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Multiple sclerosis is a complex disease, and its many patterns of progression make each case unique. Multiple sclerosis is an autoimmune disease that affects the body’s ability to send nerve signals. It occurs when your immune system attacks the myelin sheath, a protective coating on your nerve cells. The myelin sheath is like insulation on a wire. It doesn’t just protect the nerve from damage; it also keeps the signal from being lost or distorted. When your myelin coating is damaged, the nerves inside it can’t properly send signals, and the exchange of information between your body and brain is disrupted. MS also causes the immune system to attack oligodendrocytes, the myelin-producing cells that would otherwise repair the damaged sheath. When your myelin is damaged, the nerves inside it can’t properly send signals, and the exchange of information between your body and brain is disrupted.
Although no two people experience MS in the same exact way, researchers have identified 4 major types of the disease that can be used as guidelines for prognosis and treatment. To that end, MS is classified as:
Relapsing-remitting multiple sclerosis, or RRMS, is by far the most common form of the disease; in fact 17 out of every 20 people with MS will have RRMS at the time of their diagnosis. RRMS usually develops at a younger age than other forms of multiple sclerosis, typically between age 20 and 50, and affects women about two to three times as often as men. RRMS is characterized by cycles of relapse and remission. During relapse, MS symptoms appear for days, weeks, or months at a time before lessening or completely disappearing during longer periods of remission.
In Secondary progressive MS, symptoms worsen continuously, even though there may be some periods of relative stability. Most people with relapsing-remitting MS will develop secondary-progressive MS at some point in their lifetime.
The transition between relapsing-remitting MS and secondary-progressive MS usually occurs 10 or more years after the initial diagnosis, though the specific boundary line between the two types is difficult to determine.
Primary progressive MS, or PPMS, occurs when symptoms steadily worsen from the start of the disease. Symptoms may stop worsening or may even slightly improve for a while, but there are no clear remissions or relapses. About 1 out of every 10 people with MS has PPMS. PPMS affects men and women equally, and it tends to start at a later age–usually in a person’s 40s or 50s. PPMS is often the hardest form of MS to treat because the medications for relapsing MS focus on treating inflammation, which seems to be less important in this form of the disease. Progression is variable among individuals.
Progressive relapsing MS, or PRMS, is the rarest form of the disease, affecting only 1 out of every 20 people with MS. PRMS has a progressive course from onset, like PPMS, but includes superimposed acute relapses, from which there may be complete or partial recovery. Medications are available to treat inflammation and potentially slow the course of the disease, however the varying forms of MS respond to medications in different ways. There is ongoing research focusing on the treatment of progressive forms of MS, as there is currently no approved disease modifying therapy for this type of the disease. Talk to your doctor to determine which course of treatment is best for you.
MS is most commonly diagnosed in women aged 20 to 50 years. Family history of MS may raise your risk for the disease, as can some viruses, such as Epstein-Barr, the virus responsible for mononucleosis. Smoking both increases your chances of getting MS and accelerates progression of the disease.
The presence of other autoimmune diseases can also increase your risk since it reflects an auto-reactive tendency, while immune regulating compounds, like the Vitamin D your body makes as a result of sun exposure, may lower your risk.
While RRMS is defined by attacks of inflammation (relapses) in the CNS, progressive forms of MS involve much less of this type of inflammation.
In RRMS, women are affected two to three times as often as men; in PPMS, the number of women and men are approximately equal. RRMS is diagnosed earlier than the progressive disease courses:
The most common symptoms reported in RRMS include episodic bouts of fatigue, numbness, vision problems, spasticity or stiffness, bowel and bladder problems, and problems with cognition (learning and memory or information processing). People with progressive forms of MS are more likely to experience gradually worsening problems with walking and mobility, along with whatever other symptoms they may have.
MS can be challenging, both physically and emotionally, the proper medical regimen allows many people with this disease to live normal or near-normal lives.
