- Things to Know
- Age of Onset
- 5 Early Signs & Symptoms
- MS Signs and Symptoms
- List of Medications
What is multiple sclerosis (MS)?
- Multiple sclerosis (MS) is an autoimmune disease in which the immune system attacks myelinated axons in the brain and spinal cord nerve fibers (central nervous system), damaging or destroying the myelin (demyelination) and/or the axons (nerve tissue). Sclerosis means abnormal hardening or thickening of tissue, often due to inflammation.
- Myelin is a fatty substance that covers, surrounds, and protects the nerves. Think of myelin as a conduit in an electrical system that ensures messages sent by axons (nerve fibers) are not lost en route.
- MS often progresses slowly over many years (about 25 years).
- Multiple sclerosis is most commonly diagnosed in females ages 20 to 40 but may occur at any age and both genders.
- Usually, multiple sclerosis in children and teens (pediatric MS) goes undiagnosed; however, medical professionals have diagnosed about 8,000 to 10,000 children and teens in the United States with the disease.
- Symptoms of multiple sclerosis in children, teens, and adults may have common symptoms or similar first symptoms, for example:
- Blurred vision
- Other symptoms and signs of MS in children and teens include seizures and/or mental status changes like lethargy.
- People with MS often suffer intermittent attacks followed by periods of symptom remission.
- Due to the intermittent nature and variety of symptoms, MS can often be a challenging diagnosis for health care providers.
- MS attacks can last for days or months at a time followed by remissions; some individuals, however, may continue to get worse without periods of remission.
At what age does multiple sclerosis start?
- The early signs and early symptoms of multiple sclerosis usually begin between the ages of 20 and 40 years old.
- However, it is possible to have MS begin in childhood (termed pediatric MS, which includes infancy to 18) or over 40 years of age, but it occurs less frequently in these age groups.
- Only about 2%-5% of all people diagnosed with MS (MS patients or MSers) have symptoms before age 18.
- Multiple sclerosis in children and teens is difficult to diagnose, so its true frequency of occurrence is only estimated.
- In some MS patients, there is evidence that infection with the Epstein-Barr virus may help trigger MS disease.
Does multiple sclerosis cause pain?
- About two-thirds of people with MS report pain as a symptom of their disease.
- The most common types of pain experienced by people with MS are
- back pain,
- extremity pain, and
- muscle spasms.
- Lhermitte's sign is sometimes experienced by MS patients; it's a sharp "electrical" sensation that occurs in the back and into the limbs and/or runs up and down the spine (spinal cord) when the head is bent forward.
Because the pain comes from the nerves, common pain medicines like aspirin have little or no effect; however, other medications may be effective.
5 early signs and symptoms of multiple sclerosis
Because the autoimmune inflammatory response may attack some of the myelinated axons in the central nervous system (brain and spinal cord) almost anywhere, each attack's location (and severity) can be different. Consequently, the symptoms of an MS attack may be quite variable from patient to patient and can appear almost anywhere in the body. The usual first sign and symptoms often change sensory perception (paresthesias) almost anywhere in the body. Other early common symptoms include the following:
- Blurred vision or double vision
- Pain (muscular and neurologic)
Because of the highly variable symptoms, this is a disease that is difficult to diagnose when symptoms first appear. The rest of the article will present symptoms that arise from various parts of the body that can be due to MS. Unfortunately, many of the symptoms described can occur in other disease processes so it is important to have a diagnosis of MS in part by ruling out other conditions.
The diagnosis of MS usually involves a neurologist who will take your medical history, do blood tests, tests to measure electrical activity in the brain and other areas, an MRI, and an analysis of spinal cord fluid. Tests may be done to distinguish MS from stroke, thyroid-caused illness, or other debilitating diseases that cause similar symptoms to MS.
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What are multiple sclerosis (MS) signs and symptoms?
