Topic Overview
What is multiple sclerosis?
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, causing muscle weakness and other
symptoms. These patches of damage are called lesions.
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:
Whatever your symptoms are, treatment and self-care can
help you maintain your quality of life. There is no cure for MS, but it is not
fatal except in rare cases.
What causes MS?
The exact cause is unknown, but
most experts believe 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.
Experts don't know why MS happens to some
people but not others. There may be a
genetic link, because the disease seems to run in
families. Where you grew up may also play a role. MS is more common in those
who grew up in colder regions that are farther away from the equator.
What are the symptoms?
Symptoms depend on which
parts of the brain and spinal cord are damaged and how bad the damage is. Early
symptoms may include:
- Muscle problems. You may feel weak and stiff,
and your limbs may feel heavy. You may drag your leg when you walk or have trouble lifting your foot (foot drop). You may
drop things more than usual and be less coordinated.
- Visual
problems. Your vision may be blurred or hazy. You may have 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 problems. You may feel tingling, a
pins-and-needles sensation, or numbness. You may feel a band of tightness
around your trunk or limbs or a feeling of electricity moving down your back
and limbs.
- Balance problems. You may feel lightheaded or dizzy or
feel like you're spinning.
As MS gets worse, you may have
tremors and pain and feel stiff when you move. You may
have problems with
controlling urination, swallowing, and thinking
clearly. MS can lead to
depression.
Many people with MS are
sensitive to heat. Hot weather, a fever, a hot shower, or too much exercise can
make their symptoms worse until they cool down.
MS is very
unpredictable. Your symptoms may suddenly get worse with no warning, or you may
go for years without any problems.
How is MS diagnosed?
Diagnosing MS is not always
easy. The first symptoms may be vague, and many of the symptoms can be caused
by problems other than MS. Try not to be frustrated if months or even years go
by before your illness is definitely identified as MS.
MS is not
diagnosed unless a doctor can be sure that you have had at least two attacks.
The doctor will examine you, ask you questions about your symptoms, and do some
tests. An
MRI is often used to confirm the diagnosis, because
the patches of damage (lesions) caused by MS attacks can be seen with this
test.
How is it treated?
Medicines are used to treat MS:
- During a relapse, to make the attack shorter
and less severe.
- Over a long period of time, to keep down the
number of attacks and how severe they are (disease-modifying therapy). This
treatment may delay or at least reduce the damage MS does to the
body.
- To control specific symptoms—like fatigue, depression,
urinary problems, sexual difficulties, pain, or muscle stiffness.
You may find it hard to decide whether to take any of the
drugs that slow the progression of MS, especially if your symptoms have been
mild. The drugs do not work for everyone, and they often have strong side
effects. But experts say it’s usually best to start taking medicine as soon as
you are diagnosed, because damage may be going on even if you don't have
symptoms. You and your doctor will decide whether you should try any of these
drugs.
Physical therapy, occupational therapy, and
speech therapy can help you reduce some physical problems caused by MS. You can
also help yourself at home by eating right, getting regular exercise and rest,
and learning to use your energy wisely.
Dealing with the physical
and emotional demands of MS is not easy. If you feel overwhelmed, talk to your
doctor. You may be depressed, which can be treated. And finding a support group
where you can talk to other people with MS can be very helpful.
Frequently Asked Questions
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Cause
The cause of
multiple sclerosis (MS) is unknown. Because a person's
risk of MS is slightly higher when a relative (especially a parent, sister, or
brother) has MS, there may be a
genetic link.
The unusual relationship
between a person's
geographic location during childhood and the risk of
MS later in life suggests that there may be environmental factors at work in
the disease—such as
viral illnesses or other infectious diseases. But
there is no clear proof that any specific infection causes MS. Other
triggers for MS have been proposed, but none have yet
been proved.
Also, a childhood viral illness or other
environmental factor by itself is probably not enough to explain why some
people later develop MS. Research is beginning to suggest that a problem with
the body's natural defenses (immune system) occurring early in life
or after infections may trigger the onset of MS. The trigger may be an
autoimmune reaction in which the immune system attacks
myelin, the coating that protects nerve fibers.
Symptoms
The symptoms of
multiple sclerosis (MS) vary from person to person
depending 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.
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 become more severe with increased (or, less commonly, decreased)
body temperature or after a
viral infection. Symptoms of MS, such as stiffness,
tremors, pain, and difficulty thinking clearly, are similar to those of many
other conditions and do not necessarily mean you have MS.
Early symptoms
Common early symptoms of MS
include:
-
Muscle or motor symptoms, such as weakness, leg dragging, stiffness, a tendency to drop
things, a feeling of heaviness, clumsiness, or a lack of coordination (ataxia).
-
Visual symptoms, such as 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, occurring in up to 25% of those who have MS.
-
Sensory symptoms, such as tingling, a
pins-and-needles sensation, numbness, a band of tightness around the trunk or
legs, or electrical sensations moving down the back and legs.
Less common early symptoms include:
-
Balance symptoms, such
as lightheadedness or dizziness, and a spinning feeling (vertigo).
-
Bladder symptoms, such as an inability to hold urine (urinary incontinence) or to completely empty the bladder, or a loss of bladder
sensation—an inability to sense that the bladder is becoming full until there is a
sudden, urgent need to urinate.
