Multiple Sclerosis

Symptoms vary widely, depending on the amount of damage and which particular nerves are affected. People with severe cases of multiple sclerosis may lose the ability to walk or speak. Multiple sclerosis can be difficult to diagnose early in the course of the disease, because symptoms often come and go — sometimes disappearing for months.

Although multiple sclerosis can occur at any age, it most often begins in people between the ages of 20 and 40. Women are more likely to develop multiple sclerosis than are men.

MS is more likely to occur in northern Europe, the northern United States, southern Australia, and New Zealand than in other areas. Geographic studies indicate there may be an environmental factor involved.

People with a family history of MS and those who live in a geographical area with a higher incidence rate for MS have a higher risk of the disease.

Symptoms of MS may mimic those of many other nervous system disorders. The disease is diagnosed by ruling out other conditions.

People who have a form of MS called relapsing-remitting may have a history of at least two attacks, separated by a period of reduced or no symptoms.

The health care provider may suspect MS if there are decreases in the function of two different parts of the central nervous system (such as abnormal reflexes) at two different times.

A neurological exam may show reduced nerve function in one area of the body, or spread over many parts of the body. This may include:

• Abnormal nerve reflexes
• Decreased ability to move a part of the body
• Decreased or abnormal sensation
• Other loss of nervous system functions

An eye examination may show:

• Abnormal pupil responses
• Changes in the visual fields or eye movements
• Decreased visual acuity
• Problems with the inside parts of the eye
• Rapid eye movements triggered when the eye moves

Tests to diagnose multiple sclerosis include:

• Cerebrospinal fluid tests, including CSF oligoclonal banding
• Head MRI scan
• Lumbar puncture (spinal tap)
• Nerve function study (evoked potential test)
• Spine MRI

There is no known cure for multiple sclerosis at this time. However, there are therapies that may slow the disease. The goal of treatment is to control symptoms and help you maintain a normal quality of life.

Medications used to slow the progression of multiple sclerosis may include:

• Immune modulators to help control the immune system, including interferons (Avonex, Betaseron, or Rebif), monoclonal antibodies (Tysabri), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), methotrexate, azathioprine (Imuran), cyclophosphamide (Cytoxan), and natalizumab (Tysabri)
• Steroids may be used to decrease the severity of attacks

Medications to control symptoms may include:

• Medicines to reduce muscle spasms such as Lioresal (Baclofen), tizanidine (Zanaflex), or a benzodiazepine
• Cholinergic medications to reduce urinary problems
• Antidepressants for mood or behavior symptoms
• Amantadine for fatigue

The following may help MS patients:

• Physical therapy, speech therapy, occupational therapy, and support groups
• Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars
• A planned exercise program early in the course of the disorder
• A healthy lifestyle, with good nutrition and enough rest and relaxation
• Avoiding fatigue, stress, temperature extremes, and illness

These steps may help relieve some symptoms of multiple sclerosis:

• Get enough rest. Fatigue is a common symptom of multiple sclerosis, and getting your rest may make you feel less tired.
• Exercise. Regular aerobic exercise may offer some benefits if you have mild to moderate MS. Benefits include improved strength, muscle tone, balance and coordination, and help with depression. Swimming is a good option for people with MS who are bothered by heat.
• Be careful with heat. Extreme heat may cause extreme muscle weakness. Although some people with multiple sclerosis aren't bothered by heat and may enjoy warm baths and showers, be very careful before exposing yourself to extreme heat until you know how you'll react. Don't get into a hot tub or sauna unless there's someone nearby who can pull you out if necessary. If you do experience heat-related worsening of signs or symptoms, cooling down for a few hours usually will return you to your normal state.
• Cool down. Many people with multiple sclerosis experience heat-related worsening of MS symptoms. If you live in a hot and humid area, consider having air conditioning in your home. Tepid or cool baths also may provide some relief.
• Eat a well-balanced diet. Eating a healthy, well-balanced diet can help keep your immune system strong.

As is true with other chronic diseases, living with multiple sclerosis can place you on a roller coaster of emotions. Here are some suggestions to help you even out the ups and downs:

• Maintain normal daily activities as best you can.
• Stay connected with friends and family. Continue to pursue hobbies that you enjoy and are able to do.

If multiple sclerosis impairs your ability to do things you enjoy, talk with your doctor about possible ways to get around the obstacles.

Remember that your physical health can directly impact your mental health. Counselors or therapists may help you put things in perspective. They can also teach you coping skills and relaxation techniques that may be helpful.

Sometimes, joining a support group, where you can share experiences and feelings with other people, is a good approach. Ask your doctor what support groups are available in your community.