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OVERVIEW

What is multiple sclerosis (MS)?

Multiple sclerosis is an autoimmune disease that affects the nervous system. Normally, antibodies produced by the immune system help protect the body against viruses, bacteria and other foreign substances. In people who have MS, the immune system destroys the substance that surrounds and protects your nerve cells – the myelin sheath.

The CNS is made up of your brain, spinal cord, and optic nerves. Its job is to quickly send messages back and forth from the brain to different parts of the body. Damaged or destroyed myelin can slow down and block these messages.

There are four forms of MS:

• Clinically Isolated Syndrome (CIS). This is a 24-hour episode with neurologic symptoms like MS. It is caused by swollen and damaged myelin. People who have CIS should get a MRI on their brain. If lesions are found, the risk of having MS is increased. Some people may not have future episodes or develop MS.
• Relapsing-remitting MS (RRMS). This is the most common form of MS. People who have RRMS have relapses, or flare-ups, where new symptoms occur or old symptoms become worse. Then, there is a period of recovery, or remission, where symptoms get better or go away for some time. In RRMS, relapses may be triggered by an infection, such as the flu. The disease does not worsen between flare-ups.
• Primary progressive MS (PPMS). About 15% to 20% of people who have MS develop PPMS. In this form of MS, the disease gets steadily worse, with few or no relapses, remissions, or new brain lesions.
• Secondary progressive MS (SPMS). About 50% of people who have RRMS will develop SPMS. In this form, ongoing relapses and remissions may cause an increase in level of disability and new brain lesions over time.

SYMPTOMS

What are the symptoms of multiple sclerosis (MS)?

MS affects normal sensation, thinking and movement. Symptoms depend on the area of the body where the myelin sheath is damaged.

Common symptoms include:

• Vision problems, including double vision, blurriness, partial color blindness, eye pain, partial or complete loss of vision in one eye
• Thinking and memory problems
• Fatigue
• Muscle weakness
• Dizziness
• Numbness or weakness on one side or the bottom half of your body
• Trouble with coordination and balance
• Loss of bowel or bladder control
• Sensations such as numbness or tingling, “pins and needles”
• Tremors, spasms, or seizures
• Electric-shock sensations caused by moving your head in a certain way
• Vaginal dryness
• Erectile dysfunction

Symptoms of MS may come and go. Flare-ups may last for days, weeks or months. For it to be considered a relapse, symptoms must last at least 24 hours and occur at least 30 days after the last relapse. During remission, your symptoms may continue or disappear for a while.  Lesions can form and permanently affect nerves in that area.

For pregnant people, MS symptoms improve during pregnancy. Unfortunately, symptoms return within a few months of giving birth. Having MS while being pregnant does not put you or your baby at higher risk of complications. This includes pregnancy-induced hypertension (high blood pressure).

CAUSES & RISK FACTORS

What causes multiple sclerosis?

The exact cause of MS in unknown. It is most likely the result of genetic and environmental factors. Several viruses have also been linked to MS. A childhood virus may trigger MS later in life.

MS affects women more than twice as often as men. White (Caucasian) people are more likely to develop it than people of other races. MS can run in families.  Your risk of MS increases if someone in your family, such as a parent or sibling, has it.  MS can affect people of any age, but it often begins between the ages of 20 and 49. If you have another autoimmune disease, such as thyroid disease or Type 1 diabetes, your risk of developing MS is slightly higher.

Some studies show that where you live can affect your risk of getting MS. People who spend their childhood in areas with a temperate climate, such as northern United States or southern Canada, seem to be at higher risk for MS.

What causes MS?

No one really knows for sure what causes MS. It’s most likely the result of a combination of environmental, viral and genetic factors. A number of different viruses have been linked to MS. A childhood virus may trigger MS later in life.

DIAGNOSIS & TESTS

How is multiple sclerosis diagnosed?

Like other autoimmune diseases, MS may be difficult to diagnose. Often, the first symptoms of MS is vision problems. Symptoms can also affect different parts of the body. Your healthcare provider will ask you about your health history and do an exam.

