What Is Multiple Sclerosis?

Multiple sclerosis (MS) is when the immune system attacks myelin. Myelin is the covering wrapped around your nerve cells. MS affects the brain and spinal cord. 

Symptoms come and go in periods of relapse and remission. The symptoms of MS vary widely, depending on the affected nerves. But they often include extreme fatigue, numbness and tingling, vision problems, and weakness or balance problems.

MS is tricky. So many other conditions cause similar symptoms as MS. It's tempting to think you have it when you don't. And it can take years or even decades for people with MS to receive a diagnosis. Only a healthcare provider can perform tests that confirm MS.

Types of Multiple Sclerosis

MS begins with initial symptoms and continues through four phases of the disease. There is also a benign form of MS.

Clinically Isolated Syndrome (CIS)

CIS is one of the first periods of MS symptoms. Inflammation and demyelination cause CIS. Demyelination is when your nerve cells experience damage. That causes neurological problems to occur. An episode generally lasts 24 hours. 

Episodes are either monofocal or multifocal. A singular brain lesion causes one MS symptom in monofocal episodes. And multiple brain lesions cause several MS symptoms in multifocal episodes. 

CIS may not confirm MS. If an MRI reveals a brain lesion, your risk of MS increases.

Relapsing-Remitting MS (RRMS)

RRMS is the most common type of MS. About 80% of people with MS experience this phase. People with RRMS relapses of new or increasing MS symptoms, such as:

• Muscle weakness
• Trouble controlling bladder
• Feeling dizziness
• Numbness
• Tingling 
• Vision problems (for example, blurry vision, double vision, or vision loss)
• Trouble walking

Partial or complete remission may follow an attack. During remission, there is no progression of MS. If untreated, symptoms of RRMS may worsen during relapses.

Primary Progressive MS (PPMS)

PPMS impacts 10% to 15% of people with MS. It causes worsening neurologic function. Generally, people with PPMS do not experience relapses or remissions. But they may have brief periods of rest. 

A common symptom of PPMS is problems with mobility. People may notice increasing stiffness in their legs. They may have trouble walking.

Secondary Progressive MS (SPMS)

People with PPMS develop symptoms and continue progressing from the beginning without periods of remission. In contrast, people with SPMS start with RRMS with periods of remission. Eventually, their condition starts progressing without further remission.

Benign Multiple Sclerosis (MS)

Benign MS is a steadily mild illness. People have benign MS after having MS for 15 years without worsening symptoms.

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Multiple Sclerosis Symptoms

MS symptoms result from damaged nerves. Those nerves may send mixed signals to different body parts. Some of the most common symptoms include:

• Fatigue: More than 80% of people with MS experience fatigue at one point or another. Some people experience "MS lassitude." That's severe fatigue that occurs daily. It tends to become worse as the day wears on.
• Numbness: Numbness is a lack of sensation in various body parts. It's often one of the first symptoms that people with MS notice. Numbness can occur in the face, the body, or the arms and legs. It can interfere with walking, holding on to objects, and even chewing.
• Tingling: Tingling feels like your arm, fingers, or toes are falling asleep yet never waking up.
• Balance and coordination issues: Movement problems are a hallmark of MS. People may feel suddenly weak in one limb. Or they may find objects slipping quickly out of their hands. If there's damage to the cerebellum, you might also be unsteady on your feet and prone to falling. The cerebellum is the part of the brain that controls balance.
• Muscle weakness: Muscle weakness is most common in the legs. But people with MS may feel muscle weakness in other body parts. It ranges from a mild feeling of tightness to severe pain. In extreme cases, muscle spasticity can cause a person's body to become distorted and twisted. 
• Vision Problems: Vision problems can manifest as double vision, eye pain, blurred vision, or a scotoma. Scotoma causes a hole in your vision.
• Pain: Most people with MS experience pain. It's often the direct result of damaged nerves. Due to inflammation, you may also feel severe burning sensations in your legs, feet, or hands.
• Bladder issues: Bladder problems can manifest in two seemingly opposite ways. Some people have difficulty emptying their bladder. And others constantly feel like they must go to the bathroom.
• Constipation: The most common bowel problem related to MS is constipation. The nerves and muscles aren't allowing your GI system to function correctly.
• Depression: About 50% of people with MS have depression. Relapses may occur irregularly and cause stress.
• Sensitivity to certain temperatures: A person with MS may have worsening symptoms on a humid day. They may also have a high body temperature.
• Tremors: Tremors are one of the most common symptoms of MS that impact a person's quality of life.
• Cognitive difficulties: When MS causes lesions to accumulate in the brain, memory can be affected.

