Multiple sclerosis, or MS, is a disease of the central nervous system (CNS), the main network of nerves that carry electrical impulses throughout the body.
The CNS is made up of the brain and spinal cord. Both have nerve fibers that transport electrical messages from the brain to the rest of the body.
The nerve fibers are wrapped in a fatty tissue called myelin, which helps transmit the messages.
In multiple sclerosis, the myelin sheath which covers nerve fibers becomes inflamed and gradually is destroyed, leaving areas of patchy scar tissue (sclerosis) that disrupts communication between the brain and other parts of the body.
In addition, the underlying nerve fibers can also be damaged or destroyed.
This destruction of the myelin sheath and the damage to the underlying nerves can lead to a wide variety of symptoms that include numbness or tingling, balance problems, weakness, muscle spasms and blurred vision.
MS is a complex, unpredictable, and progressive disease. In some people, it can cause relatively few symptoms.
Others experience intermittent attacks. In the worst cases, people who have multiple sclerosis can lose the ability to speak, walk or write.
However, the disease does not seem to significantly shorten a person's life, and many people with multiple sclerosis are able to remain active.
Anyone can develop MS. But many patients share these characteristics:
Scientists don't know what causes multiple sclerosis.
But there is increasing evidence that the body's immune system plays a prominent role in its development, and some scientists think MS is an autoimmune disease.
The immune system, which usually protects the body by fighting germs and foreign bodies, may attack the myelin in the central nervous system.
Some researchers suspect that these attacks may be triggered by certain kinds of viral infections.
Researchers have also observed that some groups of people are much more susceptible to MS than others.
This suggests that there may be a genetic component to the disease.
The exact course of the disease in individual patients is unclear, too. MS affects people in a variety of ways.
In general, though, the disease follows several known patterns. Doctors group four of the patterns together under the heading "chronic progressive MS":
In addition, the National Institute of Neurological Disorders and Stroke estimates that up to 20 percent of people with MS have a benign form of the disease.
After the initial attacks, symptoms progress very little over the course of a person's lifetime.
A small number of patients have malignant MS, which is marked by a rapid decline that leads to disability and possibly death.
MS is rarely fatal, however, and most people with the disease have a normal life expectancy.
There are four distinct forms of multiple sclerosis, the most common of which is called RRMS, or relapsing-remitting MS.
The other three are progressive versions of the disease, including secondary-progressive multiple sclerosis (SPMS), primary-progressive multiple sclerosis (PPMS), and the rarest form, progressive-relapsing multiple sclerosis (PRMS).
Relapsing-remitting MS is defined by alternating periods of relapses and remissions.
During a relapse, also called an attack, flare-up, or exacerbation, new symptoms develop or old symptoms suddenly get worse because of acute inflammation in the CNS.
People with RRMS most often experience:
However, other symptoms are also possible, such as:
Relapses can last from 24 hours to several weeks. Technically, to be considered a relapse, the episode must last for at least 24 hours and be separated from the previous flare-up or attack by 30 days or more.
Following a relapse, people with RRMS enter a remission period, when damaged areas begin to heal and symptoms partially or completely disappear. Remissions may last for weeks, months, or even more than a year.
More than 2.3 million people around the world suffer from a form of MS, according to the National MS Society.
About 85 percent of them have RRMS when they are first diagnosed.
Multiple sclerosis is most common in Caucasians, particularly those of northern European descent, according a 2010 article in the journal Autoimmunity Reviews.
It also most often develops in people who live in temperate regions around the globe, although there are exceptions to this pattern.
The disease typically arises in people who are 20 to 50 years old.
However, RRMS most often begins when people are in their 20s and 30s, and women get RRMS two to three times more often than men, according to the National MS Society.
About half of people who had RRMS transitioned to SPMS (secondary-progressive multiple sclerosis) within 10 years, and nearly all (90 percent) transitioned within 25 years, in studies that were done before newer disease-modifying drugs were available, according to the National MS Society.
Although the newer drugs appear to slow progression, we dont know to what extent they might change the transition from RRMS to SPMS.
To diagnose RRMS, your doctor will ask about your medical history, symptoms, and when symptoms occurred.
Its important to find out if you have a pattern of relapses and remissions.
If you have only experienced a single attack, you will need to wait until a second attack occurs, which may take months or years, before you can undergo further testing and be diagnosed with RRMS.
When the protective membranes, or myelin sheaths, around your nerve fibers are damaged by RRMS, scar tissue forms.