Before making a diagnosis, your healthcare provider will rule out other possible causes of your symptoms. Your healthcare provider may also order tests:

• Blood test. Your blood can show signs of other illnesses that cause symptoms similar to the symptoms of MS.
• Neurological tests. Your healthcare provider may want you to see a neurologist who can test how well your nervous system is working. The tests will look for changes in eye movements, muscle coordination, weakness, balance, sensation, speech, and reflexes.
• Spinal tap (lumbar puncture). A small amount of fluid taken from your spine can show abnormal amounts of blood cells or proteins associated with MS. A spinal tap can also rule out a viral infection or other possible conditions.
• Magnetic Resonance Imaging (MRI). An MRI can show detailed pictures of the brain and spinal cord, and if there are any lesions present. However, lesions aren’t always caused by MS.

To diagnose MS, you must have damaged myelin in at least two areas of the CNS. You also must have had at least two relapses, or episodes, that caused damage. Your healthcare provider also needs to rule out all other potential diagnoses.

PREVENTION

Can multiple sclerosis be prevented or avoided?

You cannot prevent or avoid MS since the cause is unknown.

TREATMENT

How is multiple sclerosis (MS) treated?

There is currently no cure for multiple sclerosis. A combination of medicines, physical, speech and occupational therapies may help you cope with and relieve your symptoms, slow the progress of the disease and maintain a good quality of life. This can be done through a combination of medicine and physical, occupational, and speech therapy.

Medicines

Some people who have mild symptoms choose not to take certain medicines because of the risks associated with them and the possibility of serious side effects. Your healthcare provider will talk to you about the risks and benefits of taking medicines to treat MS.

Certain medicines can help relieve symptoms and treat short-term problems caused by MS:

• Bladder problems: tolterodine, oxybutynin
• Constipation: stool softener, laxative
• Depression: venlafaxine, paroxetine
• Pain: phenytoin, gabapentin
• Muscle stiffness and spasms (spasticity): dantrolene, baclofen
• Urinary problems: desmopressin, methenamine, phenazopyridine
• Erectile dysfunction: tadalafil, alprostadil

Other types of medicine can affect the long-term outcomes of the disease.

Interferons are a group of natural proteins made by human cells. Interferons seem to slow the worsening of symptoms of MS over time. These kinds of medicine are usually given as an injection (a shot). Some examples of interferons used to treat MS include type 1a and type 1b. Interferons may cause serious liver damage as a side effect. Other side effects include flu-like symptoms and depression.

Glatiramer acetates are thought to block the cells that damage myelin, the substance that surrounds and protects your nerve cells. People taking this drug usually experience fewer relapses and fewer new nerve cell lesions. The medicine is given as a shot (injected with a needle) once a day. Side effects may include hives or pain at the injection site, heart palpitations and shortness of breath.

Two other types of medicine may be used to treat severe or advanced MS:

• Natalizumab: This is an option for people who have tried other drugs first and have not had good results may try natalizumab. However, natalizumab can have serious side effects, and it should not be used in combination with other disease-modifying drugs. One of the known side effects is an increased risk of a fatal brain infection.
• Mitoxantrone: This is an option for people who have increased relapse and remission periods, progressive MS, or worsened symptoms. Side effects include lowered resistance to infection, and increased risk of blood and heart disease.

During relapses, affected nerve areas can become inflamed. You may have severe pain and loss of vision or bodily function. Steroids can reduce swelling and allow you to return to normal function sooner. Examples of steroids used to treat MS are prednisone (a pill) and methylprednisolone (a shot). Steroids should be taken to treat short-term symptoms. They do not treat long-term effects of MS.