Multiple sclerosis (MS) signs and symptoms include the following:
- Decreased vaginal lubrication in women
- Problems with erections in men (erectile dysfunction, impotence)
Bladder and bowel problems
- Difficulty in starting urination (urine problems)
- Frequent and/or strong urge to urinate
- Stool leakage (bowel incontinence)
Speech and swallowing problems
- Slurred speech (dysphonia due to a nervous system disorder)
- Difficulty speaking (dysarthria)
- Difficulty with chewing and swallowing foods (dysphagia)
Balance, thinking, and emotional problems
- Hearing loss
- Problems with balance
- Difficult reasoning and problem-solving (resembling ADHD symptoms)
- Memory loss
- Poor judgment
- Emotional changes
- Inability to focus
- Eye discomfort
- Vision problems or loss (usually begins in one eye)
- Double vision
- Uncontrollable eye movements
- Optic neuritis (inflammation of the optic nerve)
Muscle, movement, and spasticity problems
- Abnormal sensation in any area of the muscles
- Difficulty moving arms or legs
- Difficulty walking (gait problems)
- Problems with coordination and fine motor skills (rheumatoid symptoms)
- Weakness in one or more extremity (similar to stroke symptoms)
- Urinary problems
Numbness, tingling, and pain
- Tingling, numbness, burning, or feelings of crawling movement in the arms and legs
- Painful muscle spasms
- Facial pain
- Facial muscle twitching
- Facial weakness
As previously mentioned, individuals with MS have variable symptoms so symptoms described above are generalized symptoms. It is likely that a person with multiple sclerosis may show initial symptoms in one or two of these major categories in the early development of MS; other symptoms may or may not appear later in the disease process. However, MS is a slowly progressive disease for which there is no known cure. The goal of treatment is to reduce and/or control symptoms and prevent relapse.
What are the treatment guidelines for MS symptoms?
Multiple sclerosis is a slowly progressive disease for which there is no known cure. The goal of treatment is to reduce and/or control symptoms and prevent relapses. Treatment of multiple sclerosis has two major areas that are used to reduce and/or control symptoms and prevent relapses. The first area for controlling symptoms is to treat the underlying immune system disorder of MS; the second area is designed to reduce and/or treat MS symptoms and relapses. Primary caregivers usually seek medical advice from neurologists for treatment protocols.
List of first-line drugs to treat MS symptoms
Although the underlying or triggering mechanism for MS and for MS relapses is unknown, several drugs have been shown to have beneficial effects in people with MS symptoms including reducing the frequency and severity of clinical MS attacks. These drugs act on the immune system by modulating its response, and such agents have been approved for use for treatment. These agents include
- interferons (beta-1 a and beta-1 b; injection, solution, kit);
- glatiramer acetate (Copaxone);
- natalizumab (Tysabri): an IV medication that slows the progression of symptoms and decreases the number of flare-ups;
- fingolimod (Gilenya);
- teriflunomide (Aubagio);
- dimethyl fumarate (Tecfidera);
- methylprednisolone and other IV steroids; and
- IV immunoglobulin.
These drugs often have side effects and are usually prescribed by physicians experienced in treating people with MS. Plasmapheresis (a method to remove autoantibodies from the blood) is another technique used to reduce the autoimmune problems in certain people with MS.
The FDA recently approved the drug ocrelizumab (Ocrevus) to treat adult patients medically who have relapsing-remitting MS and for MS type, primary progressive MS (PPMS). This is the first drug the FDA approved for PPMS and is administered by intravenous infusion. Although not yet approved by the FDA, stem cell treatments for MS are available and may reduce symptoms in some patients; the treatment does not claim to cure MS.
Multiple sclerosis in children and teens is treated based on the best treatment protocol for the specific child.
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List of drugs to manage symptoms of pain, fatigue, and sexual problems
Treatments of symptoms produced in people with MS depend entirely upon the individual's problems that are generated by MS. In general, treatments of symptoms often follow the same protocols that most physicians would use to treat other patients who do not have MS. However, listed below are some of the symptoms and treatment methods used to reduce them in people with MS.
