Multiple Sclerosis (MS) Guide: Symptoms, Causes, and Treatments

What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is an autoimmune disease that affects your central nervous system (brain and spinal cord). It can cause many symptoms, like vision changes, balance problems, and weakness.

When you have MS, your immune system mistakenly attacks your brain and spinal cord. This damages the protective coating on your nerves, called myelin. It can also cause scarring (sclerosis). These changes make it hard for your body’s nervous system to work properly. 

Multiple sclerosis is a common condition. Nearly 1 million adults in the U.S. have MS.

Types of MS

There are four types of MS, which are related to how your symptoms change over time:

• Relapsing-remitting: This is the most common type of MS. People with this type of MS have attacks, which last days or weeks, followed by periods of recovery. 

• Secondary progressive MS: This is similar to relapsing-remitting, but with more limited recovery between periods of attacks. 

• Primary progressive MS: With this type of MS, symptoms steadily get worse over time — with no recovery periods. 

• Clinically isolated syndrome: This is where you have only one episode of MS symptoms. It often (but not always) progresses to one of the other types of MS.

What causes multiple sclerosis?

The exact cause of multiple sclerosis is unknown. But like most autoimmune disorders, it’s likely that MS is caused by a combination of genes and environmental triggers. 

There’s evidence that MS is linked to:

• Living in a Northern area (farther from the equator)

• Having a family member with MS

• Having a low vitamin D level

• Having excess body weight in early life

• Smoking cigarettes

• Having had a previous viral infection, like Epstein–Barr virus

MS can affect anyone, regardless of age, race, or gender. But certain groups of people are more likely to be diagnosed with MS, including:

• Women

• Young adults (The average age of diagnosis is 32 years old.) 

• White people

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Multiple sclerosis symptoms

MS can cause many symptoms — and they’re different for everyone. This is because your symptoms depend on which parts of your brain and spinal cord are affected.

Common symptoms include:

• Fatigue

• Vision changes

• Eye pain

• Balance problems

• Weakness

• Numbness and tingling

• Bladder or bowel issues

• Muscle spasms

• Mood changes

• Problems with memory or thinking

• Difficulty walking

Symptoms often vary from person to person. And for any given person with MS, their own symptoms can be unpredictable. 

Symptoms typically come on as attacks (also called “exacerbations” or “flare-ups”). Attacks start suddenly and last for a few days to several weeks. Between attacks, symptoms can get better or even go away completely.

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How is MS diagnosed?

Getting a firm diagnosis of MS can be a bit tricky. It’s best to start with a visit to a healthcare professional, who may refer you to a neurologist. A neurologist is a medical doctor who specializes in conditions of the nervous system. In most cases, they’ll start with an interview and physical exam. If you have MS symptoms, they might also suggest additional tests. These could include:

• Lumbar puncture (spinal tap)

• Magnetic resonance imaging, or MRI (a scan of your brain and spinal cord)

• Nerve conduction tests 

• Blood work

To diagnose MS, your neurologist will be looking for:

• Evidence of two or more attacks in your brain or spinal cord on the MRI

• Evidence that those attacks happened at different times

They’ll also look for evidence that your symptoms are caused by another medical problem, which would rule out MS.

Unfortunately, there’s no single test that can diagnose MS. This makes it challenging to tell whether the first symptoms are due to MS or another condition. It can take months or even years to be sure you have MS.

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MS medications

Though there’s no cure for MS, medications can help you manage your symptoms and live a full life. 

Prescription medications can:

• Modify (change) your disease: Disease-modifying therapies (DMT) are medications that keep your immune system under control. They’re available in oral, injectable, and intravenous (IV) forms. DMTs can protect you against symptom attacks and long-term disability. 

• Treat attacks: Steroids (or corticosteroids) can block inflammation in your body which can shorten an attack and make it less severe. Steroids are only used short term (3 to 5 days). They don’t change the course of your disease, and long-term use can cause side effects. 

• Manage symptoms: There are many different prescription medications to help manage whatever symptoms you’re having, including bladder problems, fatigue, pain, sexual problems, spasticity, and more. 

Some people with MS also use other therapies for managing symptoms like:

• Over-the-counter (OTC) medications

• Vitamins and supplements

• Marijuana

As mentioned, everyone is different, so it’s important to be honest with your neurologist about your symptoms and their effects on your life. Your neurologist can help you figure out which options are right for you. 

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Treatments for multiple sclerosis

In addition to medications, other treatments can help improve function, mobility, and quality of life for people with MS.

Plasma exchange for MS attacks

For severe attacks, some people can benefit from plasmapheresis (plasma exchange). Plasma exchange works by removing immune factors (which cause inflammatory attacks) from the blood. 

Stem cell therapy

This is typically reserved for people with highly active disease who don’t respond to disease-modifying treatments. A procedure called autologous hematopoietic stem cell transplantation (aHSCT) replaces dysfunctional immune cells in the body. So far, this has shown promise for relapsing MS, but it comes with risks, and research is ongoing.

Rehabilitation therapies

Rehabilitation specialists help people with MS maintain or bring back their mobility, balance, daily functioning, and independence. Specialists include:

• Physical therapists

• Occupational therapists

• Speech therapists

Complementary and alternative therapies

There’s some evidence that complementary and alternative therapies might be helpful for MS symptoms. Options include:

• Yoga

• Mind-body therapies

• Massage therapy

• Acupuncture

Diet and lifestyle

Making changes in your daily life can also help you control your symptoms and manage attacks. This means:

• Getting at least 7 hours of good-quality sleep per night

• Eating lots of whole foods and avoiding processed ones

• Making sure your vitamin D levels are normal

• Exercising regularly

• Learning to manage stress

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Living

Living with MS can be challenging. So, it’s important to keep other parts of your health and wellness in mind. For many people, this means:

• Building a strong support network

• Learning to advocate for yourself in clinical settings

• Learning to manage stress

• Engaging in mental health therapy

• Connecting with others in the MS community

It’s also important to create a care team that you feel comfortable with. A strong care team can support your overall wellness — both mentally and physically. Your care team may include all (or some) of the following:

• Primary care provider

• Neurologist

• Rehabilitation specialists

• Mental health specialists

• Case manager

• Pharmacist

• MS navigator

• Peer counselor

Having MS can also bring financial challenges. If MS is affecting your ability to work, get healthcare, or provide for yourself or your family, help is available. Check out the resource list from the National Multiple Sclerosis Society for more information.

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