What are the symptoms of multiple sclerosis (MS)?
The symptoms of MS vary from person to person. Which symptoms you have will depend on which parts of the brain or spinal cord (central nervous system) are damaged. The loss of myelin and scarring caused by MS can affect any part of the central nervous system. Myelin is the insulating coating around a nerve.
Symptoms may come and go or become more or less severe from day to day or, in rare cases, from hour to hour. Symptoms may get worse with increased body temperature or after a viral infection.
Common early symptoms of MS include:
- Muscle or motor symptoms.
These include weakness, leg dragging, stiffness, a tendency to drop things, a feeling of heaviness, clumsiness, and a lack of coordination (ataxia).
- Visual symptoms.
These include blurred, foggy, or hazy vision, eyeball pain (especially when you move your eyes), blindness, or double vision. Optic neuritis—sudden loss of vision that is often painful—is a fairly common first symptom.
- Sensory symptoms.
These include tingling, a pins-and-needles sensation, numbness, a band of tightness around the trunk or legs, and electrical sensations moving down the back and legs.
As MS progresses, symptoms may become more severe. They may include:
- Worse muscle problems, and stiff, mechanical movements (spasticity) or uncontrollable shaking (tremor). These problems may make it hard to walk. A wheelchair may be needed some or all of the time.
- Pain and other sensory symptoms.
- Bladder symptoms, such as loss of bladder sensation or not being able to hold urine (urinary incontinence) or to completely empty the bladder.
- Constipation and other bowel disorders.
- Male erectile dysfunction (impotence) and female sexual dysfunction.
- Cognitive and emotional problems, such as problem-solving and depression. These are common in people who have had MS for some time.
- Feeling very tired (fatigue). This can be worse if symptoms such as pain, spasticity, bladder problems, anxiety, or depression make it hard to sleep.
What causes multiple sclerosis (MS)?
The exact cause isn't known, but most experts believe that MS is an autoimmune disease. In this kind of disease, the body's defenses, called the immune system, mistakenly attack normal tissues. In MS, the immune system attacks the central nervous system—the brain and spinal cord.
Can multiple sclerosis be prevented?
In general, there is no way to prevent multiple sclerosis (MS) or its attacks. For people with relapsing-remitting, primary progressive, and secondary progressive, treatment with medicine may reduce the frequency of relapses and delay disability.
How is multiple sclerosis (MS) diagnosed?
Diagnosing MS isn't always easy. In some cases, it may take time.
Your medical history and neurological exam can identify possible nervous system problems. These tests are often enough to strongly suggest a diagnosis of MS. Tests may help confirm or rule out the diagnosis when your history and exam don't show clear evidence of the disease. An MRI and a neurological exam may help doctors predict which people will develop MS after a first attack of symptoms.
Tests to diagnose MS
These tests include:
- Magnetic resonance imaging (MRI) of the brain and spinal cord. This test is done to confirm a diagnosis of MS.
- Lumbar puncture (sometimes called a spinal tap). This test may be done to evaluate cerebrospinal fluid. Most people with MS have abnormal results on this test.
- Evoked potential testing. This test can often reveal abnormal areas in the brain and spinal cord and in the optic nerves of the eyes. Other tests may not find these.
Tests to confirm a diagnosis
MS is diagnosed when neurological tests and a neurological exam clearly show lesions (damaged areas). The lesions will be in more than one area of the central nervous system (usually the brain, spinal cord, or the nerves to the eyes). Tests will also clearly show that damage has occurred at more than one point in time.
Some people have had only one episode of a neurological symptom such as optic neuritis, but MRI tests suggest that they may have MS. This is known as a clinically isolated syndrome. Many of these people go on to get MS over time.
Tests to diagnose other health problems
Urinary tract tests may be needed to help diagnose a problem with bladder control in a person who has MS.
Neuropsychological tests may be needed to identify thinking or emotional problems. The person may not be aware of these problems. In most cases, these tests are in a question-and-answer format.
A blood test for JC virus antibodies may be done. This test can help you and your doctor understand your risk for getting a rare but serious brain infection called PML (progressive multifocal leukoencephalopathy).
How is multiple sclerosis (MS) treated?
Treatment can make living with MS easier. Your type of treatment will depend on how severe your symptoms are and whether your disease is active or in remission. You and your doctor will set up a schedule of appointments to watch and treat your symptoms. These checkups help your doctor find out if you may need to try a different treatment.
Different medicines are used to treat MS. Medicines called disease-modifying drugs may be used over a long period of time. They help to keep down the number of attacks and how severe they are and to slow the progress of the disease. Other medicines may be used during a relapse or to control certain symptoms.
Physical therapy, occupational therapy, and speech therapy can help you manage some physical problems caused by MS. There are also things you can do to help yourself. You can eat balanced meals, get regular exercise and rest, and learn to use your energy wisely.
In some cases, surgery may be done if you have severe tremor (shakiness) that affects movement. Or it may be done to implant a catheter or pump in the lower spinal area to deliver a constant flow of medicine to help treat severe muscle stiffness (spasticity).
Some complementary medicine treatments may help relieve symptoms of MS. For example, gingko biloba or magnetic therapy may help relieve fatigue. Talk to your doctor if you are interested in trying any of these treatments.
Dealing with the physical and emotional demands of MS isn't easy. If you feel overwhelmed, talk to your doctor. You may be depressed, which can be treated. Finding a support group where you can talk to other people who have MS can be very helpful.
What happens when you have multiple sclerosis (MS)?
Generally, MS follows one of four courses:
- Relapsing-remitting. Symptoms fade and then return off and on for many years.
- Secondary progressive. At first it follows a relapsing-remitting course. And then it becomes steadily worse (progressive).
- Primary progressive. It is progressive from the start.
- Clinically isolated syndrome. The symptoms last for 24 hours or longer and go away.
For most people, MS follows a relapsing-remitting course, at least at first. It involves a series of attacks that cause symptoms. These are called relapses, flares, or exacerbations. They may last for days or weeks and then partly or completely go away.
Relapses may be mild or severe and tend to recur over a period of years. They may become worse and more frequent over time. As time goes by, symptoms may linger after each relapse, and new symptoms often develop.
Most people live with MS for decades. Many become more disabled as they get older.
Caring for yourself when you have multiple sclerosis (MS)
If you have multiple sclerosis (MS), it is important to find ways of coping with the practical and emotional demands of the disease. These are different for everyone, so home treatment varies from person to person.
Home treatment may involve making it easier to get around your home, dealing with depression, handling specific symptoms, and getting support from your family and friends.
Modify your home to keep it safe and easy to get around.
For example, to help prevent falls, install grab bars in the bathroom and don't use throw rugs. And try adjusting your daily schedule so that your routine is less stressful or tiring.
You can do this on your own or with the help of a physical therapist.
Get help with urination problems.
At some time, most people with MS have bladder problems. Your doctor may prescribe a medicine to help you.
Avoid getting overheated.
Increased body temperature can temporarily make your symptoms worse. Use an air conditioner, keep your home somewhat cool, and avoid hot swimming pools and hot tubs. During warm or hot weather, exercise in an air-conditioned area rather than outdoors.
Eat a wide variety of wholesome foods.
This includes plenty of fruits, vegetables, grains, cereals, legumes, poultry, fish, lean meats, and low-fat dairy products. A balanced diet for a person who has MS is the same as that recommended for most healthy adults.
Change how and what you eat if you are having problems swallowing.
- Try milkshakes or juices in gelatin form. Thicker drinks make swallowing easier.
- Avoid foods such as crackers or cakes that crumble easily. These can cause choking.
- Use a blender to prepare food for easiest chewing. Soft foods need less chewing.
- Eat frequent, small meals to avoid fatigue from eating heavy meals.
Ask your doctor about physical therapy and occupational therapy to help you manage at work and home.
Make all efforts to preserve your health. Proper diet, rest, wise use of energy, and practical and emotional support from your family, friends, and doctor can all be very helpful.
Contact the National Multiple Sclerosis Society at www.nationalmssociety.org for more advice about coping with MS at home.
Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.