What Is RRMS

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,
  • Secondary progressive,
  • Primary progressive, or
  • Progressive relapsing

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.

  • Here’s an example of the difference between the two: A patient who has relapsing-remitting MS might report “Four weeks ago on Wednesday morning, I experienced a sensation of tingling and burning in my leg, it worsened over a few days, but in the weeks since then it has improved.”
  •  A patient who has secondary-progressive MS might say: “I don’t remember when exactly the tingling and burning in my leg started, but it has been getting worse very gradually for the past six months.”

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.

  • People with RRMS tend to have more brain lesions — also called plaques or scars — on magnetic resonance imaging (MRI) scans, and these lesions contain more inflammatory cells.
  • People with primary-progressive MS (PPMS) tend to have more spinal cord lesions, which contain fewer inflammatory cells.

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:

  • Most people with RRMS are diagnosed in their 20s and 30s (although it can occur in childhood or later adulthood), while the onset of PPMS tends to be in ones 40s or 50s.
  • The transition to SPMS generally occurs in people who have been living with RRMS for at least 10 years.

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.

What Causes RRMS

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 immune system. Normally, our immune system works to fight against foreign invaders such as viruses and bacteria. In the case of MS, the immune system attacks and damages nerve cells and the myelin (a sheath-like material made up of lipids and proteins) that surrounds and protects the nerve fibers. Researchers are looking into what exactly causes this autoimmune malfunction.
  • Genetics. The risk of developing MS for the general population is .01% – that’s one person for every one thousand. This number is significantly higher – one to three percent –  if you have a close relative such as a parent or sibling with MS. This data suggests that several genetic factors may be involved in the development of MS
  • Environmental Influences. More cases of MS have been reported in countries that are farther from the equator than those that are close. If an individual moves from a high risk area to a low risk area before the age of 15, he or she assumes the risk level of the new environment. MS can sometimes arise in “clusters”, affecting multiple people in a single area, as seen in the rise of MS cases in British troops (and their dogs) after their occupation of the Faeroe Islands during WWII. Scientists believe that an overreaction to certain environmental agents may trigger the immune system malfunction. However, the specific environmental factors causing this response haven’t been identified.
  • Vitamin D. Areas farthest from the equator – where the most cases of MS are reported – receive less intense sunlight than equatorial areas, which have fewer MS cases. Your body naturally produces vitamin D when your skin is exposed to sunlight, meaning that the longer our skin is exposed to sunlight, the more our body naturally produces vitamin D. This connection has caused some scientists to believe vitamin D may play a role in MS.
  • Viruses and Bacteria. Viruses such as Epstein-Barr, which is responsible for mononucleosis (another autoimmune disease), are known to cause inflammation and possibly the breakdown of myelin. Earlier this year, researchers from Weill Cornell Medical College linked Epsilon toxin, which is produced by the common food borne bacterium Clostridium perfrigens, to MS attacks.

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.

Risk Factors For RRMS

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:

  • Age. Multiple sclerosis can occur at any age, but most commonly affects people who are between 20 and 40 years old. However, individuals in their 40s and 50s may be more likely to develop a rarer, more progressive form of the disease. Healthy individuals over 60 years of age have little to worry about: MS rarely develops past age 60.
  • Gender. The ratio of female to male cases of MS has increased significantly in the past decade, and women are now about twice as likely as men to develop multiple sclerosis. In countries like Norway, where there is already a high risk of MS, this number is even higher – women there are about three times more likely to develop MS than men.
  • Family history. As mentioned before, genetics play a role. If your parent or sibling has multiple sclerosis, there’s a one to three percent chance of developing the disease as compared with the risk in the general population, which is only a tenth of one percent.
  • Certain infections. A variety of infectious viruses, such as Epstein-Barr, appear to be associated with multiple sclerosis.
  • Ethnicity. Caucasian people, particularly those whose families originated in northern Europe, are at highest risk of developing multiple sclerosis.
  • Geographic regions. Multiple sclerosis is far more common in areas such as Europe, southern Canada, northern United States, New Zealand and southeastern Australia.
  • Other autoimmune diseases. People with thyroid disease, type 1 diabetes or inflammatory bowel disease are at a slightly higher risk of developing MS.