Advanced symptoms
As MS progresses, symptoms may
become more severe and may include:
- Increased muscle problems, such as weakness,
leg dragging, clumsiness, or lack of coordination.
- Stiff,
mechanical movements (spasticity) or
uncontrollable shaking (tremor), which may make walking
hard. A wheelchair may be needed some or all of the time.
- Pain
and other sensory symptoms.
- Incontinence or, less often, an
inability to urinate (urinary retention).
- Constipation and other
bowel disorders.
-
Male erectile dysfunction
(impotence)
and
female sexual dysfunction.
-
Cognitive and emotional problems, which are common in people who have had MS for
some time.
- Cognitive problems can mean memory loss,
difficulty concentrating, reduced attention span, or difficulty finding the
correct words.
- Emotional symptoms can mean
depression,
anxiety, and anger. A rare symptom is excessive
cheerfulness that seems inappropriate.
- 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 Happens
In general,
multiple sclerosis follows one of four courses:
-
Relapsing-remitting
, where symptoms may
fade and then recur at random for many years. The disease does not advance
during the remissions.
-
Secondary progressive
, which initially follows a relapsing-remitting course. Later
on, it becomes steadily progressive.
-
Primary progressive
, where the disease is progressive from the
start.
-
Progressive relapsing
, where steady
deterioration of nerve function begins when symptoms first appear. Symptoms
appear and disappear, but nerve damage continues. Few people have this course
of MS.
Many people with MS do not follow one of these patterns
exactly. The course is often hard to predict. Not only does it vary from person
to person, but the pattern may change in an individual over time. MS may be
more severe in men than women, particularly in middle-aged men.
MS usually progresses with a series of
relapses that occur over many years
(relapsing-remitting MS). In many people the first MS attack involves just a
single symptom. It may be weeks, months, or years before you have a relapse. As
time goes by, symptoms may linger after each relapse so you lose the ability to
fully recover from the relapse. New symptoms often develop as the disease
damages other areas of the
brain or spinal cord.
Events that can mean you may have a more
severe progression of MS include:
- Frequent relapses during the first few years of
the disease.
- Incomplete recovery between
attacks.
- Early, lasting motor problems that affect
movement.
- Many lesions that show up on an
MRI early in the disease.
The duration of the disease varies. Most people who get MS
live with it for decades. People with MS often become disabled over time,
but the disease itself is rarely life-threatening and may not directly reduce your
natural life span.
Most people who develop MS have a
relapsing-remitting course. After about 10 years, about half of these
people develop secondary progressive MS.
Some people have a few
mild attacks from which they recover entirely. This is called benign MS.
Although rare, a small number of people die within several months of the
onset of MS. This is called malignant or fulminant MS.
Pregnancy and MS
Since most people diagnosed with
MS are women in their child-bearing years, questions about having children are
common. Research shows that most couples in which one partner has MS are able
to have children without MS affecting the pregnancy, labor, or delivery. Plus,
MS does not increase the risk of miscarriage, birth defects, or low birth
weight. Some women have fewer MS symptoms during pregnancy, then a temporary
relapse after delivery. But pregnancy, delivering a baby, and early motherhood
do not increase the risk of being disabled by MS over
time.
People
with MS who want to have children should talk to their doctor before trying to
become pregnant and should think about the following:
- Men with MS may need help to overcome erectile or ejaculatory
problems.
- Some medicines used to treat MS should not be used during
pregnancy, and some should not be used during breast-feeding. If you are taking
medicine for MS, use reliable birth control until you decide to try to become
pregnant. Talk to your doctor about when to stop taking the medicine. In some
cases, your doctor may suggest that you wait to start trying to get pregnant
until a relapse has ended and you are not taking medicine.
- Some
symptoms common in pregnancy and after the baby's birth can be made worse by
MS. These include depression and fatigue. Plan for any help you may need to
manage your work, household, and other children during pregnancy and for the
first few months after the baby is born.
- The baby may be slightly
more likely to develop MS later in life than a child born to parents who do not
have MS.
- Think clearly, and talk with
your partner and doctor about the future. Some people with MS become disabled
over time. Because of this, some couples decide not to have children or to have
fewer children than they might have otherwise. Other couples don't change their
plans for a family after they learn about MS.
- Find an
obstetrician to care for you through your pregnancy
and delivery. Find one who is willing to work closely with the doctor who helps you
manage your MS. Because fatigue, depression, and medicine use during
breast-feeding are all issues to think about after the baby is born, you may
also want the
pediatrician you choose for your baby to be aware of
your MS.
Complications of MS
Complications that may result
from MS include:
-
Urinary tract infections (UTIs)
. People with MS often have bladder problems, such as
the inability to control or release urine. These problems increase the risk of
UTIs.
- Constipation. Weakness and spasms in the bowel and a low
level of physical activity are common in people who have MS and can lead to
constipation.
-
Pressure sores
. These can develop when
a person has to sit or lie in bed for long periods of time, especially if the
person is unable to change positions.
- Reduced ability to move and
walk, which makes it necessary to use a wheelchair some or all of the
time.
MS
should not interfere with most routine health care procedures, such as dental
anesthesia, general anesthesia (except if you have respiratory problems), and
vaccinations, including flu shots. But it is not clear whether the nasal
spray flu vaccine (FluMist) is safe to use when you have MS. The nasal spray
vaccine should not be used by people who are taking medicines that suppress the
immune system (immunosuppressants), such as mitoxantrone, cyclophosphamide, or
methotrexate; people who have problems with their immune systems; or people
who have long-term health problems.
