Questions and Answers About Multiple Sclerosis

Whether it’s because of population growth, better diagnostic procedures, more awareness among medical providers or an increase in cases, the number of Americans with multiple sclerosis has doubled since 1975 to nearly 1 million people.

That doesn’t sound like good news, but this is: Treatments for MS have improved significantly over the past 10 years and can often effectively control symptoms and prevent the disease from progressing.

“We don’t have a cure yet,” says UNC Health neurologist Monica Diaz, MD. “But many patients diagnosed now have little disability because of advances in treatments, especially if they start treatment early.”

Multiple sclerosis is an inflammatory disease that disrupts signals to and from the brain. The result can be unpredictable symptoms, including numbness, tingling, mood changes, memory problems, pain, fatigue, vision impairment and difficulty walking. Everyone with MS experiences symptoms differently, and they can be temporary or long-lasting.

Treatments can help relieve symptoms that flare up periodically, or they can slow the progression of the disease in people whose symptoms get worse over time.

Who gets Multiple Sclerosis?

MS is three times more common in women than in men. The reason is not known, but researchers suspect it is linked to female hormones, as well as vitamin D deficiency, inflammation and obesity, which affect more women than men.

Most people are diagnosed between ages 20 and 50, but children, teens and older adults also develop MS.

Although MS often is associated with white women of northern European descent, it is being diagnosed more often in Hispanic and Black Americans, Dr. Diaz says.

The risk of getting MS in the U.S. is about 1 in 750 to 1,000, or about a 0.1 percent chance. The risk increases to between 2.5 and 5 percent for people who have a close relative—a child, sibling or parent—who has the disease, suggesting that genetics may play a role in who gets MS, she says.

“But a lot of patients are the only one in their family with MS,” Dr. Diaz says. “There must be other factors besides genetics that cause MS.”

What causes Multiple Sclerosis?

MS is an inflammatory disease that affects the brain and spinal cord. It’s characterized by degeneration of parts of the myelin, the protective layer that coats nerve fibers in the body, leading to lesions seen in the brain or spinal cord.

“We don’t know yet what triggers the body’s immune system to attack the central nervous system,” Dr. Diaz says.

There may be numerous causes, including environmental factors, she says. For example, studies have shown that people with low levels of vitamin D in their blood may be at increased risk, though it’s unclear why.

“Classically, MS tends to occur more often in people farther away from the equator who get less vitamin D from the sun,” she says. But this is not always the case.

Smoking and obesity also appear to raise risk.

Researchers are investigating whether certain viruses and bacteria could trigger MS. Studies have shown an increased risk of MS after people have been infected with Epstein-Barr virus, which causes infectious mononucleosis.

What are the symptoms of Multiple Sclerosis?

MS symptoms can manifest throughout the body.

People with MS may experience brain fog and have trouble remembering words. Their arms and legs can become weak or tingle and feel numb or painful. Stiffness and muscle spasms are common. They may have bladder problems, such as not being able to control urination, or sexual problems with arousal and orgasm. Some people lose some or all vision, usually in one eye. Some have difficulty walking and may need to use a cane or walker to prevent falls. Being intolerant of heat is another common symptom.

And while not everyone has all of these symptoms, about 80 percent of people with MS feel significant, often daily, fatigue.

“These symptoms are very troublesome for people who are trying to work and be productive,” Dr. Diaz says.

Do Multiple Sclerosis symptoms get better or worse over time?

The onset of MS symptoms is often frightening. Numbness, tingling, difficulty walking and vision loss are common and usually lead to the initial diagnosis.

Medications, including steroids, help control flare-ups of the disease and put it into remission.

But people can have relapse attacks, which may be followed again by periods of recovery when all or some symptoms disappear. The length of relapses and remissions varies by patient.

“Most people have flare-ups of the disease,” Dr. Diaz says. “We call this course of the disease relapsing-remitting.”

Sometimes, patients with relapsing-remitting symptoms will transition into a more progressive phase of MS, called secondary progressive MS, in which disability accumulates over time.

And about 15 percent of people with MS have primary progressive MS, in which symptoms worsen from the outset of the disease. People with this form tend to be diagnosed at a later age, and both men and women get this disease equally. People with primary progressive MS tend to have more difficulty walking.

How is Multiple Sclerosis diagnosed?

MS is not always easy to diagnose, as the symptoms are similar to those of many other diseases and conditions.

The criteria for diagnosing MS are:

  • Damage (lesions) in at least two places in the central nervous system (brain, spine or optic nerve)
  • Evidence that the lesions occurred at different times
  • Ruling out other diagnoses

If your doctor suspects you might have MS, they’ll give you a neurological exam, which may include testing your vision, hearing, facial sensation, strength, swallowing ability, reflexes, coordination, walking and balance.

You may undergo an MRI to detect lesions. You may also have a spinal tap to check your cerebrospinal fluid for a certain protein common in MS patients. A neurologist typically performs these tests are commonly done by a neurologist.

How do you treat Multiple Sclerosis?

When symptoms occur, initially or as flare-ups, they are usually treated with IV or high-dose oral corticosteroids, Dr. Diaz says.

If you are experiencing MS symptoms for the first time, it’s important to get medical care right away. “If you can’t see your primary care doctor the same day symptoms start, you should go to urgent care or the emergency room,” she says.

Several medications are available to manage MS. Different drugs treat different stages of the disease, so it’s important to establish an ongoing relationship with a doctor who treats MS.

How do you live a healthy life with Multiple Sclerosis?

The things everyone should do to improve and maintain their health are particularly important for MS patients, Dr. Diaz says. Lifestyle changes can help minimize flares.

“Be absolutely compliant with the treatment you and your doctor have agreed to; stay active, through physical therapy, exercises at home or walking regularly; and eat a healthy diet that includes fruits, vegetables and healthy meats,” she says.

Stay on top of regular checkups, vaccinations and age-appropriate disease screenings.

Research is ongoing for even better treatments for MS, she says, and resources are available to support patients and their families.

If you notice symptoms that are not normal for you, talk to your doctor, or find one near you.