There is currently no cure for MS, but modern treatments can significantly reduce relapses, limit new nerve damage and slow the progression of disability.
Types of Multiple Sclerosis
Relapsing-Remitting MS
Relapsing-remitting MS is the most common form at diagnosis, accounting for approximately 85% of cases.
People experience episodes of new or worsening neurological symptoms called relapses, followed by periods of partial or complete recovery known as remission.
Secondary Progressive MS
Some people with relapsing-remitting MS later develop secondary progressive MS.
In this form, symptoms and disability gradually worsen over time, sometimes with fewer obvious relapses.
Primary Progressive MS
Primary progressive MS accounts for approximately 10–15% of cases.
Symptoms gradually worsen from the beginning without clearly defined relapses and remissions.
Causes and Risk Factors
The exact cause of multiple sclerosis is unknown. It is thought to develop through a combination of genetic susceptibility, immune-system abnormalities and environmental factors.
Factors associated with a higher risk include:
Family history of MS
Previous infection with Epstein-Barr virus
Low vitamin D levels
Limited sunlight exposure
Smoking
Obesity during adolescence
Living farther from the equator
MS is not contagious and is not directly inherited from parent to child.
Symptoms
Symptoms vary considerably depending on which areas of the brain, spinal cord or optic nerves are affected.
Common symptoms include:
Blurred or painful vision in one eye, known as optic neuritis
Numbness or tingling in the arms or legs
Weakness, sometimes affecting one side of the body
An electric-shock sensation down the spine when bending the neck, known as Lhermitte's sign
Extreme fatigue
Problems with balance and coordination
Difficulty walking
Double vision
Dizziness
Muscle stiffness and spasms
Bladder problems
Bowel problems
Difficulty with memory and concentration
Mood changes
Symptoms can temporarily become worse when body temperature rises due to hot weather, exercise, fever or a hot bath.
Diagnosis
There is no single test that confirms multiple sclerosis.
A neurologist usually makes the diagnosis using a combination of symptoms, neurological examination and investigations.
The McDonald criteria are commonly used and require evidence that damage has occurred in different parts of the nervous system at different times.
MRI
An MRI scan of the brain and spinal cord is one of the most important tests.
It can identify areas of inflammation, damage and scarring known as lesions.
Lumbar Puncture
A lumbar puncture may be performed to examine cerebrospinal fluid for signs of abnormal immune activity, including oligoclonal bands.
Evoked Potentials
Evoked-potential tests measure how quickly electrical signals travel along nerve pathways.
They are particularly useful for assessing pathways involving the optic nerves.
Blood Tests
Blood tests may be used to exclude conditions that can produce similar symptoms, including:
Vitamin B12 deficiency
Neuromyelitis optica
Other autoimmune diseases
Treatment
Treatment for MS generally has three goals:
Treating acute relapses
Slowing disease progression
Managing individual symptoms
Treating Relapses
A short course of high-dose corticosteroids, such as methylprednisolone, may be prescribed during a significant relapse.
Steroids can shorten the duration of an attack but do not change the long-term course of MS.
For severe relapses that do not respond adequately to steroids, plasma exchange may be considered.
Disease-Modifying Therapies
Disease-modifying therapies (DMTs) can:
Reduce the frequency of relapses
Reduce new lesions seen on MRI
Slow the accumulation of disability
These treatments generally work best when started early in appropriate patients.
Injectable Treatments
Examples include:
Interferon beta
Glatiramer acetate
Oral Medicines
Examples include:
Dimethyl fumarate
Teriflunomide
Fingolimod
Siponimod
Cladribine
Infusion Treatments
Examples include:
Natalizumab
Ocrelizumab
Alemtuzumab
Ocrelizumab may also be used for primary progressive MS.
Rituximab is used off-label in many countries, including India, and may provide a lower-cost treatment option in selected patients.
Managing Symptoms
MS can cause many different symptoms, so treatment is often individualised.
Management may include:
Physiotherapy to improve strength, mobility and balance
Medicines for muscle stiffness and spasms
Treatment for nerve pain
Medicines and lifestyle strategies for fatigue
Management of bladder and bowel problems
Counselling or psychological support for anxiety and depression
Living With Multiple Sclerosis
Healthy lifestyle habits can support physical function and general wellbeing.
People with MS may benefit from:
Regular stretching
Walking
Swimming
Yoga
Avoiding smoking
Maintaining adequate vitamin D levels
Eating a balanced diet
Getting enough sleep
Avoiding excessive heat
Pacing activities to manage fatigue
Regular exercise can help improve strength, balance, mobility and fatigue.
MS and Pregnancy
Most women with MS can have healthy pregnancies.
Relapses often become less frequent during pregnancy but may become more common during the first few months after delivery.
Pregnancy should therefore be planned with a neurologist and obstetrician, particularly because some MS medicines may need to be stopped or changed before conception.
Outlook
The course of MS varies greatly between individuals.
Some people experience relatively mild symptoms for many years, while others develop more significant disability.
With modern disease-modifying therapies and supportive treatment, many people with MS continue to work, remain independently mobile and lead active lives.
Life expectancy for people with MS is now close to that of the general population.
When to See a Doctor
See a doctor promptly for:
Sudden or unexplained loss of vision
Painful vision in one eye
Numbness or weakness lasting more than 24 hours
New problems with balance or walking
Persistent neurological symptoms without an obvious explanation
People already diagnosed with MS should report new or worsening symptoms lasting more than 24 hours, as these may represent a relapse.
Sudden weakness on one side of the body accompanied by facial drooping or slurred speech requires emergency medical attention, as these symptoms may indicate a stroke.
The Bottom Line
Multiple sclerosis is a chronic autoimmune condition that affects the brain, spinal cord and optic nerves by damaging the protective myelin surrounding nerve fibres.
Although there is currently no cure, early diagnosis and modern disease-modifying treatments can reduce relapses, slow disease progression and help many people maintain an active and independent life.
