Multiple Sclerosis

Multiple sclerosis, often called MS, is a disease that gradually destroys the protective covering of nerve cells in the brain and spinal cord. This can cause problems with muscle control and strength, vision, balance, feeling, and thinking.

Education Topics

Complementary and Alternative Treatments

What alternative treatments are used for multiple sclerosis (MS)?

There is no cure for multiple sclerosis (MS). So far, the only treatments proved to affect the course of the disease are disease-modifying medicines, such as interferon beta. Other types of treatment should not replace these medicines if you are a candidate for treatment with them.

How is complementary and alternative medicine used to treat multiple sclerosis (MS)?

Many complementary and alternative medicine (CAM) treatments have been proposed for people who have MS. Some treatments may help relieve symptoms of MS. For example:

  • Some forms of marijuana may help with muscle stiffness (spasticity) and pain.
  • Ginkgo biloba or magnetic therapy may help relieve fatigue.
  • Reflexology may help relieve skin feelings such as tingling and numbness.

Research hasn't shown all CAM treatments to be effective. But a person with MS may benefit from safe CAM treatments along with standard medical treatment. For example, acupuncture, massage therapy, or yoga is often used. Some therapies may help relieve stress, depression, fatigue, and muscle tension. And some may improve your overall well-being and quality of life.

Talk to your doctor if you are interested in trying any of these treatments.

Complications and Comorbidities

What mental and emotional problems can be caused by multiple sclerosis (MS)?

Cognitive impairment problems can be caused by MS. These may include trouble with:

  • Memory, especially short-term memory.
  • Problem solving.
  • Keeping attention on a mental task, such as a math calculation.
  • Finding the right words to express yourself.

These problems are often quite mild early in the course of the disease. But they may get worse with time, depending on the location of tissue damage (MS lesions) in the brain. Side effects of medicines used to relieve physical MS symptoms may cause cognitive problems.

Emotional problems may include:

  • Depression. This is common in people with MS.
  • Anxiety.
  • Anger.
  • Inappropriate cheerfulness (euphoria).
  • Uncontrollable outbursts of crying or laughing at strange or inappropriate times.
  • Thoughts of suicide.

How are bladder problems treated when you have multiple sclerosis (MS)?

A person with MS may have trouble getting the bladder to empty all the way. This is because the muscle that helps to retain urine cannot relax. (This is a form of spasticity).

Sometimes urination can be started by pressing or tapping the bladder area or by straining. Medicines can also help in some cases. Examples include oxybutynin (for example, Ditropan), propantheline, or tolterodine (Detrol).

If these treatments don't help, you may need to use a urinary catheter. This is a thin flexible tube that you insert through the urethra and into the bladder. It allows urine to drain. (The urethra is the tube that carries urine outside the body from the bladder.) This is called intermittent self-catheterization. It's usually done at the toilet.

It only takes a little instruction and a few practice sessions to learn to do this procedure. It can relieve symptoms and help prevent urinary tract infections.

Course

What happens when you have multiple sclerosis (MS)?

For most people, MS follows a relapsing-remitting course, at least at first. It involves a series of attacks that cause symptoms. Symptoms fade and then return, and this pattern continues for many years. They may become worse and more frequent over time.

Definition

Multiple sclerosis

Multiple sclerosis, often called MS, is a disease that gradually destroys the protective covering of nerve cells in the brain and spinal cord. This can cause problems with muscle control and strength, vision, balance, feeling, and thinking.

MS has no cure, but medicines may help lower the number of attacks and make them less severe.

Diagnostics

How is multiple sclerosis (MS) diagnosed?

Diagnosing MS isn't always easy. The doctor will examine you, ask you questions about your symptoms, and do some tests. An MRI is often used to confirm the diagnosis. That's because the patches of damage (lesions) caused by MS attacks can be seen with this test.

Guidelines

What are the treatment recommendations for multiple sclerosis (MS)?

