What Is Multiple Sclerosis (MS)?

Multiple sclerosis (MS) occurs when your immune system attacks myelin, the sheath that surrounds your nerve cells. Without this outer covering, your nerves become damaged, causing communication problems between your brain and the rest of your body. MS is a chronic, or long-lasting, disease that can affect your brain, your spinal cord, and the optic nerves in your eyes. It can cause problems with vision, balance, muscle control, and other basic body functions. The effects of MS vary from person to person. Some people have mild symptoms and don’t need treatment, while others have difficulty moving around and doing daily tasks.

Symptoms of Multiple Sclerosis (MS)

The damage means your brain can’t send signals to your body correctly. Your nerves also don’t work as they should to help you move and feel. As a result, you may experience symptoms such as:

• Trouble focusing or remembering
• Trouble walking
• Feeling tired
• Muscle weakness or spasms
• Blurred or double vision
• Numbness and tingling
• Sexual problems
• Poor bladder or bowel control
• Pain
• Depression

At What Age Does Multiple Sclerosis Appear?

The first symptoms of multiple sclerosis usually begin between the ages of 20 and 40. Most people with MS have attacks, or relapses, when the condition gets noticeably worse. These are usually followed by periods of recovery when symptoms improve. In other people, the disease continues to get worse over time. In recent years, scientists have found many new treatments that can help prevent relapses and slow the effects of the disease.

Types of Multiple Sclerosis

There are three main types of MS:
Relapsing-remitting MS (RRMS)

This is the most common type of MS. About 85% of people with MS receive this diagnosis. With RRMS, you tend to have temporary flare-ups. These are called relapses. If you have RRMS, your symptoms are very likely to get worse during an attack. After the flare-up, you go through a phase of remission, which means you may return to your baseline with no symptoms, or your disability may increase after a relapse (called RRMS with worsening). However, your condition does not get worse during remission.

Primary progressive MS (PPMS)

If you have PPMS, your MS symptoms tend to get gradually worse after you are diagnosed. However, you don’t have distinct periods of relapse or remission. About 10% of people with MS are diagnosed with PPMS.

Secondary progressive MS (SPMS)

With SPMS, your symptoms gradually get worse over time. You may develop this type after first having symptoms of RRMS. Some medications, such as siponimod, are approved for active SPMS (with relapses or new lesions on MRI); whether medications can slow worsening in the non-active progressive phase is not clear.

First Signs of Multiple Sclerosis (MS)

Symptoms can differ from person to person. And as the condition progresses or gets worse, you may notice new symptoms. The first signs of MS often include vision changes. This is also known as optic neuritis. Problems may include:

• Complete or partial loss of vision (usually in one eye at a time)
• Pain when you move your eyes
• Blurred vision
• Double vision

Other common early signs of multiple sclerosis you may have include:

• Thinking and memory problems
• Numbness and tingling
• Exhaustion
• Loss of balance
• Dizziness
• Stiffness
• Spasms
• Tremors
• Pain
• Bladder problems
• Bowel problems

What Causes MS?

Doctors don’t know for certain what causes MS, but several things seem to make the disease more likely. People with certain genes may have a higher chance of developing it. Smoking may also increase the risk.

Some people may develop MS after a viral infection, such as Epstein-Barr virus or human herpesvirus 6, because the infection stops their immune system from working normally. The infection may trigger the disease or cause relapses. Scientists are studying the link between viruses and MS, but they don’t have a clear answer yet.

Scientists are studying the link between viruses and MS, but they don’t have a clear answer yet.

Some studies suggest that vitamin D, which you can get from sunlight, may strengthen your immune system and protect you from MS. For some people who are more likely to develop the disease, moving to sunnier areas seems to lower their risk.