Treating MS pain
- Tricyclic antidepressants
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Acetaminophen (Tylenol)
- Narcotics are seldom used
Managing sexual dysfunction in MS
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Staxyn ODT, Levitra)
- Possibly penile prosthesis
- Possibly vaginal creams
Managing fatigue in MS
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List of drugs to mange spasticity, vision, urinary, bowel, and emotional symptoms
Treating MS muscle spasms and other problems
- baclofen (Lioresal),
- dantrolene (Dantrium),
- tizanidine (Zanaflex),
- dalfampridine (Ampyra), and
- intramuscular botulinum toxin and/or phenol nerve blocks.
Treating MS eye problems
Treating MS bladder and bowel problems
Managing urinary and/or bladder problems includes
- having to schedule voiding,
- limiting fluid intake in the evening,
- reducing or stopping diuretics,
- injecting Botox into the bladder, and
- intermittent catheterization and alpha-blockers.
- increasing fluid uptake daily,
- increasing dietary fiber to help reduce constipation,
- using stool softeners, and
- taking laxatives and bulk formers such as Metamucil or similar agents.
Managing depression in MS
Antidepressants such as serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants to help with emotional changes like the pseudobulbar affect (sudden outbursts of laughing or crying).
Other problems may require less medication and more understanding of the patient's situation. For example, heat intolerance can be addressed by avoiding activities that would increase the person's temperature such as the use of saunas or staying outside in hot temperatures.
Rehabilitation therapy may help reduce symptoms of speech and muscle problems associated with swallowing, walking, and motor skills. During therapy, the patient can be introduced to devices that will help with the tasks of daily living.
What medications treat multiple sclerosis when others have not?
Cladribine (Mavenclad) oral tablets is a drug used to treat two forms of multiple sclerosis; relapsing forms that include relapsing-remitting disease and active secondary progressive disease in adults. Generally, cladribine is used in people with MS who have tried other multiple sclerosis medications that were not tolerated well or ineffective. People with clinically isolated syndrome not take cladribine.
Which specialties of doctors treat multiple sclerosis?
A neurologist administers the primary treatment of patients with MS. Additional consultation with specialists is often recommended; for example, individuals with cognitive problems may be helped by a neuropsychologist and/or a psychiatrist while those with symptoms related to the bowel or bladder may be best served by consultation with a gastroenterologist or urologist. Individuals with advanced MS with multiple problems may require (in addition to physician specialists who manage disease-modifying medications) a social worker specialist to manage the intense every day care required for a person with multiple MS symptoms. Some patients with debilitating multiple sclerosis symptoms and poor health may require a live-in caregiver.
Treatment for multiple sclerosis in children and teens is by pediatric specialists with experience in pediatric MS.
For additional information about MS, contact the Multiple Sclerosis Society and/or the MS International Federation.
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Galea, I. "Relapse in Multiple Sclerosis. BMJ April 14, 2015. <https://www.bmj.com/content/350/bmj.h1765>.
Luzzio, C. "Multiple Sclerosis Clinical Presentation." Medscape. Jan. 3, 2022. <http://emedicine.medscape.com/article/1146199-clinical>.
MS International Federation. "Pain." Aug. 30, 2018. <https://www.msif.org/about-ms/symptoms-of-ms/pain/>.
MS International Federation. "What Is MS?" Oct. 2, 2018. <https://www.msif.org/about-ms/what-is-ms/>.
National MS Society. "Pediatric MS." <https://www.nationalmssociety.org/What-is-MS/Who-Gets-MS/Pediatric-MS>.
Palmer, A. "Multiple Sclerosis and the Blood-Central Nervous System Barrier." Cardiovascular Psychiatry and Neurology. Jan. 15, 2013. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562587/>.
Podbielska, M. "Myelin Recovery in Multiple Sclerosis: The Challenge of Remyelination." Brain Sciences. Aug. 28, 2013. < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061877/>.
Rae-Grant, Alexander, et al. "Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis." Neurology 90 (2018): 777-788.
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