The National Multiple Sclerosis Society recommends that people with a definite diagnosis of MS and active, relapsing disease start treatment with medicine as soon as possible after receiving a diagnosis. Most neurologists support this recommendation. And they now agree that permanent damage to the nervous system may occur early on, even while symptoms are still quite mild. Early treatment may help prevent or delay some of this damage. In general, treatment is recommended until it no longer has a clear benefit.

The National MS Society also says that treatment with medicine may be an option after the first attack in some people who are at a high risk for MS (before MS is definitely diagnosed).

Medication Therapy

How are medicines used to treat multiple sclerosis (MS)?

Medicines for MS may be used:

  • Over a long period of time, to alter the natural course of the disease. Medicines that do this are called disease-modifying drugs, or DMDs.
  • During a relapse. They can make the attack shorter and less severe. They include corticosteroids.
  • To control certain symptoms. These include fatigue and muscle stiffness.

The DMDs used most often are:

  • Interferon beta (such as Betaseron). It's used to treat a first MS attack, relapsing-remitting MS, and secondary progressive MS.
  • Glatiramer (Copaxone). It's used to treat a first MS attack and relapsing-remitting MS.

For people who have relapsing-remitting MS, DMDs can reduce the amount of relapses and how severe they are. They may also delay disability in some people.

Some DMDs may also delay the progression of the disease and reduce relapses in some people who have primary progressive MS or secondary progressive MS.

Overview

Multiple sclerosis (MS): Overview

Multiple sclerosis, also called MS, is a disease that can affect the brain, spinal cord, and nerves to the eyes. MS can cause problems with muscle control and strength, vision, balance, feeling, and thinking. Whatever your symptoms are, taking medicine correctly and following your doctor’s advice for home care can help you maintain your quality of life.

Physical Therapy and Rehab Treatment

How are therapies used to treat multiple sclerosis (MS)?

Multiple sclerosis, often called MS, affects the central nervous system—the brain and spinal cord. It can cause problems with muscle control and strength, vision, balance, feeling, and thinking.

Rehabilitation programs often help. They include physical therapy, occupational therapy, speech therapy, and cognitive retraining.

Physical therapy

Physical therapy uses exercise of all types to help you stay as independent as possible. Your therapist will help you find which exercises are best for you. This might mean doing exercises at home or walking. Or you might exercise in a swimming pool or do yoga.

Exercises:

  • Stretch and strengthen muscles.
  • Get your heart and lungs working harder.
  • Help you with your balance.

You'll also learn how to cool off between exercises, since heat can make symptoms worse.

People with constant symptoms may need therapy every day. Others won't need it as often.

Occupational therapy

This therapy teaches you how to be as independent as possible.

You can learn how to use equipment or aids to help you with your daily life. This includes aids that help you eat, get dressed, bathe, and do other tasks.

This therapy also helps you learn how to save energy while you do those tasks. And you can learn how to do them while using a cane, a walker, or a wheelchair.

Speech therapy

MS can affect the nerves that help you to talk and swallow. With therapy, you may be able to:

  • Reduce long pauses or slurring.
  • Reduce the nasal sound that can happen when your face muscles get too relaxed.
  • Improve your speech patterns or rhythms and the way you pronounce words.
  • Learn other ways to speak, such as alphabet cards, a cell phone, or tapes.
  • Recognize swallowing problems. You can also learn what types of food are better for you to eat if it's hard to swallow.

Cognitive retraining

"Cognitive" is a word that refers to your brain's ability to do things like remember, solve problems, and make decisions. MS can make these things harder.

Therapy can often retrain your brain to find other ways to do these tasks. For example, you may learn to rely on other ways to remember and stay organized, like using a computer, a cell phone, a notebook, or a filing system.

This therapy can also help you deal with depression, anxiety, stress or fatigue. This is important, because these problems can all affect how well you can think and remember.

Risk Factors

What increases your risk for multiple sclerosis (MS)?

Experts don't know why MS happens to some people but not others. There may be a genetic link, because the disease seems to run in families. Where you grew up may also play a role. MS is more common in people who grew up in colder regions that are farther away from the equator.