Known as sclerosis and lesions, the scars are visible on magnetic resonance imaging (MRI) scans.
Compared with the other forms of MS, RRMS tends to create more brain lesions (versus lesions in the spinal cord), and the brain lesions also have more inflammatory cells, according to the National MS Society.
Although doctors may diagnose RRMS based on your history of symptoms, most often they will also use MRI scans.
Doctors used to do two MRIs at least 30 days apart and follow a complex set of criteria about where lesions show up.
But since 2010, diagnostic guidelines in the United States have become simpler.Combined with the right clinical symptoms, doctors can use just one MRI scan if they find at least two CNS lesions that are in two separate places.
These may include two lesions in two specific areas of the brain, or one in the brain and one in the spinal cord.
Doctors must also rule out other potential causes of symptoms and lesions. To do this, they perform spinal taps to test cerebrospinal fluid for inflammatory cells and antibodies.
They also test the speed of your CNS connections by stimulating specific nerve pathways and measuring the brains response (known as evoked-potential tests).
There is no cure for any form of MS.
But the Food and Drug Administration (FDA) has approved multiple drugs to treat MS, including disease-modifying medications that can slow the progression of RRMS and reduce the severity of attacks.
These drugs come in different forms, such as oral pills, injections that go under the skin or into the muscle, and intravenous (IV) infusion.
Among other treatments, there are a number of steroid drugs that can lessen symptoms during attacks by reducing inflammation. A treatment called plasma exchange can also treat exacerbations.
There are also treatments that target specific symptoms of RRMS.
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Secondary-progressive multiple sclerosis (SPMS) is one of four types of multiple sclerosis, which is an autoimmune disease that damages tissue in the central nervous system (CNS).
Multiple sclerosis (MS) disrupts the flow of nervous-system communication (electrical nerve signals) within the CNS and between the CNS and the rest of the body.
It ultimately causes a wide range of health issues throughout the brain and numerous body systems.
There are 2.3 million people worldwide who have a form of MS, according to the National MS Society.
Multiple sclerosis develops when the cells in your bodys immune system erroneously attack what are known as myelin sheaths in the CNS. These cover and protect nerve fibers while helping speed up nerve impulses.
The damage from the attacks leaves scar tissue that is visible in magnetic resonance imaging (MRI) scans, which can be used as part of the diagnosis process or to monitor the disease.
You can only get SPMS if you've already had relapsing-remitting multiple sclerosis (RRMS). RRMS is the most common type of MS, including 85 percent of people first diagnosed with the disease, which typically develops between ages 20 and 40.
About half of all people who had RRMS transitioned to SPMS within 10 years, and nearly all (90 percent) transitioned within 25 years, in studies that were done before newer disease-modifying drugs were available, according to the National MS Society.
Although the newer drugs appear to slow progression, we dont know to what extent they might change the transition from RRMS to SPMS.
People with RRMS experience alternating periods of attacks or relapses, which include worsening of old symptoms or development of new ones. Remissions, when symptoms partly or completely go away, are also possible.
These attacks are probably caused by flare-ups of inflammation in the CNS, according to a 2013 article in the journal Current Treatment Options in Neurology.
Once SPMS develops, relapses and remissions from inflammation slowly decrease or stop altogether. Instead, the disease and its symptoms steadily progress with accumulating disability. This is mainly caused by damage to or loss of nerves, known as neurodegeneration.
Numerous factors may predict how quickly a person progresses from RRMS to SPMS.
For instance, some research suggests that people with RRMS who experience symptoms related to the spinal cord might transition to SPMS more quickly than those who have visual, sensory, and sometimes brainstem-related symptoms, according to a 2006 article in The Lancet Neurology.
Other research suggests that after five years, people who have more body systems affected by RRMS will transition faster to SPMS, the report notes.
People with SPMS may continue to experience RRMS symptoms, which include but are not limited to:
People with SPMS often experience flare-ups, which worsen their RRMS symptoms or create new ones. They will also experience a gradual worsening of symptoms and disability, such as:
If youve already been diagnosed with RRMS, your doctor will look over your medical history and get a detailed account of your symptoms, their duration, and onset to see if you've transitioned to SPMS.
Your doctor will also need to determine if your symptoms are truly worsening at a steady pace or are a kind of lingering result of your last inflammatory relapse.
Otherwise, diagnosing SPMS differs little from other forms of MS and can involve several different tests, including:
There is no cure for MS, but there are a handful of newer drugs known as disease-modifying medications now available to help control relapses.
