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Multiple Sclerosis—Adult

(MS—Adult)

Definition

Multiple sclerosis (MS) is a disease of the central nervous system. It is a chronic condition that can be disabling.

There are several types of MS:

  • Relapsing-remitting MS —Symptoms suddenly reappear periodically. They last for a few weeks or months, then go back into remission (a period with no symptoms). Symptoms may get worse with each occurrence.
  • Primary progressive MS —Symptoms gradually worsen after symptoms first appear. Relapses and remissions usually do not occur.
  • Secondary progressive MS —After years of relapses and remissions, symptoms suddenly begin to progressively worsen.
  • Progressive relapsing MS —Symptoms gradually worsen after symptoms first appear. One or more relapses may also occur.

Causes    TOP

The immune system normally attacks viruses or bacteria that should not be in the body. With MS, a problem with the immune system causes it to attack healthy nerves. In particular, MS attacks the nerve fibers in the brain, spinal cord, and the nerves of the eye. The exact cause of these immune problems is unknown.

The following may contribute to the development of MS:

  • Viral or other infection
  • Genetic factors (heredity)
  • Environmental factors
  • Breaking down of parts of the nervous system

Abnormal Immune Responses Cause Nerve Damage

Myelin Sheath Damage
Copyright © Nucleus Medical Media, Inc.

Risk Factors    TOP

MS is more common in women and in people aged 15-50 years old. Other factors that may increase your chance of MS include:

  • Exposure to certain viruses
  • Family members who have MS or other autoimmune disorders, such as systemic lupus erythematosus
  • Being of Northern European descent
  • Growing up in a colder climate, as opposed to a tropical climate
  • Having certain immune system genes
  • Having inflammation of the optic nerve
  • Having low vitamin D levels
  • Smoking

Symptoms    TOP

Symptoms may range from mild to severe and may include:

  • Numbness or tingling in the face or limbs
  • Impaired vision in one or both eyes, including:
    • Blurred vision
    • Double vision
    • Loss of vision
  • Eye pain
  • Fatigue
  • Lightheadedness
  • Muscle stiffness
  • Muscle spasms
  • Muscle weakness
  • Incoordination or falling
  • Trouble walking or maintaining balance
  • Weakness in one or more limbs
  • Bladder problems including:
  • Bowel problems, including constipation
  • Sexual dysfunction
  • Slurred speech
  • Difficulty swallowing
  • Forgetfulness, memory loss, and confusion
  • Difficulty concentrating or solving problems
  • Depression

Symptoms may worsen with:

  • Heat, including:
    • Hot weather
    • Hot baths or showers
    • Fever
  • Overexertion—intense physical activity
  • Infection

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done.

Tests may include:

  • Blood tests—to rule out other diseases that may mimic MS
  • MRI scan
  • Lumbar puncture—to check the fluid around the brain and spinal cord, which may rule out other diseases
  • Sensory evoked potentials—to record the electrical responses evoked after a sensory stimulus
  • Visual evoked potential test—to look for problems in the brain that affect vision
  • Optical coherence tomography (OCT)—to look at the retina and the optic nerve

Treatment    TOP

There is no cure for MS, you can manage the disease with medication, lifestyle changes, and counseling. Treatment will help relieve symptoms, prevent relapses, delay disability, and slow disease progression. Talk with your doctor about the best treatment plan for you. Options include:

Medications

Medications can help slow progress, prevent new lesions, and manage symptoms.

Types of medications that can slow the progression of MS or prevent new lesions from developing include:

  • Interferon betas
  • Immunomodulators/immunosuppressives

Corticosteroids may be given to reduce inflammation during active phases. This may lessen the effects of the immune system on the nerve fibers and shorten the length of relapses.