Self-care Treatment Options

How can you care for yourself when you have multiple sclerosis (MS)?

General care

  • Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
  • Use a cane, walker, or scooter if your doctor suggests it.
  • Keep doing your normal activities as much as you can.
  • If you have problems urinating, press or tap your bladder area to help start urine flow. If you have trouble controlling your urine, plan your fluid intake and activities so that a toilet will be available when you need it.
  • Spend time with family and friends. Join a support group for people with MS if you want extra help.
  • Depression is common with this condition. Tell your doctor if you have trouble sleeping, are eating too much or are not hungry, or feel sad or tearful all the time. Depression can be treated with medicine and counseling.

Diet and exercise

  • Eat a balanced diet.
  • If you have problems swallowing, change how and what you eat:
    • Try thick drinks, such as milk shakes. They are easier to swallow than other fluids.
    • Do not eat foods that crumble easily. These can cause choking.
    • Use a blender to prepare food. Soft foods need less chewing.
    • Eat small meals often so that you do not get tired from eating larger meals.
  • Get exercise on most days. Work with your doctor to set up a program of walking, swimming, or other exercise that you are able to do. A physical therapist can teach you exercises if you cannot walk but can move your limbs and trunk. Or you can do exercises to help with coordination and balance. You can help improve muscle stiffness by doing exercises while lying in certain positions.

Multiple sclerosis (MS): Modifying your home

If you have trouble moving around or if you get tired easily because of MS, it may help to make some changes in your home. Here are some things you can do.

  • Change the location of furniture.

    Arrange furniture so you can hold on to something as you move around the house.

  • Use specially modified chairs.

    They can help make it easier to sit down and stand up.

  • Group the items you use most often.

    Put things like reading glasses, keys, and the telephone in one easy-to-reach place. Then you can avoid having to walk long distances to get them.

  • Tack down rugs to prevent tripping.
  • Put no-slip tape in the bathtub and install grab bars to prevent falls.

An occupational therapist can help you make these and other changes to your home, including helping you to find ways to make dressing, bathing, and eating easier. Contact the National Multiple Sclerosis Society for other sources of advice and information on adapting your home environment to meet your changing needs.

Caring for yourself when you have multiple sclerosis (MS)

If you have multiple sclerosis (MS), it is important to find ways of coping with the practical and emotional demands of the disease. These are different for everyone, so home treatment varies from person to person.

Home treatment may involve making it easier to get around your home, dealing with depression, handling specific symptoms, and getting support from your family and friends.

  • Modify your home to keep it safe and easy to get around.

    For example, to help prevent falls, install grab bars in the bathroom and don't use throw rugs. And try adjusting your daily schedule so that your routine is less stressful or tiring.

  • Be active.

    You can do this on your own or with the help of a physical therapist.

  • Get help with urination problems.

    At some time, most people with MS have bladder problems. Your doctor may prescribe a medicine to help you.

  • Avoid getting overheated.

    Increased body temperature can temporarily make your symptoms worse. Use an air conditioner, keep your home somewhat cool, and avoid hot swimming pools and hot tubs. During warm or hot weather, exercise in an air-conditioned area rather than outdoors.

  • Eat a wide variety of wholesome foods.

    This includes plenty of fruits, vegetables, grains, cereals, legumes, poultry, fish, lean meats, and low-fat dairy products. A balanced diet for a person who has MS is the same as that recommended for most healthy adults.

  • Change how and what you eat if you are having problems swallowing.
    • Try milkshakes or juices in gelatin form. Thicker drinks make swallowing easier.
    • Avoid foods such as crackers or cakes that crumble easily. These can cause choking.
    • Use a blender to prepare food for easiest chewing. Soft foods need less chewing.
    • Eat frequent, small meals to avoid fatigue from eating heavy meals.
  • Ask your doctor about physical therapy and occupational therapy to help you manage at work and home.

Make all efforts to preserve your health. Proper diet, rest, wise use of energy, and practical and emotional support from your family, friends, and doctor can all be very helpful.