These drugs reduce the frequency of relapses and the severity of symptoms. They may work for people who have just transitioned to SPMS and still experience relapses, but will probably become less effective as the disease progresses.
At this point, doctors may prescribe mitoxantrone (Novantrone), a drug that suppresses your immune system. Its the only drug approved by the Food and Drug Administration (FDA) to specifically treat SPMS (in Europe, interferon beta-1a and interferon beta-1b are also approved).
Mitoxantrone mainly works for relapses, but it does not stop the gradual worsening of symptoms. So it may only be useful for the early stages of SPMS, when there are more inflammation-related symptoms.
There are also concerns about the toxicity of mitoxantrone the drug has been linked to heart failure and leukemia, according to the American Academy of Neurology, and is not recommended for all people with MS.
Other treatments and drugs are available to help manage symptoms, such as corticosteroids, which may also be used during relapses to reduce inflammation.
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Primary-progressive multiple sclerosis, or PPMS, is an often-debilitating disease of the central nervous system (spinal cord and brain).
About 10 percent of people who have multiple sclerosis (MS) have the PPMS form of disease, according to the National MS Society.
The other three kinds of MS are the relapsing-remitting form (RRMS), the secondary-progressive type (SPMS), and the progressive-remitting form (PRMS).
PPMS stands apart from the other types of MS in how it develops, resulting in greater disability, and in how it is treated.
The main difference between PPMS and other forms of MS is how the disease progresses.
Specifically, the three other types of MS all involve inflammation that causes relapses. During relapses, new symptoms may develop or old symptoms may get worse.
By comparison, people who have PPMS dont get relapses. Although other forms of MS can harm nerve cells, PPMS is primarily driven by damage and wasting away of nerve fibers, particularly those in the spinal cord, according to a 2007 report in The Lancet Neurology.
This neurodegeneration causes a gradual worsening of neurological functioning that starts at the beginning of the disease and leads to disability.
PPMS is also typically marked by lesions that are more diffuse and contain fewer inflammatory cells. The lesions are less likely to generate new myelin sheaths as well. Additionally, people with PPMS have more lesions in their spinal cord than in their brain.
The most common form of MS, relapsing-remitting (RRMS), typically arises in people who are in their 20s and 30s, while PPMS typically begins in people when they are in their 40s and 50s, according to the National MS Society.
Women are two to three times more likely than men to get RRMS, but women and men are equally likely to get PPMS.
Overall, PPMS results in more disability than other forms of MS, and people with PPMS may require more help with everyday activities, according to the National MS Society.
About 80 percent of people who have PPMS experience partial paralysis in the lower body (spastic paraparesis), particularly in the legs, which progressively gets worse over time, according to The Lancet Neurology report.
Symptoms include:
The second-most common problem that people with PPMS develop is related to nerve damage in the area of the brain that affects coordination, causing whats known as cerebellar ataxia, according to the Lancet Neurology report.
This can result in various symptoms, including:
People with PPMS may also experience cognitive impairments that affect attention, the ability to function using multiple short-term memories (working memory), memory of words and other aspects of language (verbal memory and fluency), and orientation and geographical thinking (spatial reasoning).
Other problems, such as difficulty speaking and swallowing, may also develop.
To see if you have PPMS, your doctor will begin by getting your medical history, including a detailed account of your symptoms.
In a diagnosis of PPMS, you need to have experienced at least one year of worsening neurological function without any relapses or remissions.
Your doctor will also use diagnostics such as MRI scans, cerebrospinal fluid labs, and evoked-potential tests, which measure the speed of your brains responses.
Diagnosis of PPMS requires at least two of the following items:
There is no cure for MS. And unlike some other forms of the disease, there are no drugs that can slow the progression of PPMS.
Physical and occupational therapy, as well as regular exercise and stretching, can help people with PPMS improve their physical function and mobility, and there are medications for muscle stiffness, bladder and bowel problems, and fatigue.
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Progressive-relapsing multiple sclerosis (PRMS) is the least common form of multiple sclerosis (MS).
Multiple sclerosis is a potentially debilitating disease in which the immune system attacks the central nervous system (CNS), including the brain and spinal cord.
Only about 5 percent of people with MS are estimated to have PRMS, according to the National MS Society.
Most often, people are initially diagnosed with the primary-progressive form of MS (PPMS), and after they experience a relapse, they are diagnosed with the progressive-relapsing form.
