Multiple Sclerosis

The symptoms of MS vary from person to person. Which symptoms you have will depend on which parts of the brain or spinal cord (central nervous system) are damaged. The loss of myelin and scarring caused by MS can affect any part of the central nervous system. Myelin is the insulating coating around a nerve.

Symptoms may come and go or become more or less severe from day to day or, in rare cases, from hour to hour. Symptoms may get worse with increased body temperature or after a viral infection.

Early symptoms

Common early symptoms of MS include:

Muscle or motor symptoms.

These include weakness, leg dragging, stiffness, a tendency to drop things, a feeling of heaviness, clumsiness, and a lack of coordination (ataxia).

Visual symptoms.

These include blurred, foggy, or hazy vision, eyeball pain (especially when you move your eyes), blindness, or double vision. Optic neuritis—sudden loss of vision that is often painful—is a fairly common first symptom.

Sensory symptoms.

These include tingling, a pins-and-needles sensation, numbness, a band of tightness around the trunk or legs, and electrical sensations moving down the back and legs.

Advanced symptoms

As MS progresses, symptoms may become more severe. They may include:

• Worse muscle problems, and stiff, mechanical movements (spasticity) or uncontrollable shaking (tremor). These problems may make it hard to walk. A wheelchair may be needed some or all of the time.
• Pain and other sensory symptoms.
• Bladder symptoms, such as loss of bladder sensation or not being able to hold urine (urinary incontinence) or to completely empty the bladder.
• Constipation and other bowel disorders.
• Male erectile dysfunction (impotence) and female sexual dysfunction.
• Cognitive and emotional problems, such as problem-solving and depression. These are common in people who have had MS for some time.
• Feeling very tired (fatigue). This can be worse if symptoms such as pain, spasticity, bladder problems, anxiety, or depression make it hard to sleep.

The exact cause isn't known, but most experts believe that MS is an autoimmune disease. In this kind of disease, the body's defenses, called the immune system, mistakenly attack normal tissues. In MS, the immune system attacks the central nervous system—the brain and spinal cord.

Treatment can make living with MS easier. Your type of treatment will depend on how severe your symptoms are and whether your disease is active or in remission. You and your doctor will set up a schedule of appointments to watch and treat your symptoms. These checkups help your doctor find out if you may need to try a different treatment.

Different medicines are used to treat MS. Medicines called disease-modifying drugs may be used over a long period of time. They help to keep down the number of attacks and how severe they are and to slow the progress of the disease. Other medicines may be used during a relapse or to control certain symptoms.

Physical therapy, occupational therapy, and speech therapy can help you manage some physical problems caused by MS. There are also things you can do to help yourself. You can eat balanced meals, get regular exercise and rest, and learn to use your energy wisely.

In some cases, surgery may be done if you have severe tremor (shakiness) that affects movement. Or it may be done to implant a catheter or pump in the lower spinal area to deliver a constant flow of medicine to help treat severe muscle stiffness (spasticity).

Some complementary medicine treatments may help relieve symptoms of MS. For example, gingko biloba or magnetic therapy may help relieve fatigue. Talk to your doctor if you are interested in trying any of these treatments.

Dealing with the physical and emotional demands of MS isn't easy. If you feel overwhelmed, talk to your doctor. You may be depressed, which can be treated. Finding a support group where you can talk to other people who have MS can be very helpful.

Generally, MS follows one of four courses:

• Relapsing-remitting. Symptoms fade and then return off and on for many years.
• Secondary progressive. At first it follows a relapsing-remitting course. And then it becomes steadily worse (progressive).
• Primary progressive. It is progressive from the start.
• Clinically isolated syndrome. The symptoms last for 24 hours or longer and go away.

For most people, MS follows a relapsing-remitting course, at least at first. It involves a series of attacks that cause symptoms. These are called relapses, flares, or exacerbations. They may last for days or weeks and then partly or completely go away.

Relapses may be mild or severe and tend to recur over a period of years. They may become worse and more frequent over time. As time goes by, symptoms may linger after each relapse, and new symptoms often develop.

Most people live with MS for decades. Many become more disabled as they get older.

General care

• 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.
• If you have problems urinating, press or tap your bladder area to help start urine flow. If you have trouble controlling your urine, plan your fluid intake and activities so that a toilet will be available when you need it.
• Spend time with family and friends. Join a support group for people with MS if you want extra help.
• Depression is common with this condition. Tell your doctor if you have trouble sleeping, are eating too much or are not hungry, or feel sad or tearful all the time. Depression can be treated with medicine and counseling.

Diet and exercise

• Eat a balanced diet.
• If you have problems swallowing, change how and what you eat:
  • Try thick drinks, such as milk shakes. They are easier to swallow than other fluids.
  • Do not eat foods that crumble easily. These can cause choking.
  • Use a blender to prepare food. Soft foods need less chewing.
  • Eat small meals often so that you do not get tired from eating larger meals.
• Get exercise on most days. Work with your doctor to set up a program of walking, swimming, or other exercise that you are able to do. A physical therapist can teach you exercises if you cannot walk but can move your limbs and trunk. Or you can do exercises to help with coordination and balance. You can help improve muscle stiffness by doing exercises while lying in certain positions.