What Causes Multiple Sclerosis?

MS occurs due to damage to the myelin. That damage affects the central nervous system. It disrupts communication between your cells, brain, and spinal cord. Damage occurs when the body's immune system attacks healthy nerve cells. That causes inflammation.

Risk Factors

The exact cause of MS remains unknown. But some evidence suggests that many risk factors prompt the onset of MS, including:

• Viral infections: Some evidence suggests that the Epstein-Barr virus (EBV) links to MS. EBV is a member of the herpes family of viruses. But research is not conclusive.
• Smoking: Smokers and ex-smokers are more likely to get MS than people who never smoked. The more cigarettes you've had, the greater your risk.
• Age: MS can strike at any age. But you are most likely to experience the onset of symptoms between the ages of 20–40.
• Low Vitamin D: Our bodies produce D in response to sunlight. So, people closer to the earth's poles are more likely to experience MS than those closer to the equator.
• Gender: The disease is much more common in women than in men.
• Genetics: Having a close relative with MS increases your risk. That includes a sibling, parent, or child.

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How Is Multiple Sclerosis Diagnosed?

There's no diagnostic test for MS. Also, symptoms vary widely between people. That makes diagnosis tricky. A healthcare provider may ask you to recount your symptoms. Also, they may conduct a neurological examination. That may include:

• An MRI of the brain and spinal cord
• A lumbar puncture to assess your cerebrospinal fluid (CSP) for immunological abnormalities. A lumbar puncture is also known as a spinal tap. 
• Conduction of electrical impulses along the nerve pathways in your central nervous system

Treatments for Multiple Sclerosis

As of January 2023, there's no cure for MS. But dozens of treatments may slow its progression. Treatment depends on your goals. There are abortive, preventative, and supportive therapies. 

Treating MS usually involves steroids that fight inflammation. One example is methylprednisolone. A healthcare provider delivers the steroid through a vein in your arm daily for three to five days. Then, you will take an oral steroid pill. Over one to two weeks, you will gradually decrease your dose.

Also, you may take disease-modifying therapies. Those therapies prevent relapses during periods of remission. A healthcare provider may prescribe other medications that treat specific symptoms.

Other remedies that treat symptoms of MS include:

• Cognitive rehab: Medications don't seem to affect the mental aspect of MS. But rehabilitation methods can help. That may include memory retraining.
• Speech therapy: Speech pathologists can help MS patients with speech difficulties and swallowing. Some people may experience long pauses or slurred language. Damage in the areas of the brain that control muscles in the throat may cause swallowing problems. That can potentially lead to choking. Also, it may cause aspiration pneumonia. That happens when bits of inhaled food trigger lung infections. Altering the texture of your food can help.
• Exercise: Once, researchers warned against exercise for people with MS. Some stated it would worsen fatigue. Others noted that it sped the progression of MS. But other evidence suggests exercise is safe. It can improve strength and mental health. Simply being active while shopping or gardening can be beneficial.
• Botox: People may think of removing fine lines and wrinkles when they hear about Botox. But it also helps alleviate bladder and bowel problems in people with MS.
• Other treatments: The ancient Chinese practice of Tai Chi helps improve balance. It also helps proprioception. That's how we perceive ourselves in space. Deep breathing and rhythmic yoga movements can also help. Some people also find acupuncture effective. But researchers have not conducted any formal clinical trials.
  