In a sense, PRMS is a combination of two other forms of MS.
People with PRMS immediately experience a gradual, or progressive, decline in neurological function, similar to people who have primary-progressive MS (PPMS).
But like people with the relapsing-remitting form of MS (RRMS), they also have relapses, when one or more of their symptoms spontaneously get worse.
However, PRMS relapses are not as frequent and symptoms may not get better, as they do during RRMS remission periods.
There is some debate about whether PRMS should be considered a distinct type of MS, or if its the same thing as PPMS.
For instance, a 1999 report in the journal JAMA Neurology argued that they are the same because they appeared to be virtually indistinguishable from each other, except for the one or two relapses people with PRMS had during their lifetime.
On the other hand, a 2004 study in the Multiple Sclerosis Journal found that relapses in PRMS may occur more often than previously thought, with about three relapses on average and in many cases more than four.
The study also found that disability can accumulate more quickly with PRMS than with PPMS.
Small differences in age and sex also set apart the two diseases.
Primary-progressive disease usually arises in people during their 40s and 50s, according to the National MS Society, while the progressive-relapsing form occurs about four years earlier on average, according to a 2006 report in the journal Brain.
Primary-progressive disease is diagnosed almost equally among women and men, while the progressive-relapsing form is slightly more common in women than in men, with a ratio of about 1.4 to 1, according to the Multiple Sclerosis Journal report.
As with the other forms of MS, PRMS is associated with a wide range of symptoms that can affect numerous body systems. These symptoms may include:
As mentioned above, PRMS is generally diagnosed after a person with PPMS experiences a relapse.
Diagnosis of all forms of MS usually involve:
There is no cure for MS. For people with PRMS and other relapsing forms of MS, drugs known as disease-modifying agents may help. These newer treatments reduce inflammation, including the frequency and severity of attacks.
However, they have not yet been shown to stop the overall progression of the disease thats caused by neurodegeneration.
As with PPMS, physical and occupational therapy can help improve physical function and mobility in people with PRMS.
And various medications, such as muscle relaxants, bladder drugs, and wakefulness agents, can help treat other PRMS symptoms.
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Multiple sclerosis, or MS, is a disease of the central nervous system (CNS), which is made up of the brain and spinal cord.
The CNS regulates and controls body functions by sending and receiving electrical messages between nerve cells.
Multiple sclerosis is considered an autoimmune inflammatory disease, in which the body's immune system erroneously attacks its own healthy tissues through inflammatory and other processes.
In MS, immune cells attack myelin, a fatty tissue that forms a protective covering, called a myelin sheath, around nerve fibers and helps speed up nerve impulses traveling through the CNS.
The disease causes scar tissue (sclerosis, also called plaque or lesions) to form on nerve fibers, ultimately disrupting the flow of information within the brain and the communication between the brain and the rest of the body.
The immune system may also directly damage nerves. Overall, this activity can lead to a large range of symptoms.
Fever, hot baths, sun exposure, and stress may trigger or temporarily worsen symptoms.
Symptoms of MS vary widely in people, and the various forms of MS sometimes include different symptoms.
So it's not possible to predict how the disease will present itself or progress in any one person.
However, people with MS often experience vision problems first, including blurred or double vision, color distortions, and a condition called optic neuritis, which causes eye pain and rapid loss of vision.
Other early symptoms can include:
Fatigue is one of the most common symptoms of MS, affecting about 80 percent of people who have the disease, according to the National MS Society.
You may experience being tired all day long or become easily fatigued from mental or physical exertion. Other common MS symptoms include:
Less common symptoms of MS include:
General pain including headaches, muscle pain, and chronic back or other musculoskeletal pain and specific pain syndromes are commons symptoms of MS.
In fact, about 63 percent of people with MS experience pain, according to a 2013 report in the journal Pain.
The study found that headache and neuropathic (nerve) pain in the extremities are the most common types of pain that people experience, affecting 43 percent and 26 percent of people with MS, respectively.
The least common type of MS pain is in the face known as trigeminal neuralgia, according to the study.
Ttrigeminal neuralgia is a kind of sharp and stabbing pain in the face that originates from damage to the trigeminal nerve, which is responsible for facial motor functions and sensations. It's sometimes confused with dental pain.
Another common type of pain from MS is whats known as the Lhermitte sign, which is a brief and sharp electric-shock-like sensation that runs from the back of the head down the spine and into the limbs. People often feel it when they bend their neck forward.