If you want to donate
blood, talk to your doctor about whether it is safe for you to give blood. Find out
about local blood donation guidelines.
Because MS may affect your ability to move and walk, it
can place limits on your daily living, particularly as you age. Many people
with MS have some disability, but it is not always severe or constant. On
average, people diagnosed with MS live another 30 years or more. A few people
have a severe course of MS and die earlier.
If you or someone in
your family has MS, talk to your doctor about
how MS may affect daily living. Knowing what to expect will help you plan
for the future.
What Increases Your Risk
Your risk of developing
multiple sclerosis (MS) increases with:
-
Geographic location, or where you lived
during childhood (up to age 15). People who spend the first 15 years of their
lives in colder climates that are further away from the equator tend to be more
likely to develop MS than people who lived closer to the equator during those
years.
-
Family history of MS. People who have a parent or
sibling (including an identical twin) with MS are at slightly higher risk of
developing the disease.
- Race. People of Western European
ancestry are more likely to develop MS. It is uncommon in Native Americans,
Eskimos, Asians, and Africans.
- Being female. MS is about three
times as common in women as in men.
When To Call a Doctor
Some of the symptoms of
multiple sclerosis (MS) are similar to those of many
other illnesses. See your doctor if over a period of time you have more than
one symptom, such as:
- Blurry, foggy, or hazy vision, eyeball pain,
loss of vision, or double vision.
- A feeling of heaviness or
weakness, involuntary leg dragging, stiffness, walking problems, and
clumsiness.
- Tingling or a pins-and-needles sensation, numbness,
tightness in a band around the trunk, arms, or legs, or electric shock
sensations moving down the back, arms, or legs.
- Inability to hold
urine or to completely empty the bladder.
- Dizziness and
unsteadiness.
- Problems with memory, attention span, finding the
right words for what you mean, and daily problem-solving.
If you have been diagnosed with MS, see your doctor
if:
- Your attacks become more frequent or
severe.
- You begin having a symptom that you have not had before or
you notice a significant change in symptoms that are already present.
Watchful Waiting
Milder MS-type symptoms can be caused by many
other conditions or periodically occur in healthy people. For example, lots of
people experience minor numbness in their fingers or a mild dizzy spell once in
a while. Stiffness and muscle weakness can result from being more active than
usual.
Watchful waiting is appropriate for these types of
everyday aches and pains, so long as they do not continue.
If your
symptoms become more frequent or do not go away, talk to your doctor.
For people with MS
Talk to your doctor about
what to expect from the disease and from treatment. MS is an unpredictable
disease, but you probably can get some idea of what is “normal” and what
symptoms or problems are reasons for concern.
Some people who have MS
want active, regular support from their doctors. Others want to manage their
condition on their own as much as possible. Wherever you are in this range,
find out which signs or symptoms mean that you need to see your doctor, and
seek help when you need it.
Who To See
Health professionals who may be involved in evaluating
symptoms of multiple sclerosis and treating the condition include:
-
Family doctors
or
internists. Consult your doctor when symptoms first
develop. He or she will refer you to a neurologist if necessary. If you have
MS, your family doctor or internist can treat your general health problems even
if you see a neurologist for MS treatment.
-
Neurologists
. A
neurologist can decide whether your symptoms are caused by MS and can help you
decide what may be the best treatment for your condition.
Many university medical centers and large hospitals have
MS clinics or centers staffed by neurologists and other health professionals
who specialize in diagnosing and treating MS and may be able to provide the
most thorough evaluation.
If you have been diagnosed with MS, at
some point you may need to seek the help of:
- A
physical therapist, to assist with exercise to
maintain body strength and flexibility and deal with movement
problems.
- An
occupational therapist, to identify ways of
accomplishing daily activities if MS has caused any physical
limitations.
- A
speech-language pathologist, to improve speech,
chewing, and breathing if MS has affected the muscles of the face and
throat.
- A
physiatrist. A physiatrist can help with managing
pain, maintaining strength, and adapting to physical disability.
- A
psychologist or
psychiatrist, to evaluate and treat
depression,
anxiety or other mood disorders, and problems with
memory and concentration if these develop.
- A
pain management specialist, to help with any
significant chronic pain that MS may cause. A pain specialist,
often as part of a pain clinic, can help find ways of reducing pain when
possible and dealing with pain that doesn't go away.
- A
neurosurgeon, to perform surgery for severe
tremors or
spasticity.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Diagnosing
multiple sclerosis (MS) is not always easy. It may
take some time from when symptoms first appear to confirm the diagnosis. MS is
diagnosed when it is clear from neurological tests and a neurological
exam that lesions are present in more than one area of the
central nervous system (usually the brain, spinal
cord, or the nerves to the eyes) and that damage has occurred at more than one
point in time.
A diagnosis of MS is confirmed when you have a
combination of:1
- Two separate episodes of neurological
symptoms—such as weakness or clumsiness, vision problems, tingling or numbness,
or balance problems—that a
neurologist can verify. Each episode must have lasted
at least 24 hours and occurred at different times at least 1 month
apart.