Types of medications to help manage symptoms can include:

  • Muscle relaxants—to reduce muscle spasms
  • Potassium channel blockers—to help improve vision, motor skills, and relieve fatigue
  • Botox injections —to reduce tremor and muscle tone
  • Pain relievers
  • Antidepressants
  • Medications to help with bladder or bowel problems

Supportive Therapies

Other therapies may help relieve some physical and emotional symptoms of MS. Each therapy has unique benefits and potential side effects which may interfere with other therapies you are using. Work with your health care team to help find therapies that work best for you. Supportive therapies include:

  • Regular moderate exercise with your doctor's permission—swimming may be especially beneficial
  • Physical therapy to help maintain muscle strength and tone, dexterity, and walking ability
  • Occupational therapy to help with assisted devices and daily living activities
  • Speech and/or swallowing therapy
  • Cognitive therapy to address specific neuropsychiatric problems
  • Stress reduction techniques

Some alternative therapies that have shown some benefits for some include:

Talk to your doctor before you try any alternative therapies.

Psychological Therapies    TOP

Individual or group therapy will help you learn coping strategies for physical symptoms and emotional stress.

Avoiding Periods of Relapse    TOP

Some forms of MS have periods remissions that alternate with relapses. Take these steps to help you avoid relapses and worsening of symptoms:

  • Adhere to the treatment plan you worked out with your doctor
  • Get adequate rest
  • Avoid hot weather
  • Stay in air-conditioned places during periods of hot weather
  • Avoid hot showers or baths
  • Avoid overexertion and stress
  • Avoid infection by:
    • Using proper hygiene, especially when washing your hands
    • Staying away from people who are sick
    • Thoroughly cooking food
    • Practicing safe sex
  • Quitting smoking —smoking may worsen MS, causing the condition to progress to a more severe form

Prevention    TOP

There are no current guidelines to prevent MS.

RESOURCES:

Multiple Sclerosis Association of America
http://www.mymsaa.org
National Multiple Sclerosis Society
http://www.nationalmssociety.org

CANADIAN RESOURCES:

Multiple Sclerosis Society of Canada
http://mssociety.ca

References:

Ascherio A, Munger KL, Simon KC. Vitamin D and multiple sclerosis. Lancet Neurol. 2010;9(6):599-612.
Cohen JA, Barkhof F, Comi G, et al. Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis. N Engl J Med. 2010;362(5):402-415.
International Multiple Sclerosis Genetics Consortium, Hafler DA, Compston A, et al. Risk alleles for multiple sclerosis identified by a genomewide study. N Engl J Med. 2007;357(9):851-862.
Kang JH, Sheu JJ, Kao S, Lin HC. Increased risk of multiple sclerosis following herpes zoster: a nationwide, population-based study. J Infect Dis. 2011;204(2):188-192.
Kappos L, Radue EW. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Eng J Med. 2010;362(5):387-401.
Multiple sclerosis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated June 21, 2017. Accessed October 2, 2017.
NINDS multiple sclerosis information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Multiple-Sclerosis-Information-Page. Accessed October 2, 2017.
Rose JW, Carlson NG. Pathogenesis of multiple sclerosis. Continuum Lifelong Learning Neurol. 2007;13:35-62.
Treating MS. National Multiple Sclerosis Society. Available at
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Accessed October 2, 2017.
What is MS? National Multiple Sclerosis Society website. Available at:
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Accessed October 2, 2017.
Van der Mae IA, Simpson S Jr, Stankovich J, Taylor BV. Individual and joint action of environmental risk factors and MS. Neurol Clin. 2011;29(2):233-55.
1/4/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Healy B, Ali E, Guttmann C, et al. Smoking and disease progression in multiple sclerosis. Arch Neurol. 2009;66(7):858-864.
4/25/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Rosti-Otajärvi EM, Hämäläinen PI. Neuropsychological rehabilitation for multiple sclerosis. Cochrane Database Syst Rev. 2014;2:CD009131.
4/25/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Yadav V, Bever C Jr, Bowen J, et al. Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2014;82(12):1083-1092.
11/9/2015 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Kuo CF, Grainge MJ, Valdes AM, et al. Familial aggregation of systemic lupus erythematosus and coaggregation of autoimmune diseases in affected families. JAMA Intern Med. 2015;175(9):1518-1526.
Last reviewed September 2017 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 11/9/2015

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