Imagine this: You disconnect your cell phone from its charger as you get ready for a busy day. But even though it has been connected all night, the battery is only partially charged. You look at the cord and notice a spot where the insulation has been stripped away and the wires inside are exposed. Because the path by which the current travels is damaged, not all of the electricity sent from the outlet reached its target, your phone.
This is an apt analogy the Multiple Sclerosis Foundation uses to explain what’s happening in the nervous systems of the nearly one million Americans who have multiple sclerosis, an unpredictable, often disabling disease of the central nervous system.
[SEE: How to Describe Medical Symptoms to Your Doctor.]
What Is Multiple Sclerosis?
MS is an autoimmune disease that affects nerves in the central nervous system, which is made of the brain and spinal cord. Each nerve fiber in the brain and spinal cord is surrounded by a layer of protein called myelin, which protects the nerve and helps electrical signals from the brain travel to the rest of the body. The immune system, which is designed to protect the body from foreign invaders, gets confused and attacks its own tissues instead. With MS, the immune system attacks the brain and/or spinal cord, damaging the myelin (a fatty substance) that insulates the wire-like nerve fibers that send signals to and from the brain and body. This damage to the myelin causes scarring — “sclerosis” is Greek for “scars” — and the more of them (multiple) you have, the worse the condition becomes.
“Myelin can be compared to the insulation covering electrical wires that helps signals travel safely and efficiently,” explains Kathy Zackowski, associate vice president of research at the National Multiple Sclerosis Society. “When that myelin sheath is damaged, nerve signals travel more slowly or are blocked completely. Without myelin to protect the nerve fibers, they also get damaged.”
As the myelin and nerve fibers becomes damaged, it can cause a wide range of symptoms that affect different parts of the body — such as muscle movement, balance and vision. The large number of possible symptoms, their intermittent nature and their variability from person to person can make diagnosing MS difficult.
Signs and Symptoms
Common signs and symptoms of MS can include:
— Pain
— Numbness
— Tingling
— Fatigue
— Memory problems
— Mobility problems
— Balance issues
— Dizziness and vertigo
— Bladder and bowel problems
— Depression
— Cognitive changes
— Paralysis
“Some symptoms are subtle, such as temporary tingling or numbness in a hand or foot, and others are dramatic like vision involvement or extreme fatigue,” says Dr. Lauren Krupp, professor of neurology and the director of NYU Langone’s Multiple Sclerosis Comprehensive Care Center.
Less common symptoms may include headache, hearing loss, breathing problems, itchiness, tremor, seizures, speech problems and problems swallowing.
If you experience any of these symptoms and don’t know their source, you should talk to your doctor.
[Read: The Best Foods for an MS Diet.]
Types of MS
As with many other chronic conditions, MS isn’t just a single disease. The National MS Society recognizes three main types of MS:
— Relapsing-Remitting MS, RRMS. The first signs of RRMS usually appear when a patient is in their 20’s. It’s characterized by clearly defined attacks of new or increasing neurologic symptoms. These attacks are followed by periods of partial or complete recovery, called remissions. About 85% of MS patients are initially diagnosed with RRMS, according to a report by the MS International Federation.
— Primary Progressive MS, PPMS. The average age of diagnosis of PPMS is 40 years old. Symptoms in PPMS slowly worsen from the start of the disease without relapses or remissions, leading to increasing disability among patients with this disease. It’s defined at different points in time as either “active” (with an occasional relapse or evidence of new MRI activity) or “not active.” It can also be defined as “with progression,” meaning there’s evidence of the disease worsening or “without progression,” meaning symptoms are stable. This is a less common form of the disease affecting around 12% to15% of all MS cases, per the MS International Federation report.
— Secondary Progressive MS, SPMS. Many people with RRMS eventually develop SPMS, which is characterized by a progressive worsening of neurologic function and accumulation of disability over time. The change typically happens between 10 and 20 years after the initial diagnosis of relapsing-remitting MS. A large study published in the journal Brain shows that over a 20-year period, a relapse is followed by chronic progression of the disease in around 80% of cases. SPMS can be classified as “active,” “not active,” “with progression” and “without progression,” based on similar criteria to those used for those designations in PPMS.
Other, more rare types of multiple sclerosis include:
— Progressive-Relapsing MS, or PRMS. Only 5% of patients are diagnosed with this type of multiple sclerosis. There’s no remission, and with PRMS, symptoms worsen steadily and relatively quickly.
— Clinically Isolated Syndrome. CIS is the first instance of neurological symptoms caused by inflammation and demyelination (loss of myelin). Many people are diagnosed with this and never go on to get MS. CIS is sometimes accompanied by lesions that show up on a brain MRI.
[READ: How Do You Know If a Clinical Trial Is Right for You?]
Causes and Risk Factors for MS
The exact cause of this chronic and incurable disease is unknown, but data suggests that MS is triggered by a perfect mix of factors.
“Most likely there is an environmental trigger that combines with a specific gene combination, but knowing what that combination is has been elusive,” says Zackowski.
Although no one’s entirely sure what causes MS, certain risk factors can increase your chances of developing the disease. MS is twice as likely to strike women as men, and it usually develops between ages 15 and 60, according to the National MS Society. Some 3% to 5% of all individuals with MS experience disease onset before age 16.