- Symptoms that indicate injury to more than one part of the
central nervous system, and MRI and laboratory tests that show abnormal
findings consistent with a diagnosis of MS.
- No other disease or
condition that is clearly causing the symptoms and test results.
Your medical history and
neurological exam can identify possible nervous
system problems and are often enough to strongly suggest a diagnosis of MS.
Tests may help confirm or rule out the diagnosis when your history and
exam do not provide clear evidence of the disease.
Some people have had only one episode of a neurological symptom such as optic
neuritis, but MRI tests suggest they may have MS. This is known as a clinically
isolated syndrome. Many of these people go on to develop MS over time. MS is
diagnosed when MRI tests done a few months apart show more than one area of
neurological damage and when other tests are consistent with MS.
Tests used to diagnose MS
Tests used to diagnose accompanying conditions
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, which may be present without the person being
aware of them. Typically, these tests are in a question-and-answer
format.
Treatment Overview
Treatment can make living with
multiple sclerosis (MS) easier. Your type of treatment
will depend on the severity of your symptoms and whether your disease is active
or in remission.
Initial treatment
In an attempt to slow down the
progression of
multiple sclerosis (MS), treatment with medicine is
usually recommended when MS has been diagnosed. Findings from clinical studies
show that people treated soon after being diagnosed with MS may have better
results than those who delay treatment. Permanent damage to the
nervous system may occur in the initial stages of the
disease. Early treatment may help prevent or delay some of this damage.
Medicines used to treat MS are called disease-modifying
therapies, and they include:
These medicines suppress or
alter the activity of the
immune system.
Although these medicines do not
cure MS, they may reduce the overall number, frequency, and severity of
relapses in some people who have the
relapsing-remitting MS. They may also reduce or delay
disability with this type of MS. Some of these medicines are also used to slow disease progression
in people who have secondary progressive MS.
If you decide
not to try disease-modifying therapy at this time, you can work with your
doctor to regularly evaluate whether the disease is progressing. For more
information on this decision, see:
-
Multiple Sclerosis: Should I Start Taking Medicines for MS?
Physical therapy,
occupational therapy, and nonmedical treatment done at
home can help you manage symptoms and adjust to living and working situations.
For more information, see:
-
Multiple Sclerosis: Rehabilitation Programs.
Ongoing treatment
If you have been diagnosed with
multiple sclerosis (MS), you may need to take medicine
indefinitely.
The medicines used most commonly to treat MS are:
Other medicines your doctor may have you try include:
- Fingolimod (Gilenya). Gilenya is the only medicine for MS that you can take by mouth (oral).
- Natalizumab (Tysabri). Tysabri was taken off
the market in 2005 after studies showed the medicine could possibly be linked
to a serious infection called progressive multifocal leukoencephalopathy (PML).
Soon after, the U.S. Food and Drug Administration (FDA) re-approved Tysabri for
use in people with relapsing forms of MS. If you are taking Tysabri, you will
be watched closely for signs of any serious side effects.
-
Intravenous immune globulin (IVIG). Intravenous means the medicine is given in a
vein. Immune globulin is a protein in human blood and tissue fluids. These
proteins are similar to antibodies, which help the body's immune system
recognize and destroy foreign substances, such as bacteria and viruses.
These medicines suppress or alter the activity of the
immune system. Evidence suggests that MS is an
autoimmune disease, a disease in which the immune
system attacks normal body tissue. In this case, the myelin coating surrounding
nerve fibers is attacked by the immune system.
You also can take
other medicine during attacks or
relapses.
Corticosteroids are commonly used to shorten relapse
time and may limit its severity. But corticosteroids do not prevent
permanent disability from MS and have not been shown to delay or prevent the
progression of the disease.
If you are not taking
disease-modifying therapy at this time, you can continue to work with your
doctor to regularly evaluate the disease's progress. If new lesions develop or
existing lesions grow, you may want to reconsider your decision and begin
treatment. For more information, see:
-
Multiple Sclerosis: Should I Start Taking Medicines for MS?
You and your doctor will set up a schedule
of periodic appointments to monitor and treat your symptoms and follow the
progress of your MS. Monitoring your condition helps your doctor find out
whether you may need to try a different treatment.
Physical therapy,
occupational therapy, and nonmedical treatment done at
home can help you manage symptoms and adjust to living and working situations.
For more information, see:
-
Multiple Sclerosis: Rehabilitation Programs.
Treatment if the condition gets worse
Medicines
should relieve symptoms that cause discomfort and disability from
multiple sclerosis (MS). Symptoms such as
spasticity (stiff, tight muscles), pain, fatigue,
tremor,
depression, sexual difficulties, and
bladder problems often respond well to
medicines.
Physical therapy,
occupational therapy, and nonmedical treatment done at
home may also help you manage symptoms and adjust to living and working
situations. For more information, see:
-
Multiple Sclerosis: Rehabilitation Programs.
What To Think About
Findings from clinical trials
indicate that people treated soon after being diagnosed with MS may have better
results than those who delay treatment.
The National Multiple
Sclerosis Society recommends that people with a definite diagnosis of MS and
active, relapsing disease start treatment with interferon beta or glatiramer. This groups adds that treatment with medicine may also be considered
after the first attack in some people who are at a high risk for MS.4
Still, taking the medicine has several
significant drawbacks. The decision is a hard one for many people with MS.
