Multiple sclerosis

Multiple sclerosis (MS) is a disease that affects the central nervous system—the brain and spinal cord. It also affects the nerves to the eyes. It can cause problems with muscle strength, vision, balance, mood, sensation, and thinking.

Your nerve cells have a protective covering called myelin. Without myelin, the brain and spinal cord can't communicate with the nerves in the rest of the body. MS causes areas in the brain and spinal cord to get inflamed. It slowly damages the myelin and nerves in patches. These patches of damage are called lesions.

MS tends to get worse over time. But usually this happens slowly. It's hard to predict how MS will affect you. MS is different for each person. Some people's lives won't change much with MS. Those people may function well for a long time. But others may lose the ability to walk or do everyday tasks as the disease gets worse.

There is no cure for MS. But medicines and other treatments might help slow its progression and treat your symptoms.

The symptoms of MS vary from person to person. Which symptoms you have will depend on which parts of your brain or spinal cord are damaged. Over time, symptoms may come and go, or they may be long-lasting. Certain things like being hot or having an infection may cause symptoms to get worse for a short time. As MS progresses, symptoms may get worse.

Common symptoms

• Feeling very tired (fatigue).
• Muscle symptoms. These include weakness, stiffness, and spasms. You may be clumsy or have a tremor. These problems may make it hard to hold on to things or walk. Over time, a cane or wheelchair may be needed.
• Visual symptoms. These include blurry vision, eye pain, blindness, and double vision. Optic neuritis—a sudden loss of vision that's often painful—may be a first symptom of MS.
• Sensory symptoms. These include numbness and tingling, feelings of pins-and-needles, and coldness. They may occur in a limb or on your face or body. You may also feel a band of tightness around the trunk of your body.
• Pain. This may include headaches, nerve pain, and pain from muscle spasms.
• Bladder symptoms. These may include a need to urinate often. Or you may not be able to control or empty your bladder. You may wake up at night to urinate.
• Constipation and other bowel symptoms. You may have a hard time passing stool (constipation). Or you may lose control of your bowels.
• Sexual problems. You may be less interested in having sex. Or you may have pain during sex or have problems getting an erection.
• Cognitive problems. You may have trouble focusing. You may forget things. Or you may have trouble thinking quickly or solving problems.
• Mental health symptoms. You may feel depressed or anxious.
• Sleep problems.
• Vertigo and balance problems. You may feel dizzy or unsteady.

It isn't always easy to diagnose MS. The first symptoms may be vague. And many of the symptoms can be caused by problems other than MS.

Your doctor will use several pieces of information to diagnose MS. Your doctor will:

• Ask questions about your symptoms—past and present—and your past health.
• Do a neurological exam. This exam checks your strength and how well your nerves are working.
• Do tests.
  • You'll probably have an MRI to look for lesions in your brain. If lesions are seen, it may mean that you have MS. But having lesions doesn't always mean that you have MS. There could be other causes.
  • You may have a spinal tap (lumbar puncture).
  • You may have special nerve tests, such as an evoked potentials test.
  • Blood tests may be done to see if something else is causing your symptoms.

It may take time before your doctor can confirm that you have MS. Your doctor may need to see how your symptoms, physical exam, and MRI results change over time.

Different medicines are used to treat MS. Some may slow its progression and help prevent attacks (relapses). Some treat attacks. Others help treat the symptoms.

Physical, occupational, and speech therapy can help you manage some physical problems caused by MS. Cognitive therapy can help if you have trouble thinking clearly or remembering.

Regular exercise and physical activity can reduce some symptoms. They are helpful for everyone with MS, even if you have severe symptoms or can't do certain things. A physical therapist can help you find the best way for you to be active.

Depression and anxiety are common with MS. If you have either of these, talk to your doctor. Medicines and counseling can help.

General care

• Be safe with medicines. 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.
• Try to stay active mentally. Read or do things like crossword puzzles if you enjoy doing them.
• Keep cool. For many people, MS symptoms get worse when they are even a little bit hotter. This could be from the weather, a hot shower, exercise, or a fever. Cooling vests, neck wraps, cool cloths, air conditioning and cool showers after exercise can help. So can avoiding hot tubs and saunas.
• Seek connections. Spend time with friends, family, and others. Joining a support group for people with MS may help.
• Tell your doctor if you feel sad, depressed, or hopeless. Also tell your doctor if you have lost interest in things you usually enjoy. Medicine and counseling can help.
• If you smoke, try to quit. Smoking may increase problems caused by MS. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Try to cut down on stress. Calm yourself or release tension by doing an activity you enjoy, such as reading a book, listening to music, or gardening.

Diet and exercise

• Talk to your doctor about your diet and any supplements you take.
• Tell your doctor if you're having problems chewing or swallowing. Your doctor or a speech therapist may recommend changes to your diet to help make it easier to swallow. You may need to avoid certain foods or liquids. You also may need to change the thickness of foods or liquids in your diet.
• If you get full quickly or get tired easily when you eat, try eating smaller meals more often. You can also try a liquid meal replacement such as Ensure or Boost.
• Get exercise and physical activity on most days. Exercise can be safe even if your symptoms are severe. A physical therapist can help you find the best way to be active. Physical activity and exercise can reduce many of the symptoms of MS. Exercise might also reduce attacks (relapses).
• Ask your doctor about taking vitamin D. The doctor may suggest taking it and can suggest a dose. Low vitamin D levels may be linked to MS.