Multiple sclerosis is a chronic autoimmune disorder that affects the brain, spinal cord, and nerves, in which the body’s immune system attacks the myelin sheath (tissue that covers nerves) and nerve fibers, causing nerve deterioration, and eventually, permanent nerve damage. These immune system attacks cause patches of scarring on the myelin sheaths, which are called multiple sclerosis. Multiple sclerosis is a progressive disease characterized by periods of relapses during which the disease worsens, usually appears between the ages of 20 and 50, and affects women twice as often as men. Multiple sclerosis is categorized by the following types: Relapsing remitting multiple sclerosis (RRMS) – This type of multiple sclerosis is characterized by several relapses, after which the disease nearly completed remits (recovers) early in the disease, or periods when the disease is stable and not progressing, and includes nearly 85% of multiple sclerosis cases. More than 50% of patients with relapsing remitting multiple sclerosis will develop secondary-progressive multiple sclerosis within 10-to-25 years, although treatments have improved. Secondary-progressive multiple sclerosis (SPMS) – This type of multiple sclerosis starts out as relapsing remitting sclerosis (RRMS), but then demonstrates a progressive worsening that causes disability, and may include remissions, relapses, and periods of stable disease. Primary progressive multiple sclerosis (PPMS) – This type of multiple sclerosis maintains a steady progression of disability, with only occasional periods of stable disease or remissions and accounts for nearly 15% of multiple sclerosis cases. Tumefactive multiple sclerosis – This rare type of multiple sclerosis produces lesions and symptoms that are like those of brain tumors which can develop into relapsing remitting multiple sclerosis (RRMS). Pediatric multiple sclerosis – This rare type of multiple sclerosis affects children under the age of 18.

There are several alternative names for multiple sclerosis, including disseminated sclerosis, encephalomyelitis disseminata, MS, primary progressive MS (PPMS), relapsing remitting multiple sclerosis (RRMS), secondary-progressive MS (SPMS), and tumefactive MS.

While the exact cause of multiple sclerosis is unknown, it is thought to be an autoimmune disorder, in which, after being triggered by bacteria (Chlamydia pneumniae), a virus (Epstein Barr Virus , or environmental factors, the body’s immune system attacks the healthy cells of the nervous system, in particular the covering (myelin sheath) of the nerves, as well as that of the brain and spinal cord. Researchers believe that multiple sclerosis may also have a genetic cause because the disease occurs more commonly in individuals who have a family history of multiple sclerosis and Caucasian Americans who live in temperate climates Other risk factors for developing multiple sclerosis in individuals who may be genetically susceptible to the disease include tobacco smoking and Vitamin D insufficiency.

Symptoms of multiple sclerosis are different between individuals and depend on which nerves are affected as well as how much of the nerves are damaged. Some individuals may only have mild symptoms. Mainly affecting muscle control, symptoms of multiple sclerosis can include weakness and fatigue, clumsiness, stiff muscles (spasticity), increased muscle reflexes (hyperreflexia), tremors, unsteady gait, arm and leg weakness or partial paralysis, motor and gait problems (movement disorders and difficulty walking), slurred speech, urinary and bowel incontinence (loss of control), sexual dysfunction, and rarely, seizures. In addition to impaired muscle control, multiple sclerosis can also cause sensory problems in the arms and legs, such as tingling (paresthesia), pain, itching, and numbness (usually one-sided), loss of the ability to sense touch, dizziness, and cognitive problems. Some patients may also experience a sensation of electrical-shock down the spine into the arms and legs when bending the head forward (Lhermitte sign). Multiple sclerosis can also affect the eyes, usually one eye at a time, with symptoms such as blurred or double vision, eye pain, or even partial or complete vision loss. Eventually, some individuals with multiple sclerosis may lose the ability to walk. Multiple sclerosis is further characterized by periods of relapses and remissions, as well as periods of stability when the disease is not progressing.

While there is no cure for multiple sclerosis, treatments focus on managing its symptoms and slowing progression of the disease. Treatments for managing the symptoms of multiple sclerosis include corticosteroids (oral prednisone and intravenous methylprednisolone) and plasma exchange (for severe symptoms; plasmapheresis). Treatment to help slow progression of multiple sclerosis include disease-modifying therapy drugs (DMT), ocrelizumab (Ocrevus), for primary-progressive multiple sclerosis (PPMS), and interferon beta medications, glatiramer acetate (Copaxone, Glatopa), fingolimod (Gilenya), dimethyl fumarate (Tecfidera), diroximel fumarate (Vumerity), teriflunomide (Aubagio), siponimod (Mayzent), cladribine (Mavenclad), natalizumab (Tysabri), and alemtuzumab (Campath, Lemtrada) for relapsing remitting multiple sclerosis. Other treatments to help slow progression of multiple sclerosis include physical therapy, muscle relaxants (baclofen , tizanidine , and cyclobenzaprine, as well as Botulin Toxin A ), medications to reduce fatigue (amantadine , modfafinil , and methylphenidate (Ritalin), medications to increase walking speed (dalfampridine ), and other medications to help ease insomnia, pain, bladder or bowel control problems, or sexual dysfunction, and anti-seizure medications.

There are several online, local, national, and international support groups for multiple sclerosis, including the following: MS Connection - https://www.msconnection.org/Support/Support-Groups Multiple Sclerosis Association of America - https://mymsaa.org/msaa-help/support-groups National Multiple Sclerosis Society - https://www.nationalmssociety.org/Resources-Support/Find-Support/Join-a-Local-Support-Group

There is no cure for the progressive disease of multiple sclerosis. The outcomes (prognosis) for multiple sclerosis are that most individuals with the disease experience periods of relapses and remissions, as well as periods when the disease is stable and not progressing (relapsing remitting multiple sclerosis (RRMS). Some patients may experience steady progression of the disease (primary-progressive multiple sclerosis (PPMS). Almost 50% of individuals with multiple sclerosis develop a steady progression of the disease, with worsening symptoms, over a period of 10-to-20 years (secondary progressive multiple sclerosis (SPMS). As the disease progresses, some individuals with multiple sclerosis may need the use of assistive walking devices, such as canes, crutches, or others, while some affected individuals may lose the ability to walk.

Complications of multiple sclerosis usually arise from the symptoms of the disease and its progression, and include stiff muscles (spasticity), muscle spasms, bladder or bowel incontinence (loss of control), sexual dysfunction, cognitive problem, such as changeable moods and forgetfulness, depression, and paralysis of the legs.

If you experience any of the signs and symptoms of multiple sclerosis, such as weakness and fatigue, unusual clumsiness or gait disturbances, loss of muscle control, problems with touch sensation, tingling or numbness in arms or legs, eye pain or blurry vision, especially in one eye at a time, make an appointment to see your doctor as soon as possible.

While multiple sclerosis cannot be prevented, its symptoms can be managed, and the disease progression can be slowed with treatment.