Some wait to see whether their symptoms get worse before they make a decision
to start therapy. A small percentage of people diagnosed with MS may never have
more than a few mild episodes and never develop any disability. But there is no
way to know yet who will fall into this group.
End-of-life issues
In rare cases,
multiple sclerosis (MS) is life-threatening. If your
condition gets considerably worse, you may want to make a living will,
which allows your wishes to be carried out if you are not able to make
decisions for yourself. For more information, see the topic
Care at the End of Life.
Prevention
In general, there is no way to prevent
multiple sclerosis (MS) or its attacks. For people
with
relapsing-remitting MS, treatment with medicine may reduce the frequency of relapses and delay disability. Interferon beta or glatiramer may delay the progression of the disease for some people with
secondary progressive MS. About 4 out of 10
people with relapsing-remitting MS will progress to secondary progressive MS
within 10 years.5
Claims have been made
that MS may be brought on by injury, shock, pregnancy, or vaccinations, but
there is no scientific evidence to prove these claims. If you already have MS,
a
viral infection (such as the flu) may trigger a
relapse. During pregnancy, women with MS often have fewer relapses. In the
first few months after delivery, though, they may temporarily have more
relapses.
If you have MS, avoid
overheating your body whenever possible. Increased body temperature can
temporarily make your symptoms worse by causing the nerves already affected by
MS to function even more poorly. 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.
Home Treatment
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 or make adjustments to
your work situation. It also may help to adjust your daily schedule so that
your routine is less stressful or tiring. Excessive fatigue is a common problem
for people with MS.
- Follow
MyPyramid. Eat 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.
-
Get regular exercise, either on your
own or with the help of a physical therapist. If you want to exercise on your
own, ask your doctor or a physical therapist to recommend appropriate
exercises.
-
Deal with urination problems. At some
time, most people with MS have bladder problems that can involve difficulty
retaining or releasing urine or a combination of both. Your doctor may
prescribe a medicine to help you. It may also help to plan your fluid intake
and activities so that a toilet will be available when you need to
urinate.
- Change how and what you eat if you are having problems
swallowing, a common problem with advanced MS.
- Thicker drinks make swallowing easier. Try
milk shakes or juices in gelatin form.
- Avoid foods such as crackers
or cakes that crumble easily. These can cause choking.
- Soft foods
need less chewing. Use a blender to prepare food for easiest
chewing.
- Eat frequent, small meals to avoid fatigue from eating
heavy meals.
Physical therapy,
occupational therapy, and nonmedical treatment done at
home may also help you manage symptoms and adjust to living and working
situations. For more information, see:
-
Multiple Sclerosis: Rehabilitation Programs.
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.
For more
advice about coping with MS at home, contact the National Multiple Sclerosis
Society at www.nationalmssociety.org.
Medications
Medicines for
multiple sclerosis (MS) may be used:
- During a
relapse, to make the attack shorter and less
severe.
- Over a long period of time, to alter the natural course of
the disease (disease-modifying therapy).
- To control specific
symptoms as they occur.
Controlling a relapse
Medicines can shorten a
sudden relapse and help you recover more quickly. Temporary treatment with
medicines called
corticosteroids is the most common treatment used to
control a relapse. These medicines have not been shown
to affect the long-term course of the disease or to prevent disability.
Altering the course of MS using disease-modifying treatment
Strong evidence suggests that MS is caused by the
immune system causing
inflammation and attacking the myelin, which is the coating
surrounding the nerve and nerve fibers. Medicines that change the activity of
the immune system can reduce the number and severity of attacks that damage the
protective myelin.
Interferon beta (such as Betaseron), glatiramer (Copaxone), mitoxantrone (Novantrone),
natalizumab (Tysabri), and fingolimod (Gilenya) are the only medicines that have been approved for this
purpose. For people with
relapsing-remitting MS, these medicines can reduce
the number and severity of relapses and can result in fewer brain lesions. They
may also delay disability in some people. Some of these medicines may delay
disease progression in some people who have
secondary progressive MS.
Currently,
there is no effective disease-modifying treatment for
primary progressive MS.
Some people have
only one episode of a neurological symptom such as
optic neuritis. Yet
MRI tests suggest these people have MS. This is known
as a clinically isolated syndrome. Many of these people go on to develop MS
over time. In some cases, doctors will prescribe medicine (either interferon
beta or glatiramer) for people who have had a clinically isolated syndrome.
These medicines, when taken early or even before you have been diagnosed with
MS, may keep the disease from getting worse or extend your time without
disease.6
Relieving symptoms
Treating specific symptoms can
be effective, even if it does not stop the progression of the disease. Symptoms
that can often be controlled or relieved with medicine include:
-
Fatigue. Medicines to reduce fatigue or help you
sleep better may include amantadine (Symmetrel) or fluoxetine
(Prozac).
-
Muscle stiffness (spasticity) and tremors. Medicines
that may reduce muscle spasms or stiffness include baclofen (Lioresal),
tizanidine (Zanaflex), dantrolene (Dantrium), gabapentin (Neurontin), diazepam
(Valium), or clonazepam (Klonopin). Sometimes a combination of these
medicines works best to reduce your muscle symptoms.
-
Urinary problems and constipation. Medicines used to reduce frequent urination may include
propantheline, oxybutynin (Ditropan), or tolterodine (Detrol).
