Multiple Sclerosis

Multiple sclerosis is a chronic disease of the central nervous system. MS causes inflammation and the destruction of myelin. Myelin surrounds nerve fibers and acts like insulation on a wire preventing “short-circuits” that divert a nerve signal from having its desired effects. The “demyelination” process interferes with nerve impulse transmission. Repeated attacks can lead to a continual process of demyelination and remyelination, which produces nerve fiber scarring and progressive disability. MS is typically diagnosed in young adults between age 20 and age 40. Women are two times as likely to develop MS than men. MS is often a debilitating disease affecting physical and cognitive abilities. MS is not considered fatal and those diagnosed commonly have unaffected life spans. There currently is no known cure for MS.

Causes of Multiple Sclerosis

The cause of MS is currently unknown. Many believe it to be the result of a combination of genetic, environmental, and infectious origins. MS is not considered a hereditary or gene transmitted disease. However, the overall risk of developing MS is higher in relatives of a person with the disease than if not. Current data indicates familial recurrence rate of around 20%. This suggests that some genetic influence or predisposition should be considered and evaluated by research. Environmentally MS appears to be more common in people who live farther from the equator than those who do not. Decreased sunlight exposure and decreased vitamin D production have been associated with higher risk for MS. Researchers have explored several infectious causes and hypothesis have been made without substantial factual scientific clarity proving or disproving influence of Multiple Sclerosis.

Types of Multiple Sclerosis

Multiple Sclerosis is typically classified as one of four types: Relapsing Remitting, Secondary Progressive, Primary Progressive, & Progressive Relapsing.

Relapsing Remitting: Relapsing-Remitting MS is characterized by unpredictable episodes of symptoms followed by periods remission with no disease activity. Deficits suffered during these episodes or attacks may either resolve or leave suddenly. Approximately 85% of individuals with MS initially experience relapsing remitting MS.

Secondary Progressive: Secondary progressive MS ("galloping MS") describes those with an initial relapsing-remitting MS, who then begin to have progressive neurological decline between acute attacks without any definite periods of remission. The median time between disease onset and conversion from relapsing-remitting to secondary progressive MS is 19 years.

Primary Progressive: Primary Progressive MS afflicts approximately 10–15% of individuals with MS. It is characterized by progression of disability from onset with no remissions and improvements.

Progressive Relapsing: Progressive Relapsing MS describes those individuals who, from onset, have a steady neurological decline but also suffer clear superimposed attacks. This is the least common of all subtypes of MS. Atypical variants of MS with non-standard behavior have been described and associated with Progressive Relapsing MS.

Multiple sclerosis can cause a variety of symptoms and is often individualized to each patient.

Bladder problems appear in 80% of MS patients. The most common problems are an increase of frequency and incontinence. Some with Multiple Sclerosis have inability to begin urination, leaking, retention, and sensation of full bladder. Urinary tract infections are common with MS.

Cognitive impairments occur in about 40 to 60 percent of patients with multiple sclerosis. Some of the most common deficits are in recent memory, attention, processing speed, emotional instability, visual-spatial abilities, and executive function. Symptoms range from mild to severe. Dementia is uncommon with Multiple Sclerosis.

Emotional symptoms are common with Multiple Sclerosis. Clinical depression is the most common emotional condition associated with MS. Depression rates of those with MS is higher than the general population as well as other persons/groups who are diagnosed with chronic illnesses. Suicide accounts for approximately of 15% of deaths of person diagnosed with Multiple Sclerosis.

Fatigue is a common and often disabling symptom of MS. When evaluating fatigue associated with MS, depression should also be evaluated and treated as it's symptoms may cause fatigue.

Restrictions in mobility are common in individuals suffering from multiple sclerosis. Most persons diagnosed with MS will have difficulty walking or in mobility and require use of an aid or wheelchair at some point. One third of persons diagnosed will require use of such devices within 5 years of diagnosis.

Vision Problems are very common in MS. Up to 50% of patients with MS will develop an episode of optic neuritis. Individuals experience rapid onset of pain in one eye, followed by blurry vision. The blurred vision usually goes away but the person may have decrease color vision or decreased ability to focus. Many persons with MS also experience episodes of double vision and involuntary eye movement which make focusing difficult.