Relapsing-remitting MS is defined by inflammatory attacks on myelin (the layers of insulating membranes surrounding nerve fibers in the central nervous system (CNS)), as well as the nerve fibers themselves. During these inflammatory attacks, activated immune cells cause small, localized areas of damage, which produce the symptoms of MS. Because the location of the damage is so variable, no two people have exactly the same symptoms.
No one knows what causes your immune system to attack your nerves. Most doctors believe it is caused by some combination of genetic factors and an environmental trigger, possibly a virus. A number of ideas about what causes MS have been looked into and disproven in the past. For example: to the best of scientific knowledge MS is not caused by pets, allergies, aspartame, physical injuries, or exposure to heavy metals such as mercury and lead—although heavy metal poisoning can cause symptoms that resemble MS. Research into the precise causes of MS is ongoing, bringing us to a closer understanding of this potentially debilitating disease. The cause of MS is still under investigation. Here’s what experts are focusing on:
The good news: MS is not contagious. Contact with or exposure to someone who has MS does not put you at risk of developing it.
Doctors know more about multiple sclerosis than they used to, but there is still a lot of research to be done. Over the years, there’s been a lot of research into the causes of multiple sclerosis and the treatments for this potentially debilitating disease. So far, we know that the symptoms of MS are caused by the degeneration of nerve tissue as a result of damage to the myelin sheath, the protective coating around nerve cells, and that certain disease-modifying therapies that modulated the immune system, can lessen the likelihood of these symptoms. Many once-suspected causes, such as traumatic injuries, pets, and heavy metals, have been ruled out, while other contributing factors, such as smoking and lack of sunlight, have shown an association with MS.
These are the factors that may affect your risk of developing multiple sclerosis:
In addition to the currently suspected risk factors of age, sex, geographic location, immunological factors, and genetic/family history, researchers have:
According to the National MS Society, women get RRMS two to three times more often than men.
It may be a while before we know exactly what causes MS or how to stop it, but doctors and scientists are working hard to unravel this potentially debilitating disease. Tremendous progress has been made in treatment options, with the development of 10 new treatments for relapsing MS in the last 20 years. Much is left to do still, particularly in the realm of progressive forms of the disease, as well as remyelination and repair.
Multiple sclerosis can be hard to diagnose because symptoms may come and go. For instance, Benign MS most often can’t be diagnosed immediately, as it is dependent on the length in between symptomatic attacks, which may be years. The many symptoms of Multiple sclerosis, or MS, can sometimes make a diagnosis difficult. Relapsing-remitting multiple sclerosis (RRMS) is characterized by clearly defined attacks of worsening neurologic function. These attacks — often called relapses, flare-ups or exacerbations — are followed by partial or complete recovery periods (remissions), during which symptoms improve partially or completely, and there is no apparent progression of disease. RRMS is the most common disease course at the time of diagnosis. Approximately 85 percent of people are initially diagnosed with RRMS, compared to 10-15 percent with progressive forms of the disease.
Early symptoms of RRMS may include:
These symptoms may come and go, sometimes disappearing for months at a time; and worsened symptoms may be brought on by stress, changing temperatures, or other factors.
Before a diagnosis is made, your doctor needs to rule out the possibility of other conditions. At this time, there isn’t one specific test that can diagnose MS, and more specifically RRMS. According to the Columbia University Multiple Sclerosis Clinical Care & Research Center in New York, the diagnosis of MS requires several different types of screening. The Multiple Sclerosis Foundation (MSF) estimates that in the hands of experts, diagnosis of the condition is correct 90 to 95 percent of the time. Most likely, you’ll start with a visit to your primary care doctor, who will conduct a physical exam and ask about your current symptoms and medical history. If your doctor suspects MS, he or she may refer you to a neurologist for additional testing.
The following are the main procedures used in the diagnosis process:
These tests, combined with your symptoms and physical exam, help your doctor determine whether you have MS, and, if you do, the type of MS that you have. Then you and your doctor can develop a treatment plan best suited to your individual needs.