Medicines sometimes used to relieve constipation include bulk agents such as
psyllium (Metamucil) or daily use of laxatives.
-
Pain and abnormal sensations. Depending on the severity of the pain, both
prescription and nonprescription medicines may be tried. Over-the-counter
medicines may include acetaminophen, ibuprofen, or naproxen sodium.
Prescription medicines commonly used to reduce pain associated with MS
include baclofen (Lioresal), carbamazepine (Tegretol), and gabapentin
(Neurontin).
-
Depression. Antidepressant medicines may be used to
reduce depression that often occurs as a result of having MS. Antidepressants
often tried include tricyclic antidepressants (such as amitriptyline,
desipramine (Norpramin), or imipramine (Tofranil)) or selective serotonin
reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) or sertraline (Zoloft).
-
Sexual difficulties. Medicines used
to relieve sexual difficulties that can be associated with MS include
sildenafil (Viagra) for both men and women. Yohimbine and clomipramine may also
be given to improve
erectile dysfunction.
- Walking problems. Dalfampridine (Ampyra) is a medicine that can be used to help with walking problems caused by MS.
MS can affect many parts of the nervous system and
produce a wide range of symptoms. The choice of medicines depends on your
symptoms. Medicine may be used only some of the time or regularly, depending
on how severe or constant a particular symptom is. Changes in diet, schedule,
exercise, and other habits can also help manage some of these symptoms. See the
Home Treatment section of this topic.
Medication Choices
Controlling a relapse
Medicines used to treat
an attack of multiple sclerosis (MS) and help you recover more quickly from a
relapse include:
Relapsing-remitting MS
Medicines used
specifically for relapsing-remitting MS to reduce the number and severity of
relapses and possibly delay disability include:
-
Interferon beta (such as Betaseron).
-
Glatiramer
(Copaxone).
-
Mitoxantrone (Novantrone) for relapsing-remitting MS
that is rapidly getting worse or when other medicines for MS have not worked.
- Natalizumab
(Tysabri). This drug is now available, on a limited basis, for treating
relapsing forms of MS when other medicines for MS have not worked. Talk to your
doctor to learn more about natalizumab.
- Fingolimod (Gilenya).
Secondary-progressive MS
Medicines used to
treat and possibly delay the progression of secondary progressive MS that is
also relapsing include:
Primary-progressive MS
No medicines have been
clearly proved to help, and none have been approved for primary-progressive MS.
Some of the newer and experimental medicines, such as
immunosuppressants and
other medicines and biological chemicals (derived
from or identical to substances produced by the body) are being tested for
primary-progressive MS.
Medicines being studied
A variety of
immunosuppressants and
other medicines and biological chemicals (derived
from or identical to substances produced by the body) have been tried as
therapy for MS. While none have been clearly proved beneficial and none have
been approved for treatment of MS, these medicines may be used when standard
therapy fails.
Several medicines are currently being tested in
clinical trials. People with MS who have not responded
to standard therapy sometimes choose to take part in these trials. To learn
more about clinical trials, talk to your doctor or contact the National
Multiple Sclerosis Society at www.nationalmssociety.org.
What To Think About
Long-term treatment with
interferon beta and glatiramer can improve the quality of life for some
people who have relapsing-remitting MS by making relapses less frequent and
less severe. Some evidence suggests that these medicines may also reduce or
delay future disability caused by this form of the disease.
The
National Multiple Sclerosis Society recommends that people with a definite
diagnosis of MS and active, relapsing disease start treatment with interferon
beta or glatiramer. Most
neurologists support this recommendation and now agree
that permanent damage to the
nervous system may occur early on, even while symptoms
are still quite mild. Early treatment may help prevent or delay some of this
damage. In general, treatment is recommended until it no longer provides a
clear benefit.
The National MS Society also says that treatment with medicine may be
considered after the first attack in some people who are at a high risk for MS
(before MS is definitely diagnosed).4
Despite the recommendation, some people find it
hard to decide whether to begin disease-modifying therapy, especially when
their symptoms have been fairly mild. Some may not want to bear the risks and side effects of medicine when they are not sure they need it. Some may want to see whether their disease gets worse before they start therapy.
A small percentage of people diagnosed with MS may never have more than a few
mild episodes and may never develop any disability, but the disease is
unpredictable. For more information, see:
-
Multiple Sclerosis: Should I Start Taking Medicines for MS?
If you decide not to try disease-modifying therapy at
this time, work with your doctor to monitor your health through regular
checkups and periodic MRI scans to evaluate whether the disease is progressing.
If new lesions are developing or existing lesions are growing, you may want to
reconsider your decision and begin treatment.
Treating symptoms and relapses
The need and
desire for medicine vary. If your symptoms are mild, you may choose to manage
them without any medicine. If you have specific symptoms that are causing
problems, certain medicines may help you keep them under control. Or you may
want to use medicine only during a relapse.
You may also want to
think about:
- The possible side effects of using steroids
or other medicines to treat symptoms or control a relapse. Some people have
only minor side effects. But others may have side effects that concern them
more than their MS symptoms.
- The costs of treating symptoms and
controlling relapses. In some cases, using medicine to control symptoms and
relapses may reduce the need for hospital stays.
- Other personal
issues that you face at work or at home.
