Multiple sclerosis is a progressive disease that attacks the central nervous system, causing a wide range of symptoms that can affect different parts of the body. More than 400,000 Americans are diagnosed with multiple sclerosis (commonly called MS) every year, but new treatments are greatly helping to slow the progress of the disease and improve the quality of life for those living with it.
The exact cause of MS is unknown, but experts believe it may be related to a viral infection – possibly the Epstein-Barr virus, which causes infectious mononucleosis.
“The infection is probably acquired when you're very young, in your adolescence,” says Dr. Smith. “Then it remains dormant for all those years, until it comes out in your 30s.”
Young Caucasian women seem to have the highest risk of MS; currently, it affects three times as many women as men. Several decades ago, the risk was only slightly higher for women, but the reason for the increase is not clear.
MS symptoms can affect people in many different ways. Among the most common are fatigue, urinary and bowel symptoms, and sexual problems. It can also cause problems with movement and balance, muscle spasms, slurred speech, blurred vision and swallowing. Some people experience numbness, tingling or pain.
“MS attacks the nervous system and leads to damage, especially to the myelin sheath, which is the insulation of the nerve fibers, and those damaged areas produce the symptoms,” explains Dr. Smith. “The symptoms depend on where the damage is occurring, so location is very important.”
The disease can attack anywhere along the central nervous system, brain, spinal cord and optic nerve, causing damage which may trigger a symptom.
Symptoms can vary from person to person; one person may have eye pain, while another may have numbness below the waist. Moreover, symptoms can come and go.
“Somehow the attack on the system turns off, typically after a couple of weeks, and then the area heals and the person no longer has the symptom,” says Dr. Smith. “Perhaps the damage wasn't strong enough to produce a scar, just to cause some inflammation that healed. Or perhaps the nervous system worked around the affected area to compensate for the damage and stop the symptom.”
Because symptoms can vary so much, MS is sometimes difficult to diagnose. MRI is the most important diagnostic tool; doctors look for characteristic MS spots on the brain and spinal cord, including where they are and how they're oriented, to make the diagnosis.
Dr. Smith says there are two aspects to MS treatment. First, physicians treat the disease process itself, with the goal of slowing or stopping its progress and preventing disability. Several medications can address the immune attack that leads to the disease progression.
Once the person is stable, treatment focuses on managing symptoms. This can include medication along with physical, occupational and speech therapy, with the goal of helping patients be as functional as possible.
While there is not yet a cure for MS, recent treatments are now about 95% effective in preventing progression.
“There are so many therapies out there that help MS. So unlike in the past where I would tell a person to hope for the best, now I can tell them we can beat this,” says Dr. Smith. “We can be positive about this because we will try whatever treatment we need for you to have a normal, full life."