Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system. It occurs when the immune system attacks the protective myelin sheath surrounding nerve fibers. Common symptoms include vision problems, muscle weakness, numbness, and fatigue. It is typically diagnosed based on symptoms, neurological exams, and imaging tests like MRI. The most common form is relapsing-remitting MS, where periods of exacerbation are followed by periods of remission. While there is no cure for MS, treatments can help manage symptoms and reduce relapses.

1. Multiple Sclerosis
Multiple sclerosis (MS) is a chronic, sometimes disabling, disease of the central
nervous system affecting approximately 400,000 people in the United States,
according to the National Multiple Sclerosis Society. It affects two to three times
as many women as men. MS develops more often in Caucasians than in other
races. About 200 new cases of MS are diagnosed in the United States every week.
The cause of MS is still unknown, but most researchers think it results from an
abnormal response by the body’s immune system. Some researchers believe this
abnormalimmune responsecould be caused by a virus, although it is unlikely that
there is just one virus responsible for triggering the condition. Researchers do
know that MS is not contagious. And while it is not an inherited disease, genetic
susceptibility plays a role. There is a higher risk for MS in families where it has
already occurred. Other possible causes include environmental triggers such as
exposure to toxins and heavy metals, as well as low levels of vitamin D.
It is believed that MS is an autoimmune disease. In MS, the immune system—for
reasons still not understood—attacks and destroys myelin and the
oligodendrocytes(oligo, few; dendro, branches; cytes, cells) that produce it.
Though the body usually sends in immune cells to fight off bacteria and viruses, in
MS they misguidedly attack the body’s own healthy nervous system, thus the
term autoimmune disease.Rheumatoid arthritis and lupus are other types of
autoimmune diseases.
In multiple sclerosis, these misdirected immune cells (certain types of
lymphocytes, T-cells and killer cells) attack and consume myelin, damaging the
myelin sheath—the fatty insulation surrounding nerve cells in the brain and spinal
cord. Myelin acts like the rubber insulation found in an electric cable and
facilitates the smooth transmission of high-speed messages between the brain
and the spinal cord and the rest of the body. As areas of myelin are affected,
messages are not sent efficiently or they never reach their destination.
Eventually, there is a buildup of scar tissue (sclerosis) in multiple places where
myelin has been lost; hence the disease’s name: multiple sclerosis. These plaques

2. or scarred areas, which only are a fraction of an inch in diameter, can interfere
with signal transmission. The underlying nerve also may be damaged, further
worsening symptoms and reducing the degree of recovery. The disease can
manifest itself in many ways. Sometimes the diseased areas cause no apparent
symptoms, and sometimes they cause many; this is why the severity of problems
varies greatly among people affected with MS.
Multiple sclerosis usually strikes in the form of attacks or exacerbations. This is
when at least one symptom occurs, or worsens, for more than 24 hours. The
symptom(s) can last for days, weeks, months or indefinitely.
The most common pattern of multiple sclerosis is relapsing-remitting MS. It is
characterized by periods of exacerbation followed by periods of remission. The
remissions occur because nervous system cells have ways of partially
compensating for their loss of ability. There’s no way to know how long a
remission will last after an attack—it could be a month or it could be several
years. But disease activity usually continues at a low, often almost indiscernible
level, and MS often worsens over time as the signal-transmitting portion of the
cells—the axons—are damaged.
Most commonly, multiple sclerosis starts with a vague symptom that disappears
completely within a few days or weeks. Temporary weakness, tingling or pain in a
limb can be a first sign. Ataxia (general physical unsteadiness and problems with
coordination), temporary blurring or double vision, memory disturbances and
fatigueare also symptoms that can appear suddenly and then vanish for years
after the first episode, or in some cases never reappear.
The symptoms of MS vary greatly, as does their severity, depending on the areas
of the central nervous systemthat are affected. Most people suffer minor effects.
The disease can, however, completely disable a person, preventing him or her
from speaking and walking in the most extreme cases. The bodily functions that
are commonly affected by MS are:
 vision
 coordination

3.  strength
 sensation
 speech and swallowing
 bladder and bowel control
 sexuality
 cognitive function (thinking, concentration and short-term memory)
A varying degree of dysfunction may occur within these general areas. For
instance, one person may suffer blurred vision while another may suffer double
vision. Or one person may suffer from tremors while another will experience
clumsiness of a particular limb.
Specific symptoms associated with MS can include:
fatigue: a debilitating kind of general fatigue that is unpredictable and out of
proportion to the activity; fatigue is one of the most common (and one of the
most troubling) symptoms of MS.
cognitive function: short-term memory problems and difficulty concentrating and
thinking, typically not severe enough to seriously interfere with daily functioning,
although sometimes it does. Judgment and reasoning may also be affected.
visual disturbances: blurring of vision, double vision (diplopia), optic neuritis,
involuntary rapid eye movement and (rarely) total loss of sight.
balance and coordination problems: loss of balance, tremor, unstable walking
(ataxia), dizziness (vertigo), clumsiness of a limb and lack of coordination.
weakness: usually in the legs.
spasticity: altered muscletone can producespasms or muscle stiffness, which can
affect mobility and walking.
altered sensation: tingling, numbness (paresthesia), a burning feeling in an area of
the body or other indefinable sensations.

