Multiple Sclerosis - Adult

Causes

MS is caused by a problem with the immune system. Parts of the immune system attack nerve fibers in the brain, spinal cord, and nerves to the eyes. The exact reason why the immune system does this is not known. Things that may play a role in a person having MS include:

• Issue with genes (can be passed down in families)
• Viral or other infection
• Environmental factors

Abnormal Immune Responses Cause Nerve Damage

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Risk Factors

MS is more common in women. It often first appears in people aged 15 to 50 years of age. Other things that may raise the chance of MS include:

• Having family members who have MS or other autoimmune disorders, such as systemic lupus erythematosus
• Exposure to Epstein-Barr virus
• Being of Northern European descent
• Growing up in a colder climate, as opposed to a tropical climate
• Having certain immune system genes
• Having swelling of the nerve to the eye
• Having low vitamin D levels
• Smoking

Symptoms

Symptoms may range from mild to severe and may include:

• Numbness or tingling in the face or limbs
• Eye pain or sudden vision changes in one or both eyes, including blurred or double vision and loss of vision
• Fatigue
• Lightheadedness
• Muscle weakness, stiffness, and spasms, or weakness in one or more limbs
• Trouble walking or maintaining balance, clumsiness, or falling
• Bladder problems such as trouble with urgency, starting urination, or emptying; may also have loss of bladder control
• Bowel problems such as constipation
• Sexual dysfunction
• Slurred speech
• Difficulty swallowing
• Forgetfulness, memory loss, confusion, or problems concentrating or solving problems
• Depression

Symptoms may get worse with:

• Heat, including weather, hot baths or showers, and fever
• Intense physical activity
• Infection

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. There is no test to confirm MS. Instead the doctor will rule out other conditions that cause similar problems. Tests may include:

• Blood tests—to rule out other diseases that may look like MS
• MRI scan
• Lumbar puncture—sample and test of fluid around the brain and spinal cord
• Sensory evoked potentials—check how you respond to stimulus
• Visual evoked potential test—test the brain's response to what you see
• Optical coherence tomography (OCT)—to look at the eye and nerve to the eye

Treatment

There is no cure for MS. Treatment can help ease symptoms and prevent or slow them from happening again. For primary and secondary progressive MS, treatment can also slow the progress of the disease. It may delay disability. Options include:

Medicine

Medicine can help slow MS. It may also help manage symptoms. Types of medicine that can slow the progression of MS or prevent damage to nerve fibers include:

• Interferon betas
• Glatiramer acetate
• Immunomodulators
• Immunosuppressives

Corticosteroids may be given during active phases. It can help reduce swelling. It may lessen damage to the nerve fibers and shorten the length of relapses.

Symptoms may be managed with:

• Muscle relaxants—to reduce muscle spasms
• Potassium channel blockers—to help with vision and motor skills, and ease fatigue
• Botox injections—to reduce tremor and muscle tone
• Pain relievers
• Antidepressants
• Medicine to help with bladder or bowel problems

Supportive Therapies

MS can impact different areas of health and wellness. Supportive therapy includes:

• Regular moderate exercise—swimming may be especially helpful
• Physical therapy—to help muscle strength and tone, movement, and walking ability
• Occupational therapy—to help with daily living activities
• Speech and/or swallowing therapy
• Cognitive therapy—to address mental health changes
• Stress reduction tools

Some alternative therapies that have shown some benefits include:

• Massage
• Magnetic therapy
• Reflexology

Alternative therapies should only be used along with a medical plan. Care team can help to create a plan.

Psychological Therapies

Long term health issues and changes in ability can be stressful. Individual or group therapy can help develop coping skills. It may help ease stress and anxiety and improve quality of life.

Avoiding Periods of Relapse

Some MS have periods of time with no symptoms. Certain steps may help delay or avoid relapses. It may also keep symptoms from getting worse. Steps include:

• Stick to the treatment plan created with the doctor
• Get enough rest—adjust as needed
• Avoid hot weather
• Stay in air-conditioned places during periods of hot weather
• Avoid hot showers or baths
• Avoid overexertion and stress
• Avoid infection by:
  • Using proper hygiene, especially when washing your hands
  • Staying away from people who are sick
  • Thoroughly cooking food
  • Practicing safe sex
• Quitting smoking—smoking may worsen MS

Prevention

There are no current guidelines to prevent MS.