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Multiple sclerosis, or MS, is a disease that affects the nerves of the brain and spinal cord, which make up your central nervous system.
In people with MS, the central nervous system (CNS) is unable to adequately communicate with and coordinate the functions of the rest of the body.
Multiple sclerosis develops from damage to myelin sheaths, protective coverings around nerve fibers that are made of protein and fatty substances.
Aside from protecting nerve fibers, myelin sheaths insulate nerve cells (neurons) and increase the speed of electrical signals sent between neurons within the CNS and between the CNS and the rest of the body.
Scientists believe MS is an autoimmune inflammatory disease.
Autoimmune diseases arise when the immune system behaves abnormally, attacking otherwise healthy body tissues.
Multiple sclerosis specifically attacks myelin sheaths.
Damage to the sheaths causes scarring or sclerosis, from which the disease gets its name on nerve fibers, which can be seen on magnetic resonance imaging (MRI) scans.
In addition to damaging and removing the myelin around nerve fibers, immune cells may also directly damage the underlying nerves.
The range of symptoms associated with MS stem from a disruption in nerve-impulse transmissions caused by this immune-system activity.
It's not clear what causes a persons immune cells to start attacking the CNS in the first place, but scientists think a combination of environmental and genetic factors is behind MS.
Though MS can develop in young children and the elderly, you are at a greater risk of getting MS if you are between 20 and 50 years old, according to a 2010 article in the journal Autoimmunity Reviews.
Women are also more likely to get MS, and this disparity appears to be increasing.
Women were 1.4 times more likely to get MS than men in 1955, but by the year 2000 the ratio jumped to 2.3, according to a 2008 report in the journal Neurology.
Today, the ratio may be as high as 3.5 to 1, according to a 2013 article in the journal Therapeutic Advances in Neurological Disorders.
Your location also affects your risk of developing MS.
MS is more common in places farther from the equator, according to the Autoimmunity Reviews report.
Research has found that your risk of getting MS is lowest in tropical areas (near the equator) or in Asia, and highest in temperate areas (far from the equator), particularly in areas that have large populations of Northern European origin.
So people who live farther from the equator (such as Northern Europe) are at higher risk, but also in places such as the United States, Russia, Canada, New Zealand, and parts of Australia, especially if they are of Northern European heritage.
Research suggests that decreased sunlight and the bodys vitamin D production may be to blame for this geographical risk difference.
Interestingly, if you move to another region of the world during childhood, your risk of getting MS changes but this isn't so if you relocate after you are 15, according to a 2008 review in the journal The Lancet.
Though geography appears partly to determine risks, there are exceptions. For example, MS is rare in some ethnic populations that live far from the equator, suggesting genetics, geography, and possibly culture interact in a complex way to affect risk.
In general, Caucasians, particularly those with family heritage in Scandinavia and Scotland, are extremely susceptible to the disease, while Mongolians, Japanese, Chinese, American Indians, and Eskimos are very low risk of developing MS, according to the Autoimmunity Reviews article.
Smoking and being infected with EpsteinBarr virus, particularly during adolescence or adulthood, also increases your risk of getting MS. High dietary salt intake may further increase your risk of MS, suggest two 2013 studies in the journal Nature.
Multiple sclerosis is not considered a hereditary disease, which means you can't pass it directly to your children, but genes do play a role.
About 20 percent of people with MS have at least one relative with the disease, The Lancet report notes.
If you have a have first-degree relative with MS, such as a parent, child, or brother or sister who is not an identical twin, your risk is higher than if you dont, between 2 percent and 5 percent.
But your risk jumps to 25 percent if you have an identical twin with MS.
Research suggests that variations in the HLA-DRB1 gene are associated with an increased risk of developing MS. HLA-DRB1 belongs to a family of genes called the human leukocyte antigen (HLA) complex.
These genes help the immune system tell the difference between your bodys natural proteins and foreign ones.
Normally, the immune system is only supposed to attack foreign proteins, but in autoimmune diseases, such as MS, the immune system also attacks your bodys natural proteins.
The strongest genetic risk factor for developing MS is having a particular variant of this gene, called HLA-DRB1*15:01.
Women are more likely to have this variant than men, according to a 2011 study in the journal Neurology.
Changes in a non-HLA immune-related gene, called IL7R, have also been implicated in the development of MS.
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What makes multiple sclerosis so difficult to diagnose?
