Multiple sclerosis (MS) is a disease in which your immune system attacks the protective sheath (myelin) that covers your nerves. Myelin damage disrupts communication between your brain and the rest of your body. Ultimately, the nerves themselves may deteriorate, a process that's currently irreversible.
Signs and symptoms vary widely, depending on the amount of damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently or at all, while others experience long periods of remission during which they develop no new symptoms.
There's no cure for multiple sclerosis. However, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms.
Signs and symptoms of multiple sclerosis vary, depending on the location of affected nerve fibers. MS signs and symptoms may include:
- Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or the legs and trunk
- Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement
- Double vision or blurring of vision
- Tingling or pain in parts of your body
- Electric-shock sensations that occur with certain neck movements, especially bending the neck forward
- Tremor, lack of coordination or unsteady gait
- Slurred speech
- Problems with bowel and bladder function
Most people with MS have a relapsing-remitting course, with new symptoms (relapse) that develop over days or weeks and usually improve partially or completely, followed by a quiet period (remission) that can last months or even years. Small increases in body temperature can temporarily worsen signs and symptoms of MS, but that type of event isn't a relapse.
About 60 to 70 percent of people with relapsing-remitting MS eventually develop a steady progression of symptoms, with or without periods of remission (secondary-progressive MS). The worsening symptoms usually include problems with gait. The rate of progression varies greatly among people with secondary-progressive MS.
Some people with MS experience a gradual onset and steady progression of signs and symptoms with no relapses (primary-progressive MS).
The cause of multiple sclerosis is unknown. It's believed to be an autoimmune disease, in which the body's immune system attacks its own tissues. In MS, this process destroys myelin — the fatty substance that coats and protects nerve fibers in the brain and spinal cord.
Myelin can be compared to the insulation on electrical wires. When myelin is damaged, the messages that travel along that nerve may be slowed or blocked.
It isn't clear why MS develops in some people and not others. A combination of factors, ranging from genetics to childhood infections, may play a role.
These factors may increase your risk of developing multiple sclerosis:
- Age. MS can occur at any age, but most commonly affects people between the ages of 15 and 60.
- Sex. Women are about twice as likely as men are to develop MS.
- Family history. If one of your parents or siblings has had MS, you are at higher risk of developing the disease.
- Certain infections. A variety of viruses have been linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis.
- Race. White people, particularly those of Northern European descent, are at highest risk of developing MS. People of Asian, African or Native American descent have the lowest risk.
- Climate. MS is far more common in countries with temperate climates, including southern Canada, northern United States, New Zealand, southeastern Australia and Europe.
- Certain autoimmune diseases. You have a slightly higher risk of developing MS if you have thyroid disease, type 1 diabetes or inflammatory bowel disease.
- Smoking. Smokers who experience an initial event of symptoms that may signal MS are more likely than nonsmokers to develop a second event that confirms relapsing-remitting MS.
People with multiple sclerosis also may develop:
- Muscle stiffness or spasms
- Paralysis, typically in the legs
- Problems with bladder, bowel or sexual function
- Mental changes, such as forgetfulness or mood swings
You may be referred to a doctor who specializes in disorders of the brain and nervous system (neurologist).
What you can do
- Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
- Make a list of all your medications, vitamins and supplements.
- Write down your key medical information, including other conditions.
- Write down key personal information, including any recent changes or stressors in your life.
- Write down questions to ask your doctor.
- Ask a relative or friend to accompany you, to help you remember what the doctor says.
Questions to ask your doctor
- What's the most likely cause of my symptoms?
- What kinds of tests do I need? Do they require any special preparation?
- Is my condition likely temporary or chronic?
- Will my condition progress?
- What treatments are available?
- I have these other health conditions. How can I best manage them together?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to spend more time on. You may be asked:
- When did you begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Does anyone in your family have multiple sclerosis?
There are no specific tests for MS. The diagnosis relies on ruling out other conditions that might produce similar signs and symptoms.
Your doctor is likely to start with a thorough medical history and examination. Your doctor may then recommend:
- Blood tests, to help rule out infectious or inflammatory diseases with symptoms similar to MS.
- Spinal tap (lumbar puncture), in which a small sample of fluid is removed from your spinal canal for laboratory analysis. This sample can show abnormalities in white blood cells or antibodies that are associated with MS. Spinal tap can also help rule out viral infections and other conditions with symptoms similar to MS.
- MRI, which can reveal areas of MS (lesions) on your brain and spinal cord. You may receive an intravenous dye to highlight lesions that indicate your disease is in an active phase.
Evoked potential tests
These tests record the electrical signals produced by your nervous system in response to stimuli. An evoked potential test may use visual stimuli or electrical stimuli, in which you watch a moving visual pattern or short electrical impulses are applied to nerves in your legs or arms. Electrodes measure how quickly the information travels down your nerve pathways.
There is no cure for multiple sclerosis. Treatment typically focuses on speeding recovery from attacks, slowing the progression of the disease and managing symptoms. Some people have such mild symptoms that no treatment is necessary.