4. abnormal speech: slowing of speech, slurring of words and changes in rhythm of
speech.
difficulty in swallowing (dysphagia).
bladder and bowel problems: the need to urinate frequently and/or urgently,
incomplete emptying or emptying at inappropriate times, constipation and loss of
bowel control.
sexuality and intimacy: impotence, diminished arousal and loss of sensation.
pain: facial pain and muscle pains.
sensitivity to heat: this often causes symptoms to get worse temporarily.
Though these are some of the symptoms commonly associated with MS, not all
people with MS will experience all of them. Most will experience more than one
symptom, however. There is no typical case of MS. Each is unique.
Today, life expectancy for those with MS is normal or close to normal.
Most people with MS begin experiencing symptoms between the ages of 20 and
50. But initial symptoms may be vague, may come and go with no pattern or may
be attributed to other factors or conditions. For instance, a woman who
experiences sudden bouts of vertigo once every few months may explain away
the symptom by linking it to her menstrual cycle. Or, perhaps, someone who
suddenly has a bit of blurry vision may blame too many hours at the office.
Diagnosis
Diagnosing MS involves several tests and a lot of discussions with several types of
health care professionals. You can expect a complete physical examination, a
discussion of your medical history and a review of your past and/or current
symptoms.
You should pay attention to any symptomsuggestive of MS. Early diagnosis of MS
is important because a new generation of treatments introduced in the 1990s can
reduce the frequency and severity of MS attacks. In fact, research has prompted

5. health care professionals to change the diagnostic criteria to treat more cases of
MS as early as possible.
At this point, there are no symptoms, physical findings or tests that alone can
definitively show that a person has MS. Instead, physicians use several strategies,
including a medical history, neurologic exam, tests such as visual evoked
potentials (VEPs) and spinal taps and imaging tests such as magnetic resonance
imaging (MRI), to make a diagnosis.
For a diagnosis of MS, a health care professional must:
Discover evidence of damage in at least two separate areas of the central nervous
system (CNS), including the brain, spinal cord and optic nerves AND
Find evidence that the damages occurred at least one month apart AND
Be able to rule out all other possible diagnoses
In 2001, an international panel of experts convened to update the diagnostic
criteria to include guidelines for using MRI, VEP and cerebrospinal fluid analysis to
confirm an MS diagnosis faster. Health care professionals can use these tests to
look for a second area of damage in a person who has experienced only one MS-
like attack. These criteria were further revised in 2005 and again in 2010, termed
the Revised McDonald Criteria, to speed up the diagnostic process even more.
The specific tests that help make an MS diagnosis include the following:
MRI: Health care professionals may use MRI to scan the brain for lesions
indicating early evidence of damage, in addition to other tests. An MRI is painless
and noninvasive. If you need one, a health care professional will have you lie on
your back on a table. The table will be pushed into a tube-like structure and
detailed pictures of your brain and, sometimes, spinal cord, will be taken. These
images are able to show scarred areas of the brain.Bear in mind that a normal
MRI does not ensure that a person does not have MS. About 5 percent of MS
patients have normal MRIs, according to the National Multiple Sclerosis Society.
However, it is important to note that the longer a person has a normal MRI, the
more important it becomes to look for a diagnosis other than MS.

6. Visual evoked potential tests (VEPs): VEPs measure how quickly a person’s
nervous system responds to certain stimulation. These tests offer evidence of
neurological scarring along nerve pathways that may not show up during
neurologic exams. Evoked potential tests are painless and noninvasive. A health
care professional or technician will place small electrodes on your head to
monitor your brain waves and your response to auditory, visual and/or sensory
stimuli. The time it takes for your brain to receive and interpret messages is a clue
to your condition.
Spinal tap: A spinal tap tests cerebrospinal fluid (fluid surrounding the brain and
spinal cord) for substances that indicate strong immune activity in the central
nervous system and helps rule out viral infections and other conditions that can
causeneurological symptoms similar to those of MS. If you have this test, you will
likely be given an injection of local anesthesia. Some people experience a
transient headache and nausea after the test.
Blood tests: These may help rule out other potential causes of symptoms, such as
Lyme disease, lupus and AIDS.
If you are diagnosed with MS, it will almost certainly be one of four patterns:
Relapsing-remitting MS: This is the most common pattern of the disease at the
time of diagnosis, affecting 85 percent of patients at this stage. People with this
pattern of MS experience clearly defined exacerbations or relapses, followed by
partial or complete remissions (or recovery periods) where the disease stops
progressing.
Secondary progressive MS: According to the National Multiple Sclerosis Society,
before the introduction of disease-modifying drugs, about half of individuals with
relapsing-remitting MS experienced a gradual worsening of symptoms with or
without occasional flare-ups, minor remissions or plateaus within 10 years of
initial diagnosis. This form of MS is called secondary progressive MS. At this point,
the long-term data are not available to determine whether or not the changeover
in diagnosis from relapsing-remitting to secondary progressive MS is delayed by
treatment.

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