Besides the fact that no single test can detect the disease, MS symptoms can mimic those of a number of other conditions, and they can change over time.
Symptoms can also vary from person to person and from day to day in the same person.
Some early symptoms of MS are:
Other symptoms include:
To diagnose the disease, healthcare providers use a number of tools and tests that often help rule out other possible causes.
Medical history: Doctors ask for details about personal health history and family health history and also question patients carefully about symptoms, their duration and their onset.
Physical examination: A physical exam will most likely include tests to determine the health of nerves and muscles. Doctors may look for weakness in specific parts of the body, uncoordinated eye movements, and problems with balance, vision, and speech.
Magnetic resonance imaging (MRI): If doctors possibly suspect MS after a physical exam, they will probably order additional diagnostic tests, starting with an MRI.
During an MRI, a patient's body is placed within a magnetic field and scanned by radio waves. This combination creates detailed pictures of the part of the body being examined.
In MS, doctors take scans of the brain or spine depending on the symptoms and physical exam. The resulting pictures can show patches, or scars, in the central nervous system where myelin has been destroyed. These areas are referred to as plaques.
Since other disorders can cause these plaques, an MRI scan can't provide definitive evidence of multiple sclerosis. But doctors rely primarily on MRIs to see evidence of the disease.
MRIs are also important in tracking the progress of the disease, and doctors may order new tests from time to time to monitor a patient's condition.
Researchers also use the test to see if experimental MS treatments have an effect on scarring in the central nervous system.
Cerebrospinal fluid collection (CSF collection): If the diagnosis is still not clear, doctors may take a sample of spinal fluid.
Patients typically lie on their sides with their knees bent up. The doctor administers a local anesthetic in the lower spine and, using another needle, takes out a sample of the spinal fluid.
Doctors examine the sample for abnormalities associated with MS, such as increases in white blood cells and high levels of an antibody called immunoglobulin G.
Evoked response tests (ERTs): These electronic tests, sometimes called evoked potential tests, measure the speed of brain connections.
The most common ERTs are the visual evoked response test (VER), the brainstem auditory evoked response test (BAER) and the sensory evoked response test (SER).
In each of these tests, doctors attach wires to a patient's scalp. Then, depending on the test, they give patients visual, auditory, or sensory stimulation.
These stimuli are a checkerboard pattern patients see on a monitor, a series of clicks they hear through earphones, or short electrical impulses they feel on an arm or leg.
The tests measure the speed of visual, hearing, and sensory pathways and can detect damaged areas in the brain.
There is no cure for multiple sclerosis (MS). However, being diagnosed with MS is not a death sentence.
In this progressive neurological disease, the bodys immune system behaves abnormally, disrupting electrical messages traveling within the central nervous system (the brain and spinal cord) and to the rest of the body.
There are several types of MS drugs available today. Disease-modifying medications can slow the progression of the disease in some people, and are effective in lowering the frequency and severity of attacks or relapses (the appearance of new symptoms or the worsening of old symptoms). They also reduce lesions seen on MRI scans.
Other medications, such as corticosteroids, are used to help control severe MS attacks, which are also known as flare-ups and exacerbations.
Additionally, there are numerous treatments for managing symptoms, including bladder and bowel issues, fatigue, pain, sexual problems, and muscle spasticity.
Multiple sclerosis develops when the immune system sparks inflammation in the central nervous system (CNS) by attacking the protective cover around nerve fibers, called a myelin sheath.
There are four different types of MS: Relapsing-remitting (RRMS), secondary-progressive (SPMS), primary-progressive (PPMS), and progressive-relapsing (PRMS).
Disease-modifying medications can help treat the relapsing forms of the disease (including RRMS and SPMS), in which people experience acute attacks followed by quiet periods when symptoms are less severe.
These medications cannot help people with primary-progressive MS, which is marked by a gradual worsening of symptoms instead of acute attacks.
The Food and Drug Administration (FDA) has approved the following drugs to treat relapsing forms of MS:
The FDA has also approved the IV drug alemtuzumab (Lemtrada) for people who have forms of MS that include relapses and who haven't responded well to two or more disease-modifying medications.
Alemtuzumab works by rapidly depleting the body's supply of immune (T and B) cells, which temporarily stops the immune-system effects on your CNS and allows your body to create new cells, which might not attack myelin sheaths.
The FDA recommends only using it as a second-line therapy (after other drugs have failed) because it increases the risk of severe infections, development of new autoimmune diseases, and other potentially dangerous conditions.