Chronic Pain is a common symptom in MS. It usually appears after a lesion to the ascending or descending tracts that control the transmission of painful stimulus. Acute temporary pain is common as well as the result of the disease process. Narcotic pain control methods are typically effective for treating pain associated with MS.

Lhermitte's sign is an electrical sensation that runs down the back and into the limbs. The sign suggests a lesion of the dorsal columns of the cervical cord. Between 25 and 40% of MS patients report having Lhermitte's sign during the course of the disease process.

Dysesthesias are abnormal sensations produced by ordinary activities. The abnormal sensations are often described as painful feelings such as burning, itching, electricity, or pins and needle. These are caused by lesions of the sensory pathways.

Sexual dysfunction often affects those with MS. The prevalence of Sexual dysfunction in men with MS is around 85%. Erectile dysfunction is the most documented sexual symptom in MS.

Spasticity is common in MS. Spasticity is characterized by increased stiffness in limb movement, development of certain postures, weakness of voluntary muscle power, and involuntary spasms.

Transverse myelitis is a rapid onset of numbness, weakness, and loss of muscle function in the lower half of the body. This is the result of MS attacking the spinal cord. The symptoms and signs depend upon the level of the spinal cord involved and the extent of the involvement. Prognosis for complete recovery is generally poor. Roughly 80% of individuals with transverse myelitis have permanent symptoms from transverse myelitis.

Tremors are frequent and common with MS. Tremors can be serve and disabling. Commonly individuals with MS will experience tremors in the hands, arms, and legs.

A number of drugs have been shown to slow the progression of MS.

Commonly prescribed drugs for MS include:

Avonex (interferon beta-1a)
Betaseron (interferon beta-1b)
Copaxone (glatiramer acetate)
Novantrone (mitoxantrone)
Rebif (interferon beta-1a)
Tysabri (natalizumab)

All of these drugs work by suppressing the activity of the body's immune system. These medications do not cure MS. The goal is to reduce the frequency and severity of attacks. These drugs can improve the quality of life for many people with MS. Most doctors suggest that treatment with one of these drugs be started in most people as soon as a diagnosis of MS has been made. Each pharmaceutical company offers customer support and may also provide some financial assistance for qualifying individuals without prescription drug coverage.

Information on commonly used drugs:

Avonex (interferon beta-1a)
Use: Treatment of relapsing forms of MS, and to treat after an initial episode of inflammation.
How administered: Intramuscular (into the muscle) injection
Frequency of use: Weekly
Common side effects: Mild flu-like symptoms
Support Program: MS Active Source 1-800-456-2255



Betaseron (interferon beta-1b)
Use: Treatment of relapsing forms of MS
How administered: Subcutaneous (under the skin) injection
Frequency of use: Every other day
Common side effects: Mild flu-like symptoms
Support Program: MS Pathways 1-800-788-1467



Copaxone (glatiramer acetate)
Use: Treatment of relapsing-remitting MS
How administered: Subcutaneous (under the skin) injection
Frequency of use: Daily
Common side effects: Possible reaction at the injection site
Support Program: Shared Solutions 1-800-887-8100


Novantrone (mitoxantrone)
Use: Treatment of rapidly worsening relapsing-remitting MS and for progressive-relapsing or secondary-progressive forms of MS
How administered: Intravenous (by vein)
Frequency of use: Once every 3 months or four times a year. Maximum dose 8-12 doses
Common side effects: Nausea, hair thinning, decreased white blood cell count
Support Program: MS LifeLines 1-877-447-3243



Rebif (interferon beta-1a)
Use: Treatment of relapsing forms of MS
How administered: Subcutaneous (under the skin) injection
Frequency of use: Three times per week
Common side effects: Mild flu-like symptoms
Support Program: MS LifeLines 1-877-447-3243

In addition to the above named medications several medications have shown effective in managing symptoms of MS. Any person with MS should discuss with their physician their complaints and symptoms to evaluate what options may be available.