Multiple sclerosis (MS) is a chronic, disabling disease of the central nervous system. The disease causes inflammation, destruction, and scarring of the sheath that covers nerve fibers, called myelin, in the brain and spinal cord. As a result, electrical signals from the brain are slowed or blocked from reaching the eyes, muscles, and other parts of the body.

There are several types of MS:

• Relapsing-remitting MS—Symptoms suddenly reappear every few years, last for a few weeks or months, then go back into remission. Symptoms sometimes worsen with each occurrence.
• Primary progressive MS—Symptoms gradually worsen after symptoms first appear. Relapses and remissions usually do not occur.
• Secondary progressive MS—After years of relapses and remissions, symptoms suddenly begin to progressively worsen.
• Progressive relapsing MS—Symptoms gradually worsen after symptoms first appear. One or more relapses may also occur.

Malfunction of the body's immune system seems to be the cause of MS, but the exact cause of this malfunction is unknown.

The following conditions may contribute to MS:

• Viral or other infection
• Genetic factors (heredity)
• Environmental factors
• Degeneration of parts of the nervous system

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for MS include:

• Sex: female
• Age: 15-50 years old
• Being exposed to certain viruses
• Having family members who have MS
• Being of Northern European descent
• Growing up in a colder climate, as opposed to a tropical climate
• Having certain immune system genes
• Having inflammation of the optic nerve
• Having low vitamin D levels (may be a risk factor)
• Smoking (may be a risk factor)

Symptoms may range from mild to severe and may include:

• Numbness or tingling in the face or limbs
• Impaired vision in one or both eyes, including:
  • Blurred vision
  • Double vision
  • Loss of vision
• Eye pain
• Fatigue
• Dizziness
• Muscle stiffness
• Muscle spasms
• Muscle weakness
• Incoordination or falling
• Trouble walking or maintaining balance
• Weakness in one or more limbs
• Bladder problems including:
  • Urgency
  • Hesitancy
  • Incomplete emptying
  • Incontinence
• Bowel problems, including constipation
• Sexual dysfunction
• Slurred speech
• Difficulty swallowing
• Forgetfulness, memory loss, and confusion
• Difficulty concentrating or solving problems
• Depression

Factors that may trigger or worsen symptoms include:

• Heat including:
  • Hot weather
  • Hot baths or showers
  • Fever
• Overexertion
• Infection

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

• MRI scan —a test that uses magnetic waves to make pictures of structures inside the brain and spinal chord
• Evoked potentials—a test that records the electrical responses evoked after a sensory stimulus
• Lumbar puncture (spinal tap)—removal of a small amount of fluid from around the spinal cord to check for white blood cells, antibodies, and proteins
• Blood tests to rule out other diseases that may mimic MS (eg, B12 deficiency , Lyme disease , autoimmune disease)
• Visual evoked potential test —to look for problems in the brain that affect vision

The goals of MS treatment are to relieve symptoms, prevent relapses, delay disability, and slow disease progression.

Treatments include:

Medications may include:

• Corticosteroids—to reduce nerve tissue inflammation and shorten MS flare-ups
• Interferon beta (Betaseron)—(a protein that naturally occurs in the body)—used to suppress the immune system
• Glatiramer acetate —to help prevent MS relapses by modifying the function of the immune system
• Other immunosuppressive drugs, such as:
  • Intravenous immunoglobulin
  • Cyclophosphamide (Cytoxan)
  • Mitoxantrone (Novantrone)
  • Azathioprine (Imuran, Azasan)
  • Methotrexate (Rheumatrex, Trexall)
• Intravenous immunoglobulin
• Natalizumab (Tysabri)—for relapsing MS (This medication is under a mandatory registration program.)
• Muscle relaxants—to treat muscle spasms or stiffness
• Other drugs to treat:
  • Fatigue
  • Depression
  • Pain
  • Bladder or bowel problems

Therapies and changes may include:

• Regular moderate exercise with your doctor's permission (Swimming is especially beneficial.)
• Physical therapy to help maintain muscle strength and tone, dexterity, and walking ability
• Massage
• High fiber diet to prevent constipation
• Stress reduction techniques
• Quitting smoking —Smoking may worsen MS, possibly causing the condition to progress to a more severe form.

Individual or group therapy will help you learn coping strategies for physical symptoms and emotional stress.

If you are diagnosed with MS, follow your doctor's instructions .