Contact the National Multiple Sclerosis Society at www.nationalmssociety.org for more advice about coping with MS at home.

Signs and Symptoms

What are the symptoms of multiple sclerosis (MS)?

The symptoms of MS vary from person to person. Which symptoms you have will depend on which parts of the brain or spinal cord (central nervous system) are damaged. The loss of myelin and scarring caused by MS can affect any part of the central nervous system. Myelin is the insulating coating around a nerve.

Symptoms may come and go or become more or less severe from day to day or, in rare cases, from hour to hour. Symptoms may get worse with increased body temperature or after a viral infection.

Early symptoms

Common early symptoms of MS include:

Muscle or motor symptoms.

These include weakness, leg dragging, stiffness, a tendency to drop things, a feeling of heaviness, clumsiness, and a lack of coordination (ataxia).

Visual symptoms.

These include blurred, foggy, or hazy vision, eyeball pain (especially when you move your eyes), blindness, or double vision. Optic neuritis—sudden loss of vision that is often painful—is a fairly common first symptom.

Sensory symptoms.

These include tingling, a pins-and-needles sensation, numbness, a band of tightness around the trunk or legs, and electrical sensations moving down the back and legs.

Advanced symptoms

As MS progresses, symptoms may become more severe. They may include:

  • Worse muscle problems, and stiff, mechanical movements (spasticity) or uncontrollable shaking (tremor). These problems may make it hard to walk. A wheelchair may be needed some or all of the time.
  • Pain and other sensory symptoms.
  • Bladder symptoms, such as loss of bladder sensation or not being able to hold urine (urinary incontinence) or to completely empty the bladder.
  • Constipation and other bowel disorders.
  • Male erectile dysfunction (impotence) and female sexual dysfunction.
  • Cognitive and emotional problems, such as problem-solving and depression. These are common in people who have had MS for some time.
  • Feeling very tired (fatigue). This can be worse if symptoms such as pain, spasticity, bladder problems, anxiety, or depression make it hard to sleep.

Treatment Options

How is multiple sclerosis (MS) treated?

Treatment can make living with MS easier. Your type of treatment will depend on how severe your symptoms are and whether your disease is active or in remission. You and your doctor will set up a schedule of appointments to watch and treat your symptoms. These checkups help your doctor find out if you may need to try a different treatment.

Different medicines are used to treat MS. Medicines called disease-modifying drugs may be used over a long period of time. They help to keep down the number of attacks and how severe they are and to slow the progress of the disease. Other medicines may be used during a relapse or to control certain symptoms.

Physical therapy, occupational therapy, and speech therapy can help you manage some physical problems caused by MS. There are also things you can do to help yourself. You can eat balanced meals, get regular exercise and rest, and learn to use your energy wisely.

In some cases, surgery may be done if you have severe tremor (shakiness) that affects movement. Or it may be done to implant a catheter or pump in the lower spinal area to deliver a constant flow of medicine to help treat severe muscle stiffness (spasticity).

Some complementary medicine treatments may help relieve symptoms of MS. For example, gingko biloba or magnetic therapy may help relieve fatigue. Talk to your doctor if you are interested in trying any of these treatments.

Dealing with the physical and emotional demands of MS isn't easy. If you feel overwhelmed, talk to your doctor. You may be depressed, which can be treated. Finding a support group where you can talk to other people who have MS can be very helpful.

What Causes It

What causes multiple sclerosis (MS)?

The exact cause isn't known, but most experts believe that MS is an autoimmune disease. In this kind of disease, the body's defenses, called the immune system, mistakenly attack normal tissues. In MS, the immune system attacks the central nervous system—the brain and spinal cord.

What It Is

What is multiple sclerosis (MS)?

Multiple sclerosis, often called MS, is a disease that affects the central nervous system—the brain and spinal cord. It can cause problems with muscle control and strength, vision, balance, feeling, and thinking. MS is different for each person. It can be minor or severe. Most people are somewhere in between.

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