For acute attacks of MS, especially severe ones that interfere with a person's mobility, safety, or ability to function, doctors may prescribe corticosteroids.
These medications, which include dexamethasone (Decadron), methylprednisolone (Solu-Medrol), H.P. Acthar Gel (ACTH), and prednisone (Deltasone), help treat attacks by reducing the body's inflammation.
For people who cannot handle steroid drugs, a treatment called plasmapheresis (plasma exchange) is available. Plasma is the liquid part of your blood, and it contains autoantibodies, a type of protein that the immune system produces to attack the body's cells and tissues.
Plasmapheresis involves separating plasma from your blood cells, and then returning the blood cells to your body along with fresh plasma or a plasma substitute.
During and after acute attacks, doctors may recommend various treatments for symptomatic relief, such as physical therapy; the use of horses to assist with walking and gait issues; and neuro-rehabilitation (speech therapy, psychotherapy, and occupational therapy, among others) to help with MS cognitive, emotional, and neurological problems.
Given the wide range of symptoms caused by MS, doctors may also prescribe a variety of drugs, such as muscle relaxants, antidepressants, antispasmodics, and pain medications.
Numerous complementary and alternative therapies exist that may help treat MS, including but not limited to:
However, for most of these treatments, there's little evidence they work for MS, and some of them lack adequate studies to come to any conclusions about their effectiveness, according to the American Academy of Neurology (AAN).
A 2006 review in the International MS Journal came to similar conclusions.
Some of these treatments do, however, hold promise. Magnetic therapy, for instance, may help reduce fatigue, and reflexology may be helpful for "pins and needles" sensations (paresthesia), AAN reports.
Additionally, medical marijuana pills and the oral medical marijuana spray appear to help with muscle spasticity and pain, and frequent urination.
A 2014 study in the journal JAMA Neurology also suggests that vitamin D may slow the progression of MS and reduce the severity of symptoms.
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Multiple sclerosis is a lifelong disease of the brain and spinal cord (central nervous system, or CNS).
The disease disrupts the flow of information within the CNS, as well as the communication between the brain and the rest of the body, resulting in a wide range of symptoms.
Just a few examples include:
Despite the multitude of symptoms associated with MS, most people with the disease go on to live long lives.
In the United States, people with MS have a life expectancy that is six years shorter than people without the disease, according to a 2014 study that used information from a population that had commercial health insurance, published in the journal of Multiple Sclerosis and Related Disorders.
There is no cure for MS, but there are numerous "disease-modifying medications" that may slow the progression of some forms of the disease and reduce the frequency and severity of relapses, or attacks (the worsening of old symptoms or development of new ones).
People with MS who take these medications have a better life expectancy than those who don't, a 2012 research report in the journal Neurology showed.
More than 2.3 million people are affected by multiple sclerosis worldwide, according to the National MS Society.
More than 10 percent of them, between 250,000 and 350,000, live in the United States.
What's more, multiple sclerosis is up to 3.5 times more common in women than men, although the sex difference is a lot smaller for some forms of the disease.
There are four types of MS: Relapsing-remitting (RRMS), secondary-progressive (SPMS), primary-progressive (PPMS), and progressive-relapsing (PRMS).
According to the National MS Society, about 85 percent of people with MS are diagnosed with RRMS, which has alternating periods of attacks (also known as flare-ups, relapses, or exacerbations) and remission periods, when symptoms improve or disappear.
Most people with RRMS go on to develop SPMS, wherein the sharply defined periods of relapses and remissions become less frequent and the disease gradually gets worse.
About 10 percent of people with MS have PPMS. They experience a gradual worsening of symptoms from the beginning of the disease, with no relapses or remissions.
The rarest form of the disease, PRMS, occurs in less than 5 percent of people with MS. They also have progressive worsening of symptoms from the get-go, but they experience occasional relapses too.
Multiple sclerosis is not considered a fatal disease. However, it is associated with various life-threatening complications, hence the lower life expectancy. These complications may include:
A 2012 study in the journal BMJ Open looked at the causes of death for 81 people with MS who were part of a 21-year clinical trial of a disease-modifying drug. Of the 69 deaths that could be assessed, 78.3 percent of them were MS-related, and most were from lung infections.
A 2014 report in the journal PLoS One found that sepsis (caused by blood infections) was responsible for the most deaths, with lung infections following close behind.