Treatments for attacks
- Corticosteroids, such as oral prednisone and intravenous methylprednisolone, are prescribed to reduce nerve inflammation. Side effects may include insomnia, increased blood pressure, mood swings and fluid retention.
- Plasma exchange (plasmapheresis). The liquid portion of part of your blood (plasma) is removed and separated from your blood cells. The blood cells are then mixed with a protein solution (albumin) and put back into your body. Plasma exchange may be used if your symptoms are severe and haven't responded to steroids.
Treatments to modify progression
No therapies have shown benefit for slowing the progression of primary-progressive MS. For relapsing-remitting MS, certain medications can lower the relapse rate and reduce the rate of formation of new lesions, particularly early in the disease course.
The options include:
- Beta interferons. These medications, which are injected under the skin or into muscle, can reduce the frequency and severity of relapses. Beta interferons can cause side effects such as flu-like symptoms and injection-site reactions. You'll need blood tests to monitor your liver enzymes.
- Glatiramer acetate (Copaxone). This medication may help block your immune system's attack on myelin. The medication must be injected beneath the skin. Side effects may include skin irritation at the injection site.
- Dimethyl fumarate (Tecfidera). This twice-daily oral medication can reduce relapses. Side effects may include flushing, diarrhea, nausea and lowered white blood cell count.
- Fingolimod (Gilenya). This once-daily oral medication reduces relapse rate. You'll need to have your heart rate monitored for six hours after the first dose because your heartbeat may be slowed. Other side effects include high blood pressure and blurred vision.
- Teriflunomide (Aubagio). This once-daily medication can reduce relapse rate. Teriflunomide can cause liver damage, hair loss and other side effects. It is also known to be harmful to a developing fetus.
- Natalizumab (Tysabri). This medication is designed to block the movement of potentially damaging immune cells from your bloodstream to your brain and spinal cord. The medication increases the risk of a viral infection of the brain called progressive multifocal leukoencephalopathy. It is generally given to people who have more severe or active MS, or who do not respond to or can't tolerate other treatments.
- Mitoxantrone (Novantrone). This immunosuppressant drug can be harmful to the heart and is associated with development of blood cancers. Mitoxantrone is usually used only to treat severe, advanced MS.
Treatments for signs and symptoms
- Physical therapy. A physical or occupational therapist can teach you stretching and strengthening exercises, and show you how to use devices that can make it easier to perform daily tasks.
- Muscle relaxants. You may experience painful or uncontrollable muscle stiffness or spasms, particularly in your legs. Muscle relaxants such as baclofen (Lioresal, Gablofen) and tizanidine (Zanaflex) may help.
- Medications to reduce fatigue.
- Other medications. Medications may also be prescribed for depression, pain, and bladder or bowel control problems that are associated with MS.
To help relieve the signs and symptoms of MS, try to:
- Get plenty of rest.
- Exercise. If you have mild to moderate MS, regular exercise can help improve your strength, muscle tone, balance and coordination. Swimming or other water exercises are good options if you're bothered by heat. Other types of mild to moderate exercise recommended for MS include walking, stretching, low-impact aerobics, stationary bicycling, yoga and tai chi.
- Cool down. MS symptoms often worsen when your body temperature rises. Avoiding exposure to heat and using devices such as cooling scarves or vests can be helpful.
- Eat a balanced diet. Results of small studies suggest that a diet low in saturated fat but high in omega-3 fatty acids, such as those found in olive and fish oils, may be beneficial. But further research is needed. Studies also suggest that vitamin D may have potential benefit for MS.
- Relieve stress. Stress may trigger or worsen your signs and symptoms. Yoga, tai chi, massage, meditation or deep breathing may help.
Living with any chronic illness can be difficult. To manage the stress of living with MS, consider these suggestions:
- Maintain normal daily activities as best you can.
- Stay connected to friends and family.
- Continue to pursue hobbies that you enjoy and are able to do.
- Contact a support group, for yourself or for family members.
- Discuss your feelings and concerns about living with MS with your doctor or a counselor.
- Experience. Each year, Mayo Clinic specialists treat more than 2,800 people with MS.
- Expertise. At Mayo Clinic, neurologists work closely with other specialists in physical medicine and rehabilitation, urology, neuro-ophthalmology, and other areas to help manage the problems associated with MS.
- Individualized treatment. The signs and symptoms of MS, and outcomes of therapy, can vary greatly. Mayo Clinic specialists tailor their approach to this complex disease to your specific situation.
- Pediatric center. The National Multiple Sclerosis Society has recognized the Pediatric Multiple Sclerosis Center at Mayo Clinic's campus in Rochester, Minnesota, as a Pediatric MS Center of Excellence. The multidisciplinary center focuses on the evaluation and treatment of children with MS and other central nervous system disorders.
- New ideas. Mayo Clinic researchers are working to improve diagnosis and treatment of MS. You have access to the expertise of Mayo's clinician-researchers.
Mayo Clinic in Rochester, Minn., ranks No. 1 for neurology and neurosurgery in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals for neurology and neurosurgery by U.S. News & World Report.
