Patient education: Multiple sclerosis in adults (The Basics)

What is multiple sclerosis? — Multiple sclerosis ("MS") is a disease that causes vision problems, numbness and tingling, muscle weakness, and other problems.

MS is an "autoimmune" disease. Normally, the immune system works as the body's infection-fighting system. It protects you by attacking and killing germs and other cells that could make you sick. When a person has an autoimmune disease, the immune system starts to attack the body's healthy cells by mistake. This is called an "autoimmune response."

In MS, the immune system attacks and damages nerve cells and their connections in the brain and spinal cord (figure 1).

What are the symptoms of MS? — The condition can cause many symptoms, but not everyone with MS has all of them. Plus, the symptoms of MS can also be caused by problems other than MS.

In general, MS symptoms can include:

●Numbness, tingling, and feeling "pins and needles"

●Muscle weakness or spasms, which can cause you to drop things or fall

●Vision problems, eye pain, and odd eye movements

●Feeling dizzy or off balance, which can cause you to fall

●Trouble walking or speaking

●Problems controlling your bowels or bladder

●Problems with sex, like having less interest in sex or not enjoying sex

●Sensitivity to heat, which makes symptoms worse

●Trouble thinking clearly

●Feeling very tired

Most people with MS have only a few of these symptoms. But people with severe MS can have most or all of them.

Are there different forms of MS? — Yes. Doctors give different names to MS, depending on how it progresses.

MS can be:

●Relapsing-remitting – This means that the symptoms of MS come and go. When the symptoms flare up, it is called an "attack" or "relapse." These attacks can last for days to weeks and usually get better slowly. Between attacks, people often feel pretty normal. But some people have problems that last even after an attack gets better. Relapsing-remitting is the most common type of MS.

●Secondary progressive – Some people who start with relapsing-remitting MS get to a point where the symptoms begin to steadily get worse even when they are not having attacks. This is called "secondary progressive" MS.

●Primary progressive – This means that the symptoms steadily get worse from the beginning.

Doctors also use the term "active MS" or "active disease." This means that a person is having new attacks of MS or new signs of MS on imaging tests. Active MS can happen in people with relapsing-remitting, secondary progressive, or even primary progressive MS.

Will I need tests? — Yes. If your doctor suspects that you have MS, they can order an "MRI scan" of your brain and sometimes your spinal cord. An MRI is an imaging test that creates pictures of the inside of your body. It can show whether your brain or spinal cord has signs of MS.

However, an MRI scan might not be able to show right away if you have MS. In many cases, doctors diagnose MS only after seeing how symptoms and test results change over time.

In some cases, your doctor might order other tests to help figure out if you have MS. These might include:

●Lumbar puncture (sometimes called a "spinal tap") – During this procedure, a doctor puts a thin needle into your lower back and removes a small amount of spinal fluid. Then, they check the fluid for signs of MS.

●"Evoked potentials" or "evoked responses" – This is a way for the doctor to look at the electrical signals in your brain and spinal cord. It involves sticking small "electrodes" to your skin. The doctor can then measure the nerve signals in your brain while you look at lights, listen to sounds, or feel a mild electrical current.

●Optical coherence tomography – This test uses a special light to look at the inside of your eyes for signs of MS.

In other cases, you might need blood tests to check for diseases that can be similar to MS.

Should I see a doctor or nurse? — See your doctor or nurse right away if you have any of the symptoms listed above and you do not know what is causing them.

How is MS treated? — It depends on what type of MS you have. Your doctor can talk to you about your options and the best medicines for your situation.

There are different ways to:

●Treat attacks – If you have an MS attack, your doctor can give you medicines called steroids. These are different than the steroids athletes take to build up muscle. They reduce the body's autoimmune response, so they can shorten the length of an attack.

●Prevent attacks – There are several different medicines for people who have active MS. (This means that they are having new attacks or their MRI scans show new signs of MS.) These medicines are called "disease-modifying therapy." They do not cure the disease. But they lower the chances that MS symptoms will flare up.

Some of these medicines come in shots. Many people learn to give themselves the shots. Some medicines for MS come as pills or capsules that you can swallow. Others are given through a thin tube that goes into a vein, called an "IV." There are different schedules for the IV medicines, but most involve doses only every few weeks or months.

●Relieve symptoms – Doctors can also treat symptoms of MS. This can help improve your quality of life. It can involve taking medicines or making other changes.

Talk to your doctor or nurse about all of your symptoms, even if you think they are not related to MS. For example, if you feel depressed, leak urine, or have problems with sex, tell your doctor or nurse. It can be hard to talk about these things. But there are often treatments that can help.

What if I want to get pregnant? — If you have MS, talk to your doctor before you start trying to get pregnant. Certain MS medicines are not safe during pregnancy. Other MS medicines might be OK during pregnancy, if necessary.

Some doctors recommend stopping MS medicines right before and during pregnancy when possible. If you have an MS attack while you are pregnant, you can still safely take steroids to deal with symptoms.

What will my life be like? — It can be scary to learn that you or a loved one has MS.

Remember that in most people, MS progresses very slowly. On average, it takes many years before MS causes serious disability. Plus, the medicines used to treat MS are often very good at preventing attacks. Some people with relapsing-remitting MS can go many months or even years between attacks. Even so, it's impossible to say how fast symptoms will get worse for any 1 person.

If you are struggling to manage your symptoms, talk with your doctor or nurse. They might be able to recommend different treatments to try. Some people also find it helpful to join a support group or talk with other people who are living with MS.