How To Prevent Multiple Sclerosis Flares

As of January 2023, there aren't effective ways to prevent MS. Researchers need to know what makes the immune system attack healthy nerve cells. That may help develop preventative therapies.

Identifying environmental factors that trigger MS may prevent the disease. Some risk factors are unmodifiable. Those include sex, genetics, and age. But you may be able to control some environmental triggers, including: 

• Increase your vitamin D: MS rates are highest in North America, southern Australia, and northern Europe. That suggests that the farther you live from the equator, the greater your risk. Research has found a link between location and MS. That link may be sun exposure or vitamin D levels in the body. The human body generates vitamin D in response to sunlight.
• Avoid smoking: Smoking increases your risk of MS and its severity. It also speeds the progression of the disease. Not smoking has many health benefits. Quitting smoking is a clear step to lower your risk.
  

Comorbid Conditions

Research has found that MS is often comorbid with several other health conditions. People with MS are more likely to develop the following complications:

• Anxiety and depression: It is not uncommon for people with MS to have feelings of stress and helplessness due to the unpredictability of flares. Those feelings cause people with MS to have an increased risk of anxiety and depression, which can affect the severity of MS symptoms. Counseling and building support systems can help stave off adverse mental health effects.
• Autoimmune disease: In one study published in 2021 in the Journal of Neurology, researchers stated that MS shares risk factors with many other autoimmune diseases. Those similarities may explain why the conditions are comorbid. Some of the most common autoimmune diseases reported by people with MS include thyroid disease, rheumatoid arthritis, and inflammatory bowel disease (IBD).
• Chronic lung disease: Nearly 10% of people with MS also experience chronic lung disease. Research has found that chronic lung disease is more common in people 45 and younger than others.
• Gastrointestinal (GI) disease: According to one study published in 2022 in the Annals of Clinical and Translational Neurology, IBD is more commonly reported among people with MS than the general population. The researchers suggested that the similar immune responses of the conditions may explain their relation.
• Vascular and cerebrovascular disease: Some of the most common vascular diseases reported by people with MS are high blood pressure and high cholesterol. Also, cerebrovascular diseases include cognitive dysfunction. Research has found that the risk of those conditions increases with age.
  

Living With Multiple Sclerosis

Typically, MS is not a fatal condition. Still, in one study published in 2017 in the Journal of Neurology, Neurosurgery, and Psychiatry, researchers found that people with MS had a seven-year shorter lifespan than the general population.

But luckily, with effective therapies and treatments, people with MS can manage their symptoms and mitigate flares. Those flares can be random, making daily activities stressful. However, there are some methods to help cope while treating MS, like:

• Eat a balanced diet: No special diet prevents MS or cures its symptoms. But diet may affect specific symptoms. For example, low-fat, high-fiber foods that give you energy could help you avoid fatigue.
• Exercise: Exercising helps improve your health. Try strength exercises, yoga, or Tai Chi.
• Prioritize sleep: Some people with MS have sleep issues. Insomnia, frequent nighttime urination, narcolepsy, and leg spasms are common. A good night's sleep helps prevent fatigue. It's essential to prioritize it. 
• Build a support system: Family and friends may help your condition feel less stressful. A support group of others dealing with MS may also be helpful.
  

A Quick Review

MS is when the immune system attacks and damages your nerve cells. It causes inflammation of your central nervous system. The symptoms of MS can vary widely. They depend on the affected nerves. Extreme fatigue, numbness and tingling, vision problems, and muscle weakness are common.

Some people with MS go through periods of relapses and remission. That makes the onset of symptoms random. That inconsistency can make daily life frustrating and stressful. So, treatment and healthy behaviors are essential.