·         Problems thinking or concentrating

·         Sudden paralysis, typically in the legs

Are there multiple types of MS?

Because the central nervous system is so complex, two people with MS may have two completely different sets of symptoms, different speeds of disease progression and differences in the timing and severity of symptom relapses. These differences have led doctors and researchers to break MS into four categories to better classify each patient’s condition.

Clinically isolated syndrome (CIS)— With CIS, patients experience a single neurological episode of inflammation or demyelination (the destruction of myelin) in the CNS lasting at least 24 hours. People with CIS have symptoms characteristic of MS, but do not yet meet the criteria for a full diagnosis of MS. People with CIS may or may not go on to develop MS.

Relapsing-remitting MS (RRMS) – RRMS is the most common disease course for MS. It is characterized by distinct attacks of new or increasingly worse neurological symptoms. These attacks (called relapses) are then followed by periods of partial or even complete recovery (called remissions), giving this classification the name “relapsing-remitting.” During remissions, all MS symptoms may disappear or some may persist and even become permanent. According to the National Multiple Sclerosis Society, 85 percent of people with MS are initially diagnosed with RRMS.

Primary progressive MS (PPMS) – In PPMS, patients experience worsening neurologic function and disability from the time they first experience symptoms. There are no relapses or remissions with PPMS. Approximately 15 percent of people with MS are diagnosed with PPMS.

Secondary progressive MS (SPMS) – Those diagnosed with RRMS will eventually transition to a secondary progressive MS course. With SPMS, there is a progressive worsening of neurologic function and disability over time following the initial relapsing-remitting (RRMS) course. In SPMS, occasional relapses may occur, as well as periods of stability or remission.

Is MS contagious or inherited?

You cannot catch multiple sclerosis from another person; it’s not contagious or transmissible. MS is not considered an inherited disease, but if a close family member, such as a parent or sibling, is diagnosed with MS, you may be slightly more likely to be diagnosed at some point in your life.

How is multiple sclerosis diagnosed?

Unfortunately, there is no single test that can be used to diagnose MS. Instead, diagnosis is based on several factors, including physical findings and medical tests. Your doctor’s first goal will be to rule out other causes for the symptoms you’re experiencing. Some conditions — such as Lyme disease, collagen-vascular diseases, hereditary disorders and AIDS — all produce symptoms that may mimic MS. If other conditions have been ruled out, MS diagnosis is generally based on neurological evidence of lesions or myelin damage in at least two separate areas of the nervous system that can be proven to have occurred at different points in time.

Your physician will most likely perform a series of tests to establish a firm MS diagnosis. For some, a neurological exam and a medical history are enough to confirm a diagnosis. For others, methods such as blood tests, an MRI, cerebrospinal fluid analysis or evoked potential tests may be necessary.

After examination and testing, your doctor will review all test results to determine whether clinically definite MS can be diagnosed, or if your symptoms are more consistent with clinically isolated syndrome. If results are inclusive, your doctor may diagnosis you with “probable MS” and ask that you follow up for testing later on to see whether symptoms have progressed or not.

What are the treatment options for multiple sclerosis?

MS is not curable, but it is treatable. Treatment for MS typically focuses on slowing the progression of the disease, easing recovery after relapse, managing symptoms and maintaining overall health. Below is a breakdown of the commonly used treatment methods.

Disease management – Disease-modifying treatments can be used to decrease the number of MS attacks, slow the progression of the disease and decrease the number of lesions within the CNS; these include a wide variety of options, including injections, infusions and oral medications. Your doctor will discuss them all and help you weigh the potential benefits and risk of each to find the correct choice for your MS.

Relapse management – A relapse is a sudden onset of new MS symptoms lasting at least 24 hours, separated by at least 30 days from the previous episode. Relapses can be managed with corticosteroids or adrenocorticotropic hormones (ACTH). Corticosteroids can shorten the duration of minor symptom attacks and decrease any swelling or inflammation of nerve fibers. ACTH is used for those who cannot tolerate, or whose symptoms have not responded to, corticosteroids. It is administered as an intramuscular injection for several weeks.

Symptom management – Managing symptoms before, during and after they occur can make living with MS less frightening and help you maintain a good quality of life. Symptom management usually includes medical, rehabilitative, psychological and lifestyle approaches to treatment. Depending on your symptoms and their severity, your doctor may recommend medications, physical therapy or a change in exercise or diet. It is recommended that you discuss each new symptom with your doctor early on to help prevent the symptom from worsening.

Can I have children if I’m diagnosed with MS?

Yes! It is completely safe for women diagnosed with MS to become pregnant and have children. The disease does not hurt one’s chances of becoming pregnant or carrying a child to full term.

Some studies have even found that pregnancy is associated with MS remission, especially during the second and third trimesters. However, if you are planning to get pregnant or have recently found out you’re pregnant, it’s important to discuss your medication options with your doctors. Most MS medications should not be used while pregnant, so it’s a good idea to set out a plan to stop and restart your medications.

If you have questions about your chances of developing multiple sclerosis or if you or a loved one have experienced symptoms consistent with the disease, contact your health care physician today. With MS, early treatment can make a big impact on your quality of life and ability to live life to the fullest.