Also keep in mind that it can be hard to tell whether
medicine is helping. Multiple sclerosis is a disease with spontaneous
remissions, which means that your condition can improve on its own, without any
treatment. Just because your symptoms improve after treatment does not mean
that a treatment is working.
Surgery
People with
multiple sclerosis (MS) who have severe
tremor (shakiness) affecting movement may be helped by
surgery. People with severe
spasticity (muscle stiffness) may be helped by
insertion of a spinal pump to deliver medicines when oral medicines
fail.
Surgery Choices
Surgery options include:
-
Deep brain stimulation for tremor.
Severe and disabling tremor that occurs with the slightest movement of the
limbs may be helped by an implanted device that stimulates an area of the
brain. A
neurological surgeon performs the surgery to implant
the device.
- Implantation of a drug catheter or pump, for
spasticity. People who have severe pain or spasticity may benefit from having a
catheter or pump placed in the lower spinal area to deliver a constant flow of
medicine, such as baclofen (Lioresal).
What To Think About
Deep brain stimulation usually
is a last resort after all other options have been tried without success to
treat MS symptoms. Only people with severe tremor are candidates.
Other Treatment
The unpredictability and
variety of symptoms caused by
multiple sclerosis (MS) make it a disease that people
have tried to treat in many different ways.
Experimental medical treatments
Experimental
treatments for MS involve reducing the activity of the
immune system with
immunosuppressants or through methods such as
total lymphoid irradiation, in which the entire lymph
node system is exposed to radiation. While these methods have been used with success in
the treatment of certain other medical conditions, they have failed to produce
significant benefits when tested in controlled clinical trials. They remain
experimental treatments for MS, although they may be considered for people who
do not respond to any other therapy.
Stem cell transplant
, which uses immature cells from the bone marrow, has been studied. Early results show that stem cell transplant may delay disability, especially in people with relapsing-remitting MS.7 It is not currently
recommended for treating MS.
Complementary therapies
Other types of treatment
for MS are provided by therapists or others who do not operate within
mainstream medical practice. Their
alternative medical approaches attract many people
who have MS, particularly those who have not had much success with conventional
treatments. Many people with MS use complementary or alternative therapies in
addition to more standard therapy.
None of these complementary
therapies have been shown through clinical research to be effective in treating
MS and are not recommended by most doctors. But sometimes people with MS find
that even though complementary therapies do not slow the progression of the
disease, the therapies help them feel better. Talk to your doctor if you are
interested in trying any of the complementary therapies.
Other Treatment Choices
Many complementary therapies have been proposed as
treatments for MS. None of these treatments have been shown to modify the
course of the disease. Some of those most commonly used are:
Although clinical research has not shown any of these
complementary therapies to be effective, a person with MS may benefit from safe
nontraditional therapies that complement conventional medical treatment. Some
complementary therapies may help relieve
stress and muscle tension. And some may improve your overall
well-being and quality of life.
Clinical research also has been
unable to show that treatments such as bee venom therapy, Prokarin (a caffeine
and histamine combination),
removal of mercury fillings (dental amalgams), and
hyperbaric oxygen therapy have any benefits for people
with MS. Some of these therapies may be harmful as well as expensive and are not recommended by most experts.
What To Think About
There is no cure for MS. So far, the only treatments proved
to affect the course of the disease are interferon beta (such as Betaseron), glatiramer (Copaxone), mitoxantrone (Novantrone),
natalizumab (Tysabri), and fingolimod (Gilenya). Other types of treatment should not replace these medicines if you are a candidate for
treatment with them.
No complementary therapies have been proved
effective in the treatment of MS. But some people have reported that
complementary therapies have worked for them. This may be in part due to the
placebo effect, which is common in people who are
being treated for MS. This also may be due to the fact that some complementary
therapies, while not treating the disease itself, may affect a person's overall
sense of well-being and help the person feel better and healthier. And, in some
cases, symptoms may improve on their own.
If you have MS and are
thinking about trying a complementary treatment, get the facts first. Consider
these questions with your doctor:
-
Is it safe? Talk with
your doctor about the safety and potential side effects of the treatment. This
is especially important if you are on drug therapy for MS, because some
complementary treatments in combination with drug therapy can be quite
dangerous. A treatment that could be harmful to you and may or may not improve
your symptoms is not worth the risk.
-
Does it work? Because MS symptoms can come and go, you may find it hard to
judge whether a particular treatment is really working. Keep in mind that if
you get better after using a certain treatment, the treatment is not always the
reason for the improvement. MS may often improve on its own (spontaneous
remission).
-
How much does it cost? An
expensive, unproven treatment that may or may not help you may not be worth its
cost. Beware of therapy providers or products that require a large financial
investment at the beginning of a series of treatments.
-
Will it improve my general health? Even if they are not
effective in treating MS, some complementary practices (such as acupuncture,
massage, or yoga) may be safe and may lead to healthy habits that improve your
overall well-being. These might be worth trying.
With a hard-to-treat disease like MS, it can be tempting
to jump at the promise of an effective treatment. Be cautious about trying
unproven treatments.
