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Multiple Sclerosis

What is multiple sclerosis (MS)?

Illustration of the nervous system

Multiple sclerosis (MS) is a chronic disease of the central nervous system. It is thought to be an autoimmune disorder. It is an unpredictable condition that can be relatively benign, disabling, or devastating. Some individuals with MS may be mildly affected, while others may lose their ability to see clearly, write, speak, or walk when communication between the brain and other parts of the body becomes disrupted.

Myelin is a fatty tissue that surrounds and protects the nerve fibers. Myelin is lost in multiple areas with MS. This loss of myelin forms scar tissue called sclerosis. These areas are also called plaques or lesions. When damaged in this way, the nerves are unable to conduct electrical impulses to and from the brain.

What causes multiple sclerosis?

There are many possible causes of MS, including the following:

However, not enough is known about the role these factors play to definitively describe why a particular patient develops MS.

What are the symptoms of MS?

The symptoms of MS are erratic. They may be mild or severe, of long duration or short. They may appear in various combinations, depending on the area of the nervous system affected. The following are the most common symptoms of MS. However, each individual may experience symptoms differently. Symptoms may include:

Symptom categories of MS

Primary symptoms. A direct result of demyelination, the destruction of myelin (the fatty sheath that surrounds and insulates nerve fibers in the central nervous system) may result in the following:

  • Weakness

  • Numbness

  • Tremor

  • Loss of vision

  • Pain

  • Paralysis

  • Loss of balance

  • Bladder and bowel dysfunction

Secondary symptoms. Complications that arise as a result of the primary symptoms, for example:

  • Paralysis can lead to bedsores.

  • Bladder dysfunction may cause repeated urinary tract infections.

  • Inactivity can result in weakness, poor postural alignment and trunk control, muscle imbalances, decreased bone density, and/or shallow, inefficient breathing.

  • Becoming less mobile because of weakness and difficulty swallowing can lead to an increased risk of pneumonia.

Tertiary symptoms. The social, vocational, and psychological complications of the primary and secondary symptoms, for example:

  • A person who becomes unable to walk or drive may lose his or her livelihood.

  • Strain of dealing with a chronic neurological illness may disrupt personal relationships.

  • Depression is often seen among people with MS.

The symptoms of MS may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is multiple sclerosis diagnosed?

With today's medicine, there is no definitive test available to diagnose multiple sclerosis. However, a probable diagnosis can be made by following a careful process which demonstrates findings that are consistent with MS, that also rule out other causes and diseases.

What are the two criteria used when diagnosing MS?

  1. There must have been two attacks at least one month apart. An attack is a sudden appearance of or worsening of any MS symptom or symptoms that lasts at least 24 hours.

  2. There must be more than one area of damage to the central nervous system myelin, the sheath that surrounds and protects nerve fibers, which must have occurred at more than one point in time and was not caused by any other disease.

More commonly nowadays, a single attack together with certain patterns of changes in brain tissue seen on a magnetic resonance image (MRI) of the brain (see the description of this below) can strongly suggest the diagnosis of MS.

What does an evaluation for MS cover?

Evaluation for MS involves a complete medical history and neurological exam, which includes:

Evaluation procedures for MS

The following may be used when evaluating for multiple sclerosis:

Evaluation and diagnosis of MS requires a variety of tools to rule out other possible disorders and a series of laboratory tests that, if positive, confirms the diagnosis.

Treatment for MS

Specific treatment for MS will be determined by your doctor based on:

Treatments for the conditions associated with MS may include the following:

There is no cure yet for MS. However, there are strategies to modify the disease course, treat exacerbations, manage symptoms, and improve function and mobility.

Rehabilitation for people with MS

Rehabilitation varies depending on the range, expression, severity, and progression of symptoms. MS rehabilitation may help to accomplish the following: