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Multiple Sclerosis

What is multiple sclerosis (MS)?

Multiple sclerosis, often called MS, is a disease that affects the central nervous system—the brain and spinal cord. It can cause problems with muscle control and strength, vision, balance, feeling, and thinking.

Your nerve cells have a protective covering called myelin. Without myelin, the brain and spinal cord can't communicate with the nerves in the rest of the body. MS gradually destroys myelin in patches throughout the brain and spinal cord. These patches of damage are called lesions. They cause muscle weakness and other symptoms.

MS is different for each person. You may go through life with only minor problems. Or you may become seriously disabled. Most people are somewhere in between. Generally, MS follows one of four courses:

  • Clinically isolated syndrome. The symptoms last for 24 hours or longer and go away.
  • 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 becomes progressive. "Progressive" means it steadily gets worse.
  • Primary progressive. The disease is progressive from the start.

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, ginko biloba or magnetic therapy 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.

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).

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.