Other Places To Get Help
Organizations
|
National Institute of Neurological Disorders and
Stroke
|
| NIH Neurological Institute |
| P.O. Box 5801 |
| Bethesda, MD 20824 |
| Phone: |
1-800-352-9424 |
| Phone: |
(301) 496-5751 |
| TDD: |
(301) 468-5981 |
| Web Address: |
www.ninds.nih.gov |
| |
|
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
|
|
|
Multiple Sclerosis Foundation
|
| 6350 North Andrews Avenue |
| Fort Lauderdale, FL 33309-2130 |
| Phone: |
1-888-MS-FOCUS (1-888-673-6287)
(954) 776-6805 |
| Fax: |
(954) 351-0630 |
| Email: |
support@msfocus.org |
| Web Address: |
www.msfacts.org |
| |
|
This not-for-profit organization provides support services and
information on holistic, alternative, and conventional medical care options for
people with multiple sclerosis (MS). It does not endorse any single health care
approach but provides information on all. It publishes a quarterly
newsletter.
|
|
|
Multiple Sclerosis International Foundation (MSIF)
|
| Phone: |
+44 (0) 20 7620 1911
|
| Fax: |
+44 (0) 20 7620 1922 |
| Email: |
info@msif.org |
| Web Address: |
www.msif.org |
| |
|
The Web site has information about multiple sclerosis, how to find support (including maps with lists of MS societies around the world), how to get involved, stories from people with MS, research news, and other resources. The Multiple Sclerosis International Federation (MSIF) was established in 1967 as an international body linking the activities of national MS societies around the world.
|
|
|
National Multiple Sclerosis Society
|
| 733 Third Avenue |
| Third Floor |
| New York, NY 10017-3288 |
| Phone: |
1-800-FIGHT-MS (1-800-344-4867) |
| Web Address: |
www.nationalmssociety.org |
| |
|
This organization has many resources for people with multiple
sclerosis (MS). It provides referrals to neurologists and other health
professionals, physical activity programs, and affiliations with 80 MS
treatment centers throughout the United States. It operates counseling services
at the chapter level and assists in family and social support, independent
living, and referrals to long-term care facilities. It compiles current
research reports, publishes pamphlets and the Inside MS
magazine for consumers, and has a network of over 140 local chapters and
related support groups.
|
|
References
Citations
-
Polman CH, et al. (2005). Diagnostic criteria for
multiple sclerosis: 2005 revisions to the McDonald Criteria. Annals of Neurology, 58(6): 840–846.
-
Sadiq SA (2005). Multiple sclerosis. In LP Rowland,
ed., Merritt's Neurology, 11th ed., pp. 941–963.
Philadelphia: Lippincott Williams and Wilkins.
-
Tintoré M (2003). New diagnostic criteria for multiple
sclerosis: Application in first demyelinating episode. Neurology, 60(1): 27–30.
-
National Clinical Advisory Board of the National
Multiple Sclerosis Society (2007). Disease Management Consensus Statement. New York: National Multiple Sclerosis Society. Available
online:
http://www.nationalmssociety.org/for-professionals/healthcare-professionals/publications/expert-opinion-papers/index.aspx.
-
Lindsey JW, Wolinsky JS (2008). Demyelinating
diseases. In EG Nabel, ed., ACP Medicine,
section 11, chap. 9. Hamilton, ON: BC Decker.
-
Faggiano CM, et al. (2008). Recombinant interferon beta or glatiramer acetate for delaying conversion of the first demyelinating event to multiple sclerosis. Cochrane Database of Systematic Reviews (2).
-
Burt RK, et al. (2009). Autologous non-myeloablative haemopoietic stem cell transplantation in relapsing-remitting multiple sclerosis: A phase I/II study. Lancet Neurology, 8(3): 244–253.
Other Works Consulted
- Burton JM, et al. (2009). Oral versus intravenous steroids for treatment of relapses in multiple sclerosis. Cochrane Database of Systematic Reviews (3).
- Courtney AM, et al. (2009). Multiple sclerosis. Medical Clinics of North America, 93(2): 451–476.
- Fox RJ, Arnold DL (2009). Seeing injectable MS therapies differently: They are more similar than different. Neurology, 72(23): 1972–1973.
- Giesser B (2008). Reproductive Issues in Persons With Multiple Sclerosis. Clinical Bulletin: Information for
Health Professionals. Available online: http://www.nationalmssociety.org/for-professionals/healthcare-professionals/publications/clinical-bulletins/index.aspx.
- Goodin DS, et al. (2007). Neutralizing antibodies to interferon beta: Assessment of their clinical and radiographic impact: An evidence report: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 68(13): 977–984.
- McDonald WI, et al. (2001). Recommended diagnostic
criteria for multiple sclerosis: Guidelines from the International Panel on the
Diagnosis of Multiple Sclerosis. Annals of Neurology,
50(1): 121–127.
- Polman CH, et al. (2006). A randomized,
placebo-controlled trial of natalizumab for relapsing multiple sclerosis.
New England Journal of Medicine, 354(9):
899–910.
- Yousry TA, et al. (2006). Evaluation of patients
treated with natalizumab for progressive multifocal leukoencephalopathy.
New England Journal of Medicine, 354(9):
924–933.
Credits
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
Anne C. Poinier, MD - Internal Medicine |
|
Primary Medical Reviewer
|
Adam Husney, MD - Family Medicine |
|
Specialist Medical Reviewer
|
Colin Chalk, MD, CM, FRCPC - Neurology |
|
Last Revised
|
May 12, 2010 |