Risk factors for MS, according to the National MS Society, include:
— Having a first-degree relative (parent or sibling) with MS
— Having certain gene mutations — researchers have identified some 600 mutations that may increase risk
— Being white, particularly being descended from Northern Europe
— Having low levels of vitamin D, which may be why MS is more common in countries farther from the equator, including Canada, the northern United States, New Zealand, southeastern Australia and Europe
— Having certain viral infections or bacteria, including Epstein-Barr, human herpes virus-6 (HHV-6), canine distemper, chlamydia, pneumonia or measles
— Smoking, which leads to higher incidence of MS as well as faster progression of the disease
— Obesity in childhood and adolescence, particularly among girls
New research is exploring air pollutants as a possible contributor to MS. A 2022 study in the journal Multiple Sclerosis found that high levels of ozone pollution in a child’s environment can trigger MS in individuals with genetic predispositions to the disease.
[READ: A Patient’s Guide to Brain Disease]
Diagnosing MS
No single test can diagnose MS. Rather, your doctor will take a detailed medical history and run blood tests to help rule out other possible problems (such as other autoimmune diseases, vitamin deficiencies, spine conditions and other possible culprits). The National MS Society reports that in order to make a diagnosis of MS, a physician must:
— Find evidence of damage in at least two separate areas of the central nervous system, which includes the brain, spinal cord and optic nerves AND
— Find evidence that the damage occurred at different points in time AND
— Rule out all other possible diagnoses
To do this, you’ll undergo a neurological exam and physical testing to evaluate your mental, emotional and language functions, balance and coordination, reflexes, gait and vision. You’ll likely have tests to evaluate the electrical activity in your brain as well as an MRI — a non-invasive imaging test that creates clear images of the brain and spinal cord. Your doctor may also examine your cerebrospinal fluid with a spinal tap.
Treatments for MS
Although MS isn’t curable, it can be managed. Starting aggressive treatment with medications known as disease-modifying therapies as early as possible can help quiet disease activity before it causes more damage, reducing MS relapses and progression of disability.
There are now more than 25 disease-modifying therapies, including beta interferons and immunosuppressants, that alter the way the immune system works. Some DMTs are delivered by injection, some by IV infusion and others by oral medications.
Immunotherapy focuses on stopping the immune system from mistakenly attacking myelin, brain cells and optic nerves. Important MS medications that help keep immune cells from attacking include natalizumab (Tysabri) and fingolimod (Gilenya).
Treatment may also include oral steroids to reduce nerve inflammation and speed recovery from relapses, also known as MS attacks. Some patients also have plasma exchange — a procedure in which the liquid part of the blood is separated from the blood cells. The blood cells are then mixed with a protein solution and put back in the body.
People with MS may also take medications to manage symptoms such as fatigue and bladder problems and undergo physical or occupational therapy to help them move better.
“There are a variety of disease-modifying treatment medications and the best one for you might require tailoring to your needs and preferences,” Zackowski says. “But don’t stop there. Take advantage of rehabilitation services, including occupational, physical and speech-language therapies. Addressing symptoms can provide immediate relief and have a big impact on your quality of life.”
The good news is that MS is rarely fatal. The MS Foundation reports that people with MS can die of related complications such as infections or pneumonia, but that the leading causes of death in the MS community are the same as for the general population, including heart disease, cancer and stroke. Nevertheless, scientists continue to look for a cure and are working on developing medications that will encourage the body to rebuild the damaged myelin.
Lifestyle measures
Small lifestyle choices do make a difference for physical and emotional well-being generally, and this is also true for people with MS, according to Zackowski.
— Exercise is one of the most important things you can do to help slow the progression of MS. There are plenty of studies showing exercise can improve a host of MS symptoms, including walking speed, balance, brain fog, fatigue, even depression. One problem, though, is that elevations in body temperature can lead to a flare-up of symptoms, so exercises where you can stay cooler, such as swimming or gentle yoga, may be good options.
— Diet is another lifestyle intervention that’s gaining traction. While there’s no one eating plan that helps MS, there are studies looking at specific features of a diet that may be important, Zackowski notes. “A low-fat Mediterranean diet might be key, but we need more data before making conclusions,” she says. For better overall health and disease management, consider avoiding certain foods that promote inflammation or disrupt the gut microbiome and adopting an MS diet as much as possible.
— Emotional wellness plays an influential role in the overall health of people with MS. Research shows that psychological interventions including cognitive behavioral therapy, mindfulness-based interventions, stress management and self-management skills training improve depression, fatigue and sleep in people with MS. “These interventions can successfully treat multiple symptoms and have very few side effects, except that they require time and effort from the person who wants to make the gains,” Zackowski says.
Home safety tips
“As many as 75% of MS patients will be affected by balance problems sometime during the course of their disease, so their homes need to be safety-proofed for possible falling,” says Dr. Devon Conway, staff neurologist in Cleveland Clinic‘s Mellen Center for Multiple Sclerosis Treatment and Research. “MS patients can arrange for a physical or occupational therapist to make a home visit. An assessment will be made, along with suggestions on how to make the patient’s home safer,” Conway says.
Several common adjustments the National Multiple Sclerosis Society recommends, include:
— Putting grab bars in the tub, shower and near the toilet
— Removing throw rugs
— Creating an unobstructed path throughout the house
— Keeping night lights on to lead the way in darkened hallways.
— Getting rid of clutter
— Making sure furniture is sturdy and easy to use
— Putting pots, pans and dishes where they can be reached easily without climbing or standing on tiptoe
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Multiple Sclerosis: Causes, Signs and Treatments originally appeared on usnews.com
Update 03/10/25: This story was previously published at an earlier date and has been updated with new information.