People with MS experience different symptoms. Because most cases of MS are characterized by cycles of attacks (relapses) and periods of recovery (remissions), some problems may appear early in the disease and then disappear for months or years at a time. You may have only a few symptoms that go away and come back without changing, or you can have several symptoms that worsen as the disease progresses. One of the hallmarks of MS is the variability of its symptoms. No two people are likely to experience the same set of symptoms in the same way. Some symptoms may come and go or appear once and not again. Which symptoms you have depends on the area of the brain or spinal cord that has been damaged.
The symptoms of relapsing-remitting MS may include:
An RRMS attack can last anywhere from 24 hours to several weeks. An attack can involve:
Tell your doctor about symptoms of a relapse as soon as possible. Treating it quickly may reduce permanent damage and disability.
There’s no cure for MS, but it’s not fatal. The University of Maryland Medical Center (UMMC) reports most people with MS experience a normal (or near normal) life span and will not become severely disabled as the majority of MS cases relapse remit either entirely or partially. RRMS varies a great deal from person to person; and for this reason it’s impossible to offer a prognosis with any degree of certainty. There are some people with RRMS that experience more frequent and severe relapses, while others stay in remission for years, and others go on to develop a progressive form of the disease or have permanent disabilities. The good news is that most people with MS do not become permanently disabled and most live a normal or near-normal lifespan. It is important to note that suicide rates among people with MS are higher than those in the general population. However, with the proper treatment and support system to help you through life with MS, you should be able to remain happy and healthy.
Here are ten tips to help you live with MS:
All these tips in mind, it’s important that you talk to your doctor to see which options are best for you.
Since there are no specific tests for multiple sclerosis, and RRMS in particular. The risk of developing MS is extremely low for the general population – only 1 in 1000 – MS is not a disease that you need to be regularly screened for. Knowing your family history and other risk factors may help you better understand your risk of developing the disease, but remember that MS is in many ways unpredictable.
If you think you may have MS or RRMS, visit your doctor. He or she will be able to conduct the proper diagnostic tests. (hyperlink “diagnostic tests” to the “Diagnosing MS” page, where tests are listed)
There are no proven ways to prevent multiple sclerosis.
There is no cure for MS, but there are medications that may help to treat attacks, manage symptoms, and reduce the progression of the disease. If your MS is mild, you may not need any medication.
The following medications are approved by the Food and Drug Administration (FDA):
Certain MS medications have been shown to increase risks of pregnancy complications, so make sure to talk to your doctor before taking any medications if you are trying to become pregnant, are pregnant, or are breastfeeding.
To decrease relapse frequency and slow progression of the disease, for example, your doctor may prescribe:
Other common prescription medications include corticosteroids for inflammation, and muscle relaxants for stiffness and spasms.
Physical therapy and a treatment called plasmapharesis, in which blood is removed from the body, cleaned of antibodies, and returned, can also be helpful in shortening the duration of symptoms of an attack.
There are four basic types of MS. Out of every twenty people diagnosed with MS,
About 65%— or 11 out of 17—people diagnosed with relapsing-remitting MS will go on to develop the fourth type of the disease, secondary progressive MS. If you have relapsing-remitting, secondary progressive with relapses, or progressive-relapsing MS, there are 10 FDA-approved medications that may slow disease progression and decrease frequency of attacks. When choosing one of these disease modifying medications, you and your doctor should take into consideration your symptoms, disease progression, and possible side effects.
In addition to these disease-modifying treatments, corticosteroids are used intermittently to shorten duration of attacks.
Twelve medications have been approved by the FDA for the specific treatment of RRMS, along with progressive-relapsing MS. All twelve medications have demonstrated the ability to reduce the number of relapses—sometimes known as attacks or exacerbations—and the number of new lesions—also known as plaques or scars—by MRI. These medicines may also slow disease progression—and MS specialist recommend beginning one of these prescription medicines at point that RRMS diagnosis is confirmed. These medications have different methods of delivery:
Lemtrada is used for those with RRMS that have not had a good response to at least two other disease-modifying medications. Novantrone Is used specifically for those that have worsening RRMS, meaning that the disease has begun to progress, despite treatment with first-line therapies, along with those that have secondary-progressive MS.
