Multiple Sclerosis

Disease Summary

Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system. Autoimmune disorders cause the body’s immune system to attack itself and destroy healthy tissue. In MS, the immune system targets and attacks myelin tissue in the brain, which disrupts nerve “communication” leading to various symptoms throughout the body. MS is a lifelong condition and although not currently curable, many treatments are available that can reduce bothersome symptoms and decrease the risk of disease progression.

There are four main sub-types of MS:

Relapsing-remitting MS (RRMS)
The majority of patients start with this form of MS. With RRMS, a patient will have attacks (called relapses) followed by periods of full or partial recovery (or remission). Symptoms can appear for several days to weeks and will go This form of MS is diagnosed when a patient has more than one relapse.

Secondary-progressive MS (SPMS)
Patients with SPMS will have worsening symptoms with or without relapses and remissions. Relapses are more common during the early stages. About 78 – 85% of patients enter the SPMS phase within 25 years of MS diagnosis.

Primary-progressive MS (PPMS)
10 – 15% of patients with MS will have PPMS, which is diagnosed by worsening symptoms for at least six months. A patient with this type will not experience relapses or remissions—the disease will worsen with some improvements from time to Patients with PPMS tend to be older and do not respond as well to standard MS treatments.

Progressive-relapsing MS (PRMS)
This is a rare sub-type of MS that affects 5% of MS patients. Like patients with PPMS, symptoms will worsen from the beginning with relapses from time to time.


How is MS diagnosed?

There are two basic signs that confirm a diagnosis of MS. The first is finding signs of the illness in different parts of your nervous system. The second is reporting two or more flare-ups of the disease. Please talk to your doctor or other healthcare professional about the following tests and procedures:

Medical history
Review of your overall health picture, including all symptoms and when they started. A worksheet has been included in this packet to help you provide a personal list of medications.

Nervous system performance
Testing reflexes, balance and coordination, vision, and checking for areas of tingling or

Diagnostic tests
MRI of brain and spinal cord
Evoked Potential Test: Evaluates how quickly and accurately your nervous system responds to certain stimulation
Spinal Tap: An office procedure where spinal fluid is drawn using a needle and sent to a lab


Possible symptoms of multiple sclerosis

Patients with MS may experience flare-ups (series or pattern of attacks) and remissions (periods of no symptoms). Every patient with MS will have a different set of symptoms, and will likely not experience all of the symptoms listed below. Symptoms may go into remission completely, leaving no damage or some degree of permanent damage. They may also worsen by stress, extreme tiredness, and changes in temperature (including indoor/outdoor as well as body temperature). Any changes or worsening of symptoms listed below should be shared with a doctor or other healthcare professional.

Bladder or bowel dysfunction
Problems with urinating or passing stools—includes frequent urination, incontinence, or constipation.

Chronic pain
Burning pain or pressure that is caused by damaged nerve endings.

Cognitive difficulties
Problems with memory, reasoning, speech, and speed of processing information.

Depression
Feeling sad is a common reaction to having a chronic illness. Medications can also contribute to this.

Fatigue
The feeling of tiredness or having a lack of energy. This is the most common complaint of MS patients, usually in the late afternoon or early evening.

Muscle weakness/balance issues
The lack of coordination or having trouble with walking.

Numbness and tingling
One of the earliest symptoms—numbness in the lower or middle abdomen occurs in up to 55% of MS patients.

Sexual dysfunction
Decreased sexual drive and impaired sensation.

Spasticity
Condition of rigid or stiff muscles that can affect walking, movement, and speech.

Vision changes
Blurred or double vision followed by some vision loss (rarely involves both eyes at the same time).