In addition to the currently suspected risk factors of age, sex, geographic location, immunological factors, and genetic/family history, researchers have:

  • Identified around 100 genes that increase a person’s risk for MS
  • Found that African American women have a higher risk for MS than once thought
  • Determined that obese adolescents are more likely to go on to develop MS as adults than are adolescents of a healthy weight. If obese adolescents have one or more MS risk genes, their chances of developing MS are even higher.

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.

Diagnosing RRMS

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:

  • Numbness or weakness in one or more limbs
  • Double vision, blurred eyesight, or partial blindness
  • Tingling or pain sensations
  • A feeling like an electric shock when you move your head
  • Tremors
  • Poor coordination or unsteadiness
  • Slurred speech
  • Feelings of dizziness or fatigue

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:

  • Physical examination. One of the first steps in diagnosing MS is a thorough physical exam, including a discussion with the doctor of your symptoms and medical history.
  • Blood Analyses. Laboratory blood tests can help rule out other possible causes for your symptoms.
  • Neurological examination. A neurologist examines the function of the cranial nerves that control your senses (sight, taste, and hearing) as well as motor movement (including the movement of your eyes and the muscles involved in speech).
  • Magnetic resonance imaging (MRI). This non-invasive test takes pictures of your brain and spinal cord and detects any lesions – areas of inflammation that can be signs of MS.. Five percent of people with MS do not have abnormalities detected on a   MRI. That’s why a “negative” scan won’t completely rule out MS. Boomers beware – , some common changes of aging may look like MS on a MRI.
  • Visual Evoked Potentials (VEP). This procedure records your nervous system’s response to electric or visual stimulation. Subsequent tests can tell doctors if myelin has been damaged.
  • Lumbar Puncture. Also known as a spinal tap, it tests your spinal fluid for signs of MS and can rule out infections and other conditions that may seem like MS, can also look for signs of the disease, including elevated white blood cells and other proteins that imply abnormal immune function in the central nervous system

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.

Symptoms of RRMS

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:

  • Eye problems  like double vision or blurred vision (vision problems may be the first sign of RRMS)
  • Numbness or tingling in one or more limbs
  • Heat sensitivity
  • Electric-shock sensations or radiating pain that occurs with certain head movements like bending the neck
  • Vertigo or dizziness
  • Trouble moving, muscle stiffness
  • Problems with sexual function
  • Difficulty with balance and coordination
  • Difficulty thinking clearly
  • Depression
  • Bladder and/or bowel control issues
  • Weakness
  • Overwhelming fatigue 

An RRMS attack can last anywhere from 24 hours to several weeks. An attack can involve:

  • One or many symptoms
  • Worsening of an existing symptom
  • Development of a new symptom
  • Remissions can last for a year or more.

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.

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.

Living With RRMS

Here are ten tips to help you live with MS:

  • Be good to yourself. Eat healthy, learn stress reduction techniques and get enough rest.
  • Don’t be alone. MS support groups are the best way to be in touch with others who have the condition. You can also find online support networks, message boards and video chats.
  • Respect your energy. If you feel fatigued, don’t fight it. Instead, look for ways to conserve your energy. For example, if shopping is draining, you can order online — even your groceries.
  • Remind yourself. If you suffer with memory loss, keep a list handy. It’s something many boomers do already.
  • Stay chill. Keep your body temperature within the normal range. Overheating can trigger an MS attack. Keep a small fan and water mister on hand; during colder months, use layers. Start showers with cool water, increasing temperature slowly.
  • Be honest. Let family and close friends know what you’re going through, especially when you’re feeling discouraged.
  • Update your doctor. If your physical limitations are preventing you from carrying out daily activities, or your symptoms are worsening, don’t wait to let your doctor know.
  • Consider counseling. Sometimes, people have problems that are better addressed one-on-one with a professional.
  • Keep a diary. Write down your experiences, symptoms, and feelings. Not only will this be a valuable tool for your doctor, but a diary can also help you vent your stress and fears.
  • Be proactive. Educate yourself about your condition so you can join in making decisions about your healthcare.
  • Have patience. Living with MS takes practice. Don’t get mad at yourself if you struggle with budgeting your energy at first. Be sure to get enough sleep, and take time to plan out your day so you can make sure you have enough energy.
  • Stay flexible. There may be good days and bad days. Make backup plans, and allow extra time for travel or other tasks.
  • Don’t give up. Things you enjoyed before MS may take extra effort now, but keeping up with your hobbies and interests can help you through the disease.
  • Ask for help when needed. Friends and family can help with daily tasks, or just by lending an ear. Let people know their help is welcome, and if you are having difficulty doing things for yourself, keep a list of jobs that need doing, in case someone offers.
  • Exercise. Regular exercise can help you keep your mind and body working and slow the progression of the disease. Try walking, swimming, yoga, or tai chi for a low-impact workout.
  • Manage your stress. Stress management may reduce your risk of new MS lesions. Try counseling, psychotherapy, a stress management program, or a support group. Visit or call the National MS Society at 1-800-344-4867.
  • Don’t smoke. Smoking can worsen your symptoms and the disease course. If you smoke, quitting now can help you stay healthier longer. Talk to your doctor if you have a hard time quitting on your own.
  • Get enough sunlight. Vitamin D—especially the type produced by your body from sun exposure—may protect you from MS or from worsening of the disease. Other sources include fortified milk and cereals, and fatty fish such as salmon.
  • Remember that some things can be relearned. If something is hard for you to do, a different method may make it possible again. Ask your physical therapist or occupational therapist for techniques.
  • Take charge of your own health. The best treatment for you depends on your symptoms, the type of MS, and your response to medications. You may also consider physical therapy, counseling, lifestyle changes, occupational therapy, and new diet and exercise habits.