Though MS can sometimes be a debilitating disease, the majority of people who have it don't become severely disabled, according to the National MS Society.
About a third of people with MS completely lose their ability to walk, while many others can function using canes or crutches (or a scooter or motorized wheelchair for long distances).
People with MS who have the best prognosis are usually those who:
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Multiple sclerosis, or MS, is associated with a wide range of symptoms that affect numerous body parts and systems.
For instance, the disease often affects the muscles, causing loss of balance, spasms, and weakness.
It can also lead to difficulty chewing and swallowing, and it even affects bladder and bowel control.
But these symptoms are only the beginning: When left untreated, MS can cause life-threatening complications.
It may come as a surprise, but people with MS are at high risk of contracting a number of infections.
Bladder problems are very common in people with MS, affecting at least 80 percent of them, according to the National MS Society.
Some people have trouble holding their urine (incontinence), while others can't fully empty their bladder (retention).
If the bladder isn't completely emptied, the retained urine may allow bacteria and fungi to grow out of control, creating a serious urinary tract infection.
This bladder dysfunction may also lead to kidney infections.
In the worst cases, the microbes find their way into the bloodstream, which can cause whats known as sepsis, a chemical response in the blood that creates a whole-body inflammation that, in turn, may cause organ failure and death.
In fact, sepsis may be the biggest cause of MS-related deaths, according to a 2014 report in the journal PLoS One.
Sometimes, people with MS have trouble chewing and swallowing. This can allow foods and liquids, including your own mucus, to go the wrong way down and deposit in the lungs.
That may lead to a potentially fatal complication: aspiration pneumonia, which develops from inflammation and fluid accumulation in the lungs.
Multiple sclerosis may also cause the respiratory muscles to become weakened, reducing airway clearance, which raises the risk of lung and other respiratory tract infections.
Lung infections were the second-biggest cause of MS-related deaths in study PLoS One reported in 2014. Other research gives it the top spot for cause of death in people with MS.
The good news is that most people with MS are not severely physically disabled, and are still able to walk, according to the National MS Society.
However, many do require canes or crutches, and complications do happen among people with MS who aren't disabled.
For instance, weakened muscles and balance issues from MS increase the risk of physical trauma from falls and accidents.
For those who are disabled by MS, long hours in bed or in a wheelchair can cause pressure sores, also known as bedsores and pressure ulcers.
As the name implies, these sores are injuries to skin tissue resulting from prolonged pressure in particular spots.
These sores must be taken seriously because they can cause difficult-to-treat infections and may develop into life-threatening sepsis.
Lack of walking and movement also weakens muscles.
What's more, decreased mobility and the lack of weight-bearing activity can increase a person's risk of osteoporosis, which can lead to broken bones, especially when combined with the high risk of falling among people with MS.
Corticosteroid drugs also increase the risk of developing osteoporosis.
This is particularly unfortunate, since these drugs are an important option for reducing inflammation and treating an MS relapse, or attack, which is the development of new symptoms or worsening of old ones.
Scientists don't fully understand the relation between depression and MS.
On the one hand, depression may be a direct physical effect of MS.
MS develops when the immune system attacks the protective myelin sheaths that envelop nerve fibers in the central nervous system, which includes the spinal cord and the brain.
So its plausible that when there is damage to myelin sheaths, and then the underling nerve fibers of brain areas involved with emotion (such as the hippocampus), people may develop behavioral changes including depression.
Multiple sclerosis can also change what is known as the bodys neuroendocrine system, which oversees hormone release, including hormones implicated in depression, such as serotonin.
On the other hand, depression may develop as a result of the stresses and challenges associated with having MS.
The medications used to treat MS, such as interferon beta, can also cause depression.
Whatever the cause, depression is common among people who have MS.
People with MS have a 40 percent to 60 percent chance of developing depression in their lifetime, according to a 2006 article in the Journal of Rehabilitation Research and Development.
Additionally, depression is twice as common overall in people with MS compared with other groups that have different chronic diseases.
People with MS even have more severe depression than people who have other neurologically based chronic illnesses, the report notes.
Along the same lines, people with MS are more likely to commit suicide, though it's unclear just how much higher their risk is.
A 1991 Canadian study found that suicide risk for people with MS was 7.5 times higher than in the age-matched general population.
But a 2005 Danish study found that the risk of suicide for people with MS was twice as high as it was for the general Danish population, a big difference from the Canadian studys results, although still a substantial risk.
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Source: http://www.everydayhealth.com
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