At Mayo Clinic, we assemble a team of specialists who take the time to listen and thoroughly understand your health issues and concerns. We tailor the care you receive to your personal health care needs. You can trust our specialists to collaborate and offer you the best possible outcomes, safety and service.
Mayo Clinic is a not-for-profit medical institution that reinvests all earnings into improving medical practice, research and education. We're constantly involved in innovation and medical research, finding solutions to improve your care and quality of life. Your doctor or someone on your medical team is likely involved in research related to your condition.
Our patients tell us that the quality of their interactions, our attention to detail and the efficiency of their visits mean health care — and trusted answers — like they've never experienced.
Why Choose Mayo Clinic
What Sets Mayo Clinic Apart
Multiple sclerosis can be difficult to diagnose because it shares signs and symptoms with other neurological disorders. Mayo Clinic specialists have experience with distinguishing MS from these mimickers. At Mayo Clinic, precise diagnosis is key to guiding individualized treatment.
The National Multiple Sclerosis Society has recognized Mayo Clinic in Rochester, Minnesota, as a Pediatric MS Center of Excellence. Although MS is normally associated with young adults, onset of the disease before age 18 is increasingly recognized. Mayo specialists have experience diagnosing pediatric MS.
At Mayo Clinic, neurologists work closely with doctors specializing in physical medicine and rehabilitation, bladder management (urologists), mental health conditions (psychiatrists), brain and eye conditions (neuro-ophthalmologists), and other areas to create individualized treatment plans for people with MS and related conditions.
As a recognized Pediatric MS Center of Excellence, Mayo Clinic in Rochester has pediatric neurologists with experience treating children with MS.
Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.
Specialists in neurology at Mayo Clinic's campuses in Phoenix and Scottsdale, Arizona, diagnose and treat adults with multiple sclerosis.
For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.
- U.S. Patients
- International Patients
Specialists in neurology at Mayo Clinic in Jacksonville, Florida, diagnose and treat adults with multiple sclerosis.
For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.
- U.S. Patients
- International Patients
Specialists in neurology at Mayo Clinic in Rochester, Minnesota, diagnose and treat adults with multiple sclerosis. Specialists in child and adolescent neurology diagnose and treat children with MS.
For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.
- U.S. Patients
- International Patients
See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.
Mayo Clinic researchers are working to improve the diagnosis and treatment of multiple sclerosis. Specific efforts include finding causes of the disease and developing strategies for remyelination and axonal repair.
Read more about research in the Mayo Clinic Multiple Sclerosis Laboratory and in the Center for Multiple Sclerosis and CNS Demyelinating Diseases.
See a list of publications by Mayo Clinic doctors on multiple sclerosis on PubMed, a service of the National Library of Medicine.
- Orhun H. Kantarci, M.D.
- B Mark Keegan, M.D.
- Vanda A. Lennon, M.D., Ph.D.
- Claudia F. Lucchinetti, M.D.
- Andrew McKeon, M.B., B.Ch., M.D.
- John H. Noseworthy, M.D.
- Marc C. Patterson, M.D.
- Sean J. Pittock, M.D.
- Moses Rodriguez, M.D.
- Brian G. Weinshenker, M.D.
- Dean M. Wingerchuk, M.D.
July 10, 2014
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- Daroff RB, et al. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa.: Elsevier Saunders; 2012. https://www.clinicalkey.com. Accessed April 4, 2014.
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- Olek MJ. Epidemiology and clinical features of multiple sclerosis in adults. http://www.uptodate.com/home. Accessed April 4, 2014.
- Wingerchuk DM (expert opinion). Mayo Clinic, Rochester, Minn. May 13, 2014.
- Kantarci O. Treatment of primary progressive multiple sclerosis. Seminars in Neurology. 2013;33:74.
- Keegan BM. Therapeutic decision making in a new drug era in multiple sclerosis. Seminars in Neurology. 2013;33:5.
- Goldman L, et al. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed April 4, 2014.
- Lotze TE. Pathogenesis, clinical features, and diagnosis of pediatric multiple sclerosis. http://www.uptodate.com/home. Accessed April 5, 2014.
- Kantarci OH, et al. Novel immunomodulatory approaches for the management of multiple sclerosis. Clinical Pharmacology & Therapeutics. 2014;95:32.
- Olek MJ. Treatment of relapsing-remitting multiple sclerosis in adults. http://www.uptodate.com/home. Accessed April 4, 2014.
- Olek MJ. Treatment of acute exacerbations of multiple sclerosis in adults. http://www.uptodate.com/home. Accessed April 4, 2014.
- Wingerchuk DM. Multiple sclerosis: Current and emerging disease-modifying therapies and treatment strategies. Mayo Clinic Proceedings. 2014;89:225.
- Pizzorno JE, et al. Textbook of Natural Medicine. 4th ed. St. Louis, Mo.: Churchill Livingstone Elsevier; 2013. https://www.clinicalkey.com. Accessed April 4, 2014.
- Riggin EA. Decision Support System. Mayo Clinic, Rochester, Minn. April 22, 2014.