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.

Medication And Treatment

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):

  • Corticosteroids (oral prednisone and intravenous methylprednisolone) reduce the inflammation during relapse.
    Beta interferons (Avonex, Betaseron, Extavia and Rebif) slow the progress of MS, as well as reduce the number of attacks and lessen their symptoms. Interferons are naturally produced in the human body to help fight infection, and beta interferons have been found to reduce inflammation.
    Glatiramer acetate (Copaxone) may reduce the number of MS attacks. Doctors believe that glatiramer acetate works by blocking your immune system’s attack on myelin. The drug is injected once a day.
    Fingolimod (Gilenya) traps immune cells in your lymph nodes. It may reduce attacks of MS and short-term disability.
    Natalizumab (Tysabri) works by interfering with the movement of potentially damaging immune cells from your bloodstream to your brain and spinal cord.
    Mitoxantrone is an immunosuppressant that can be harmful to the heart, and is also associated with development of blood cancers like leukemia. Because of these risks, it’s usually only used to treat active severe cases.
    Teriflunomide (Aubagio) reduces attacks and lesions in people with MS.


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:

  • Beta-interferons
  • glatiramer acetate, or Copaxone
  • fingolimod, or Gilenya.
  • teriflunomide, or Aubagio
  • dimethyl fumarate, or Tecfidera
  • natalizumab, or Tysabri

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,

  • 17 have relapsing-remitting MS;
  • two have primary progressive MS; and
  • one has progressive-relapsing 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.

  • Beta-interferons, with the brand names Avonex, Rebif, Extavia and Betaseron, are among the most commonly prescribed medications, and are administered periodically via injection. Beta interferons work to prevent inflammation, but since they can change cell counts in your bloodstream, periodic blood tests are recommended to protect against infection and/or liver damage. About 40% of people taking beta interferon will experience some flu like side effects with these medication.
  • Glatiramer Acetate, brand name copaxone, is also given via injection daily or three times weekly, and works by inducing immune tolerance to myelin to limit further damage. Glatiramer is associated with less-severe systemic side effects than Beta-interferons, though site reactions can be bothersome.
  • Fingolimod, known as Gilenya, is a pill that works by trapping immune cells in the lymph nodes and blocking their entry into the bloodstream and therefore the CNS. Fingolimod has been shown to be more effective than beta-interferons,but can slow your heartbeat and could raise risk of infection, so it isn’t recommended for individuals with certain pre-existing conditions.
  • Teriflunomide, or Aubagio, is a pill that works by inhibiting overactive immune cells—and while as effective as high dose high frequency beta-interferon, it may cause liver damage, so there is careful monitoring of liver function in the first six months of treatment.
  • Dimethyl fumarate, or Tecfidera, is a twice daily pill that limits oxidative stress to prevent relapses of multiple sclerosis. Almost half of people will have some gastrointestinal side effects or flushing, a sensation of heat or itching and a red blush of the skin, when starting this medication.
  • Natalizumab, or Tysabri, is an intravenous medication used to block immune cells from entering the brain and spinal cord, but it may put you at a higher risk for progressive multifocal leukoencephalopathy, or PML, a potentially lethal brain infection.
  • Mitoxantrone, or novantrone is approved for rapidly worsening SPMS or severe RRMS, but is very rarely used due to risk of heart failure and leukemia.