New treatment developments include:
Additionally, a clinical trial review committee has recommended that relapsing-progressive MS be categorized as a form of primary-progressive MS in order to make research, diagnosis, and treatment easier following a re-examination of MS categorization guidelines. It may be a while before we know exactly what causes MS or how to stop it, but doctors and scientists are working hard to unravel this potentially debilitating disease. Tremendous progress has been made in treatment options, with the development of 10 new treatments for relapsing MS in the last 20 years. Much is left to do still, particularly in the realm of progressive forms of the disease, as well as remyelination and repair.
Doctors are increasingly incorporating complementary treatments such as these within individualized, multimodal treatment plans for MS management. At present, more than one hundred medical institutions offer some nontraditional treatments to patients in addition to conventional medicine, physical therapy, and rehabilitation therapy your doctor might prescribe you, there are a number of alternative and complementary treatments that may help with your MS symptoms. These include:
Caring for your overall health can make a big difference in how you experience Multiple Sclerosis. Diet and exercise are key to living well with MS. While there is no universal diet that is best for those with MS, there are many things that can be done that will be beneficial and help keep symptoms at bay.
Exercise and MS
Regular exercise has a number of benefits that may help you manage your MS. Exercise:
More than a dozen studies have shown that exercise can help manage MS symptoms. Benefits of regular exercise for patients with MS include:
Unfortunately, MS does not always make exercise easy. Symptoms like fatigue, heat sensitivity, muscle spasms, and mood swings can make it difficult to get to the gym. Certain forms of exercise can be easier than others. For example:
A physical therapist would be able to help you understand your personal health and fitness needs, as well as design an exercise routine that works best with your MS symptoms. Remember to keep cool when you exercise. Wear lightweight, breathable clothing, drink plenty of water, and keep an eye on the outside temperature. If it gets too hot, you may want to exercise indoors, where there’s air conditioning, or take advantage of the cooling vests and other cooling apparel that are available. Remember that increasing your core temperature can worsen MS symptoms, but it doesn’t cause damage in the nervous system. Cooling off should help the symptoms resolve.
Always talk to your doctor before you start a fitness regimen. With your doctor’s approval, an appropriate exercise routine can be a key part of living a healthy life with MS.
Diet and MS
Though there is no universal diet for people with MS, there are several steps you can take towards healthy living:
Try supplements after discussing with your doctor. Avoid supplements that are known or purported to be immune stimulants, such as Echinacea or high doses of Vitamin C or Zinc; as MS is a disease characterized by an overactive immune system There is some data indicating that Gingko and Evening Primrose Oil may confer benefit, but speak to your doctor to see what’s right for you.
Just because a product can be purchased without a prescription, that doesn’t mean it is advised or safe for MS patients. While scientists are searching for the perfect dietary approach to MS, it’s important to remember balance and moderation. Talk to your doctor before deciding on a new dietary routine.
Other tips for living well with MS:
If you have already been diagnosed with MS, see your doctor if:
Typically, a neurologist would be the specialist to treat MS patients. But because this disease has wide-ranging symptoms, you may need other kinds of support.
Members of your medical team may include:
Getting a diagnosis of multiple sclerosis can be frightening. and you’ll probably have a lot of questions.
It might help to bring this list to doctor’s appointment:
March is National MS Education and Awareness Month founded by the Multiple Sclerosis Foundation (MSF) and affiliated groups to raise the public’s awareness of the disease.
National Multiple Sclerosis Society (NMASS) can keep you up-to-date on research and help you find a support group.
National Institute of Neurological Disorders and Stroke (NIH-NINDS), one of the National Institutes of Health, which leads research on MS.
Multiple Sclerosis International Federation (MSIF) offers a global perspective on MS research, news and treatment.
Multiple Sclerosis Association of America (MSAA) provides programs and services for people affected by MS and can help you find resources in your area.
National Center for Complementary and Alternative Medicine You can get the latest evidence-based research on complementary and alternative medical treatments for MS from this agency, a division of NIH.
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