Multiple sclerosis (MS) is an illness involving the brain and spinal cord in which the body attacks the covering (myelin) of the nerves. This causes damage and communication problems in the brain and between the brain and the rest of the body. Symptoms can change depending on how bad the disease is. People can become disabled when nerves are permanently damaged.

MS is the most common central nervous system disease for young adults. People usually develop MS between 20 – 40 years old, though it can begin earlier. Females are twice as likely to develop MS. The disease is more common in the North and in Caucasians. In the United States, fewer than 1 in 100 people have MS.

Signs and Symptoms

Symptoms change depending on where nerve damage is and how much there is. Patients can have vision problems if it goes to the nerves of the eye. This is sometimes one of the early problems. Other early symptoms can be sensory problems such as dizziness, numbness, tingling, burning feelings, and tight muscles in the legs. Fatigue is common and usually causes more problems than the other symptoms.

Common MS symptoms:

• Fatigue
• Numbness, tingling (“pins and needles”), or burning sensation in hands, arms, or legs
• Weakness
• Chronic pain
• Balance and coordination problems
• Dizziness
• Heat sensitivity
• Slurred speech
• Partial or complete visual loss
• Double vision
• Trouble with attention, memory, and other thinking skills
• Sleep problems (e.g., restless leg syndrome)
• Depression
• Bowel and bladder problems
• Sexual dysfunction

 
Subtypes of Multiple Sclerosis

There are four subtypes of MS. Some people change from one kind to another as the disease goes along, while others stay the same.

Relapsing-remitting MS (RRMS): The most common subtype, seen in over 3/4 of MS patients. It is called “relapsing-remitting” because sometimes the disease gets worse (a relapse), followed by at least some recovery (remitting).

Secondary progressive MS (SPMS): Most people with the first type of MS will change to this type of MS over the course of 10-20 years. Symptoms get worse over time, but there are sometimes periods of improvement.

Primary progressive MS: This subtype is seen in about 10% of MS patients and is more difficult to treat. Symptoms become steadily worse from the beginning without any times when they get a lot better, although there may be times when they stay the same.

Progressive-relapsing MS: This is an uncommon type. Only about 5% of patients with MS have this. Symptoms become slowly worse from the beginning with times when they get much worse. There are no times when they get much better.

Cognition in Multiple Sclerosis

Most people with MS have problems with their thinking, like problems with paying attention or remembering things. These problems can lead to having a hard time working or doing other everyday tasks. Sometimes these problems aren’t noticed at first because problems seeing or walking may seem more important.

Common Thinking Problems:

• Thinking more slowly
• Having trouble pulling up words or memories
• Problems with paying attention
• Difficulty doing complicated things, or trying to do a few things at once
• Trouble with telling where things are, which can lead to accidents
• Feeling like it’s hard to think because of feeling fatigued

There are some ways to work around these problems. You could try:

• Working on one thing at a time
• Keeping things you need a lot (like glasses, wallets, phones, or keys) in the same place all the time so they don’t get lost
• Scheduling more time to do things, especially things that are complicated
• Keeping lists or a planner to help track things to do
• Using a pill box to manage medications, or even getting an automated pill dispenser
• Setting reminders on your phone to help remember things
• Getting more sleep, or allowing time for naps to reduce fatigue
• Getting rid of things that can cause accidents, like rugs that are easy to trip over

Prognosis – How MS Changes over Time

For many people, MS symptoms do get worse over time. Problems with motor skills can cause difficulties with driving, and even eventually with walking. Many people keep working for years after their diagnosis, but for a lot of people their symptoms keep them from working at some point. Most people find it takes them longer to do things than it used to, and there may be some everyday things they cannot do at all. If symptoms become very bad, the person with MS may need a caretaker to help with everyday tasks.

Treatments for Multiple Sclerosis

There is no cure for MS yet. Disease modifying therapies (DMTs) help to cut back how often MS symptoms happen and how bad they are, and some other medications speed up how fast you can recover. Sometimes medicines are used to treat symptoms of MS rather than the MS itself. Keeping stress low, exercising, and getting plenty of rest can also keep MS from flaring up. It is important for people with MS to plan out their day so that they don’t overdo it, because that can set them back for a couple of days while they recover.

Doctors Involved in Care of Multiple Sclerosis

Usually, to diagnose MS, a primary care doctor will send a patient to a neurologist. They may also send their patient to other types of specialists. Here is how each doctor helps their patient:

• Primary Care – This doctor is important for managing a patient’s care and treating common problems, like sore throats. This doctor recognizes problems and orders tests, and sends their patient to doctors who are specialists if their patient has a complicated problem.
  
  
• Neurology – The neurologist diagnoses MS by looking at pictures of the brain. He orders and reads other tests, like studies of how well the nerves are working. He treats the symptoms of MS, such as muscle spasms, and watches for flare-ups of symptoms.
  
  
• Neuropsychology – The neuropsychologist tests to see how well the patient is able to think. These tests tell us how well they can do things like pay attention and remember information. The neuropsychologist can also recognize emotional problems like depression and make sure these are being treated. Many times, the neuropsychologist makes recommendations for the patient and their family about if the patient can safely keep driving or working given how the MS is affecting their thinking.

Effects on Family Members

Multiple sclerosis can also be stressful for family members. They usually worry about the person who is diagnosed. They might become too protective. All of this can also lead to more arguments. As MS goes along, usually people have to take on different roles and responsibilities in the family, which can be difficult for everyone.

Resources

The National Multiple Sclerosis Society – 1-800-344-4867
The Multiple Sclerosis Association of America – 1-800-532-7667
Above MS (associated with Biogen) – 1-800-456-8855