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:

  • Six are injectable—Avonex, Betaseron, copaxone, Extavia, Pregridy, Rebif
  • Three are oral—Aubagio, Gilenya, Tecfidera
  • Three are infused—Lemtrada, Novantrone, Tysabri

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:

  • The FDA’s approval of dimethyl fumarate, or Tecfidera—a new oral medication for relapsing MS treatment—that has been shown to reduce MS attack frequency by 50%.
  • The identification of Tob1, a molecule associated with immune cells, as a “biomarker”, or indicator that may help determine whether or not an individual’s MS will progress after the first attack.
  • Research suggesting that smoking inhibits the effect of interferons, and therefore lessens the potential efficacy of beta-interferon treatment.
  • Research suggesting that malfunctions in the mitochondria—the cell’s energy producers— may be a factor in nerve damage caused by MS. Further mitochondrial research is being conducted as a result.
  • Trials for “anti-LINGO” therapy, which is aimed at stimulating myelin-regeneration to reverse nerve damage caused by MS.
  • Additional trials for a new, more definitive blood-based MS diagnostic test.

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.


Complementary and Alternative Treatment

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:

  • Acupuncture, a form of traditional Chinese medicine that focuses on repairing the flow of bodily energy through the insertion of small needles into several of the body’s more than 400 acupuncture points. Evidence suggests that acupuncture may help relieve MS-related symptoms like fatigue, pain, spasticity, numbness and tingling, bladder problems, and depression. There is little evidence, however, suggesting that acupuncture can lower the frequency of MS attacks or slow disease progression.
  • Acupressure, which uses concentrated pressure in the place of needles to balance energy flow at acupressure points, may also be effective in treating MS symptoms
  • Qi Gong and Herbalism, which are other forms of Chinese medicine. Qi Gong is a set of physical and mental exercises aimed at aligning the body’s energy. Herbalism involves the ingestion of symptom or disease-specific specific herbs, typically in tea form. Both have been reported to reduce inflammation, stress, and help lessen physical symptoms of MS. Speak with your physician about specific herbs you are considering adding to your regimen.
  • Frequent massages can help to reduce stress and depression.
  • Evening primrose oil (linoleic acid) has shown promise in improving MS symptoms. It can be taken as an oral supplement. It’s also found in sunflower seeds and safflower oil.
  • Marijuana, according to anecdotal evidence, helps relieve spasticity and other MS-related symptoms.
  • CCSVI surgery. A “remedy” called CCSVI (chronic cerebrospinal venous insufficiency) may contribute to nervous system damage in MS. The Journal of Vascular and Interventional Radiology published a study concluding that using CCSVI surgery (an angioplasty procedure that opens the veins) in patients with MS “appears to be a safe procedure resulting in significant clinical improvement.” However, the procedure is controversial, and many doctors dispute the small study’s findings.
  • Chiropractic Therapy focuses on the alleviation of pressure on the nerves through a manipulation of the spine and skeletal system. An abundance of anecdotal evidence suggests that it may help alleviate MS-related pain, especially in the lower back.
  • Homeopathy. Many patients report an improvement in symptoms after taking homeopathic remedies, in which herbal extracts are diluted to a non-toxic concentration. Avoid agents that are likely to stimulate the immune system, even in low doses.
  • Postural or movement-based approaches, such as the Alexander technique or applied kinesiology. The Alexander technique aims to re-train the body to move in a way that does not cause pain, while applied kinesiology aims to heal patients by rehabilitating muscles that are associated with affected organs or body systems. Be sure to talk with your doctor before you try any new treatments, including alternative and complementary therapies.