Therapy

Different therapies can be helpful for people who have MS:

• Physical Therapy (PT) can help with walking, strength, balance, posture, fatigue and pain. PT can include stretching and strengthening exercises, and training to use mobility aids like canes, scooters or wheelchairs. Your physical therapist can also help you adapt your exercise routine to accommodate your symptoms or flare-ups.
• Occupational Therapy (OT). The goal of OT is to help improve your level of independence and safety at home and at work. Your therapist can show you how to use tools to help in daily tasks. Your therapist can also recommend changes to your physical living or working space to make your tasks easier. Your therapist may help you continue to pursue activities or hobbies that you enjoy.
• Speech Therapy can help you better control muscles used for talking and swallowing.

Living with multiple sclerosis

Living with MS, a chronic (ongoing) illness, can be physically and emotionally hard. Certain lifestyle changes can help improve your quality of life and keep you as strong and healthy as possible.

Eat a well-balanced diet that is low in fat and high in fibre. A healthy diet will keep your immune system strong and give you the best chance of good health.

Continue to exercise if your doctor says it is okay. Exercise can improve your muscle tone and strength, balance, coordination, and even your mood. Stretching exercises can help with stiffness and mobility.

It is important to get enough exercise, but it is also important to get plenty of rest. MS causes fatigue, so pay attention to your needs. You may have to make accommodations in your work or family schedule to include time for rest.

 Too much heat can cause nerve pain and lead to extreme muscle weakness. Be careful using hot tubs or saunas and taking hot baths or showers. If heat bothers you, find ways to cool down. A cool bath or air conditioning may help.

 Get support from friends, family, your community, a support group, your healthcare provider or other health care professionals. Try to maintain as normal a life as you can and continue to do the things you enjoy. This can help you keep a good mood and healthy state of mind.

Multiple Sclerosis and Pregnancy

Pre-pregnancy planning is important for women. Certain medicines used to treat MS symptoms are not safe for your baby during pregnancy. These include medicines called “disease-modifying drugs.” Another group is called “chemotherapeutic drugs.” This includes azathioprine or methotrexate. Your healthcare provider may suggest that you stop taking these medicines before trying to get pregnant.

Some other medicines that are considered safe during pregnancy can be helpful in treating MS symptoms. Your doctor may recommend that you change medicines while you are trying to get pregnant and during your pregnancy. Some medicines used to treat MS may be passed on to babies during breastfeeding. This is not safe for the baby. Talk to your healthcare provider about your breastfeeding plans.

If MS affects your ability to walk, you may notice that walking becomes even more difficult during pregnancy. This is because the weight you gain during pregnancy can shift your balance. You might need to be extra careful to avoid falls. You may need crutches or other walking assistance devices, or you may need to use a wheelchair.

You may also become tired more easily, especially later in the pregnancy. Plan ahead so your schedule allows you to get plenty of rest. Talk to your partner, family and friends if you need help taking care of other children, doing chores or running errands.

Urinary tract infections (UTIs) are more common in pregnant women who have MS. Drink plenty of water and let your healthcare provider know if you have any symptoms. Your healthcare provider may want you to have monthly urine tests to make sure a UTI doesn’t sneak up on you.

Labor and Delivery

Some women who have MS have damage to the spinal cord that interferes with their ability to tell when labor starts. This is rare but may be a concern for some women. If you have reduced feeling in your pelvic area or abdomen, talk to your healthcare provider. They can talk to you about other clues that can help you tell you are starting labor.

Sometimes, women who have MS experience damage to the nerves that help tell the muscles to push during delivery. If this is the case, you may need some extra help to deliver your baby vaginally or you may need a cesarean section (C-section). You may also need a C-section if you become overly tired during labor. Anesthesia is not any riskier for women who have MS than other women. Babies born to women who have MS have no greater risk of birth defects, physical, or intellectual disabilities.

Make a plan for life after giving birth. Some women experience a “flare” or increase in symptoms after the delivery. You may be extra tired. The risk for post-partum depression is the same for women who have MS and those who do not. Talk to your healthcare provider if you are experiencing depression.

FOR MORE INFORMATION

Multiple Sclerosis Society of Canada

https://mssociety.ca/