Risk Factors for Multiple Sclerosis

What causes MS is unknown. However, you may be more likely to develop MS if you:

• Were assigned female at birth (AFAB)
• Are in your 20s, 30s, or 40s
• Don’t spend much time in the sun
• Live in a cloudy, rainy, or dark climate
• Smoke
• Are fighting a viral infection such as Epstein-Barr virus
• Have a family history of MS

Ethnicity also plays a role. Rates of developing MS are highest among Black people, followed by White and Hispanic people. Asian and Native American individuals are at the lowest risk. People with higher vitamin D levels, those who live in sunnier climates, and those who spend more time outdoors are less likely to develop MS.

How Is MS Treated?

There is no cure for MS, but a variety of treatments can help you feel better and keep your body working well. Your doctor may also prescribe medications that can slow the course of the disease, prevent or treat attacks, ease your symptoms, or help you manage the stress that comes with the disease.

Medications that may slow your MS or reduce nerve damage include:

• Alemtuzumab (Lemtrada)
• Beta interferon (Avonex, Betaseron, and Rebif)
• Cladribine (Mavenclad)
• Dalfampridine (Ampyra): does not slow the disease; it is used to improve walking in some patients
• Dimethyl fumarate (Tecfidera)
• Diroximel fumarate (Vumerity)
• Fingolimod (Gilenya)
• Glatiramer (Copaxone)
• Mitoxantrone (Novantrone)
• Monomethyl fumarate (Bafiertam)
• Natalizumab (Tysabri)
• Ocrelizumab (Ocrevus)
• Ofatumumab (Kesimpta)
• Ozanimod (Zeposia)
• Ponesimod (Ponvory)
• Siponimod (Mayzent)
• Teriflunomide (Aubagio)
• Ublituximab-xiiy (Briumvi)

Your doctor may give you steroids to make your MS attacks shorter and less severe. You may also try other medications, such as muscle relaxants, tranquilizers, or botulinum toxin (Botox), to ease muscle spasms and treat some of your other symptoms.

A physical therapist can teach you exercises to maintain your strength and balance and to help you cope with fatigue and pain. An occupational therapist can make working and taking care of yourself easier by teaching you new ways to do certain tasks. If you have trouble getting around, a cane, walker, or braces can help you walk more easily. Along with treatment, there are other things you can do to ease your MS symptoms. Exercise regularly and avoid too much heat to boost your energy. Ask your doctor about doing yoga to reduce fatigue or stress. Take care of your emotional health, too. It’s okay to ask your family, friends, or a counselor for help with any stress or anxiety you may feel. Support groups are also great places to connect with other people living with MS.

Living With MS

There are several things you can do to ease the symptoms of multiple sclerosis:

Prioritize sleep. Make sure you get enough good-quality sleep. Keep consistent sleep and wake times to maintain good sleep hygiene. If you have obstructive sleep apnea or another sleep disorder, talk to your doctor about treating it.

Eat well. Nutrition plays a role in health, so a balanced diet can help you feel your best. Eat whole grains instead of refined grains. Avoid or limit processed foods and added sugar. Eat plenty of fruits and vegetables.

Exercise regularly. Staying active on a regular basis can improve your strength, balance, and coordination.

Stay cool. Symptoms may get worse when your body temperature is high. Avoid heat or wear clothing that helps you stay cool.

Relieve stress. Stress can trigger symptoms, so find a way to reduce stress that works for you. Yoga, meditation, or massage may help.

Avoid smoking. Smoking is linked to a wide range of diseases and conditions. It can also cause MS symptoms to get worse faster.

Get regular care. See your doctor or healthcare provider regularly to keep track of your symptoms. Ask about new and upcoming treatments.

Adapt your environment. Make the changes you need in your living spaces to accommodate your multiple sclerosis. This may mean things like clearing clutter, adding grab bars, and making other adjustments.

Anticipate possible changes. MS can change how much you are able to work (and may keep you from working). As a result, you may earn less (or have no income at all). In one study, people with MS who had lower socioeconomic status became disabled more quickly. These participants were also more likely to develop SPMS, meaning their neurological function worsened, and to do so more quickly.

Seek support Connecting with other people who have MS can provide the mental and emotional support you need to live well.