Care Guide

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:

  • Improves your heart and lung health
  • Aids in maintaining a healthy weight
  • Strengthens your muscles
  • Helps stabilize your mood, and
  • May help with symptoms such as fatigue, memory, muscle spasms, and bowel and bladder problems


More than a dozen studies have shown that exercise can help manage MS symptoms. Benefits of regular exercise for patients with MS include:

  • Better walking ability
  • Slower disease progression, and
  • Improvement in brain function


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:

  • Walking is healthy and low-impact. It does not require any special equipment, but if the weather outside is uncomfortable, an adjustable-speed treadmill can allow you to go for a walk in climate-controlled comfort.
  • Swimming improves your coordination, can help you feel less tired, and doesn’t overheat your body as quickly as other forms of exercise.
  • Activities that improve your overall strength and mobility, like stretching, low-impact aerobics, and weight training, may give you better control over some of the physical symptoms of MS.
  • Practices like yoga and Tai Chi may help you relax as they make you more flexible and improve your balance and range of motion.
  • Importantly, an exercise routine that you enjoy is more likely to become a habit than one that you have to struggle through each day.

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:


  • Keep a healthy weight. If you’re overweight or underweight, it can be hard to get the energy you need.
  • Watch portion sizes. Oversized meals can be deceptive sources of excess calories.
  • Eat a diet low in saturated fat and cholesterol. Saturated fats found in dairy products and red meat are more difficult for your body to metabolize, and are therefore harder for you to burn off. Switch to unsaturated fats like those found in salmon, nuts, and avocados. Not only will this help you stay at your ideal weight, it may also lower your body’s production of Prostaglandin 2, a chemical that may increase MS inflammation.
  • Don’t skip meals or make drastic changes like low-carb, gluten-free, allergen-free, raw, or vegetarian diets without first talking to your doctor. Skipping meals, cutting out food groups, and certain nutrient excesses can be harmful, and may worsen MS symptoms like fatigue.
  • Avoid excess salt, sugar, and alcohol when possible, there is some suggestion that these could trigger MS attacks.
  • Get plenty of Vitamin D. Scientists are uncertain as to whether supplementation of Vitamin D can reduce symptoms or slow the course of the disease, but lack of sunlight and low blood levels of vitamin D are associated with MS development. You can get vitamin D naturally from sunlight, or from fortified milk and cereals, and fatty fish such as salmon. It is important, however, to be aware that wearing sunscreen may inhibit the production of vitamin D—talk to your doctor about the right strategy for you. Remember that Vitamin D is a fat soluble vitamin, so supplements should be taken within an hour of a meal containing some fat.
  • Eat a balanced diet with plenty of fruits and vegetables. Fruits and veggies can be great sources of healthy antioxidants like:
  • Beta-carotene, a pigment found in vegetables like carrots, sweet potatoes, and spinach, that is converted to vitamin A in the body
  • Lutein, a carotenoid found in dark green leafy vegetables like broccoli, spinach, and kale, and
  • Vitamins A, C, and E, which can help your body neutralize free-radicals, potentially damaging molecules such as cigarette smoke and pollutants, and prevent inflammation in the body that could worsen MS symptoms. Vitamin A can also be found in eggs, other dairy, and liver.

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:

  • Manage your pain. There’s no reason to suffer with pain, which can lead to further physical limitations, as well as depression. Speak to your doctor about possible treatments, which may include over-the-counter and prescribed medications.
  • Reduce stress. Anxiety can trigger MS symptoms and even increase pain. Meditation and deep breathing are two techniques that can help you relax.
  • Socialize. Isolation may make you feel worse. Engage with your family and friends and consider contacting an MS support group

When To Contact A Doctor

If you have already been diagnosed with MS, see your doctor if:

  • Your attacks become more frequent or severe.
  • You begin having a symptom that you haven’t had before or you notice a significant change in symptoms that are already present.

Questions For Your Doctor

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:

  • A physical therapist (PT), who designs exercise programs to help manage physical symptoms
  • A social worker to help you connect to community resources
  • An occupational therapist (OT) to support your independence and productivity at home and at work
  • A speech language pathologist (S/LP), to evaluate and treat problems with speech, swallowing or cognitive ability
  • A psychiatrist or psychologist to help you adapt and cope
  • A urologist, who specializes in urinary problems in men and women and sexual issues in men.

Questions For A Doctor

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:

  • How severe is my condition?
  • What is the usual prognosis for people who have this type of MS?
  • How do you expect my condition to progress?
  • How might MS affect my daily life?
  • What type of treatment do you recommend?
  • Why do you recommend this particular course of treatment?
  • Are there any lifestyle changes that help to slow or stop the progression of my multiple sclerosis? If so, what changes do you recommend?
  • Will medication(s) be used to treat my condition?  What are their side effects?


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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