Multiple Sclerosis

Multiple sclerosis (MS) is a disease of the central nervous system, which comprises the brain, spinal cord and optic nerves. MS is an autoimmune disease in which the person's immune system mistakenly damages healthy nerves in the brain and spinal cord. The damage disrupts or stops the normal flow of nerve impulses, causing a reduction in or loss of body function.

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Symptoms

Multiple sclerosis can cause problems with muscle control and strength, vision, or balance and sensation. Symptoms vary from person to person and may come and go or become more or less severe from day to day.

Symptoms may include:

  • Weakness
  • Leg dragging
  • Stiffness
  • Loss of balance
  • Movement problems
  • Tendency to drop things
  • Feeling of heaviness, clumsiness or a lack of coordination
  • Numbness or tingling in the feet or hands
  • Stiff, mechanical movements or uncontrollable shaking
  • Pain or other sensory symptoms
  • Bladder issues, such as inability to control urination or inability to urinate
  • Constipation and other bowel disorders
  • Erectile dysfunction

Vision symptoms may include:

  • Blurred, foggy or hazy vision
  • Eye pain, especially with movement
  • Rapid eye movement
  • Vision loss, usually in one eye
  • Double vision

As the disease progresses, in addition to physical symptoms some MS patients may experience cognitive problems such as memory loss, difficulty concentrating or speech issues, as well as emotional symptoms, including depression or mood disorders.


Causes and Risk Factors

The cause of multiple sclerosis is unknown, but more women than men are diagnosed with the disease. Since the risk of MS is significantly higher when a parent has been diagnosed with the disease, genetic factors may play a role. The unusual relationship between a person's geographic location during childhood and the risk of MS later in life suggests that there may be environmental factors at work in the disease.

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Diagnosis

A doctor will take a medical history and perform a neurological examination. Because there is not a definitive test to confirm MS and symptoms can be the same as those of other nervous system disorders, diagnostic tests will help rule out other causes in addition to confirming a diagnosis.

These tests may include a magnetic resonance imaging (MRI) scan of the brain and spinal cord. More than 90 percent of people who have MS have an abnormal MRI. For people already diagnosed with multiple sclerosis, MRI scans also may be used to follow the progression of the disease.

The patient's medical team may order a lumbar puncture, also known as a spinal tap, and cerebrospinal fluid analysis, as well as nerve function tests.

Blood tests may be performed to rule out other conditions that have similar symptoms.

A diagnosis of multiple sclerosis is confirmed when the following are present without another explanation for the symptoms:

  • The patient has had at least two neurologic episodes with signs and symptoms of MS (weakness or clumsiness, vision problems, tingling or numbness, or balance problems) lasting at least 24 hours and occurring at least one month apart.
  • There is at least one symptom that indicates an injury to one part of the central nervous system, and laboratory tests show abnormal findings in at least one other area of the central nervous system.
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Treatments

Multiple sclerosis has no cure, but medications can be prescribed to help improve patient quality of life.

There are currently 10 FDA-approved medications available that modify disease activity, slowing the progression of MS and reducing the number and seriousness of attacks in people with relapsing-remitting MS. Choosing the right medication requires careful consideration of the risks and benefits, along with close collaboration with an experienced neurologist with experience in treating the disease, such as those at the Multiple Sclerosis Center in Cedars-Sinai’s Department of Neurology.

When a patient has an MS attack, corticosteroids can be given to shorten and lessen the severity of the relapse.

Other medications are available that can relieve MS symptoms such as spasticity (stiff, tight muscles), pain, fatigue, tremor, depression and bladder problems.

Physical and occupational therapy and home treatment methods also may help a patient manage symptoms and adjust to living and working situations.