Multiple sclerosis affects the brain and spinal cord and causes symptoms such as fatigue, difficulty walking, and speech issues. There’s no cure yet, but various treatments can help manage the symptoms.
Multiple sclerosis (MS) is a chronic condition involving your central nervous system (CNS). With MS, your immune system attacks myelin, which is the protective layer around nerve fibers.
MS causes inflammation and temporary lesions. It can also lead to lasting lesions caused by scar tissue, which interferes with messages in the affected areas of the brain and spinal cord.
There’s no cure for MS, but it’s possible to manage symptoms. Learn more about the causes of MS, how it’s treated, and more.
People with MS experience a wide range of symptoms. Due to the nature of the disease, symptoms can vary widely from person to person.
They can also change in severity over time and even from day to day.
Some of the most common symptoms associated with MS include:
Fatigue
Around 80% of people with MS report having fatigue, according to the National Multiple Sclerosis Society (NMSS). Fatigue due to MS can make it harder to do everyday tasks.
Difficulty walking
Difficulty walking can occur with MS due to:
- numbness in your legs or feet
- difficulty balancing
- muscle weakness
- muscle spasticity
- difficulty with vision
Difficulty walking can also lead to injuries if you fall.
Vision problems
Vision problems are often some of the first symptoms for many people with MS. They may affect one or both eyes. These issues may come and go, get worse over time, or resolve entirely.
Common vision problems associated with MS include:
- optic neuritis, which can cause pain or blurry vision in one eye
- diplopia, or double vision
- nystagmus, or involuntary movement of the eyes
- loss of vision in one visual field or both eyes
- blindness
Speech issues
MS lesions in the brain can affect speech. These speech issues, also known as dysarthria, can range from mild to severe.
Symptoms of dysarthria can include:
- slurred speech
- “scanning” speech, where there are long pauses between words or syllables
- changes in the volume of speech
Other symptoms
Other common symptoms of MS can include:
- acute or chronic pain
- tremors
- cognitive issues involving concentration, memory, and word-finding
- difficulty chewing and swallowing
- sleep issues
- problems with bladder control
MS can begin with mild to severe symptoms, and it can progress slowly or rapidly. Three of the most common early symptoms of MS are:
- Numbness and tingling that affects the arms, legs, or one side of your face: These sensations are similar to the pins-and-needles feeling you get when your foot falls asleep. However, they occur without a trigger.
- Uneven balance and weak legs: You may find yourself tripping easily while walking or doing some other type of physical activity.
- Double vision, blurry vision in one eye, or partial vision loss: These symptoms can be early indicators of MS. You may also have eye pain.
These early symptoms may go away only to return later. You may go weeks, months, or even years between flare-ups.
These symptoms can have many different causes. Even if you have these symptoms, it doesn’t necessarily mean that you have MS.
A healthcare professional, often a neurologist, performs a neurological exam to diagnose MS. They typically also talk with you about your clinical history and order tests to confirm the diagnosis.
Diagnostic testing may include:
- MRI scan: Using a contrast dye with the MRI allows your doctor to detect active and inactive lesions throughout your brain and spinal cord.
- Optical coherence tomography (OCT): In this test, a picture of the nerve layers in the back of your eye is taken to check for thinning around the optic nerve.
- Spinal tap (lumbar puncture): Your doctor may order a spinal tap to find abnormalities in your spinal fluid. This test can help rule out infectious diseases. It can also be used to look for oligoclonal bands (OCBs), which can be used to diagnose MS.
- Blood tests: Doctors order blood tests to help eliminate the possibility of other conditions that have similar symptoms.
- Visual evoked potentials (VEP) test: This test stimulates the nerve pathways to analyze electrical activity in your brain. Brain stem auditory-evoked and sensory-evoked potential tests may also be used to diagnose MS.
An MS diagnosis requires evidence of demyelination occurring at different times in more than one area of your brain, spinal cord, or optic nerves.
What is demyelination?Damage to the protective myelin layer around your nerves is called demyelination. It prevents your nervous system from efficiently sending signals in the areas that are affected.
A diagnosis also requires ruling out other conditions that have similar symptoms, such as:
Your MS may change and evolve. You can only have one type of MS at a time, but knowing when you transition to a progressive form of MS may be difficult to pinpoint.
Types of MS include:
Clinically isolated syndrome (CIS)
CIS is a pre-MS condition involving one episode of symptoms lasting at least 24 hours. These symptoms are due to demyelination in your CNS.
Although this episode is characteristic of MS, it’s not enough to prompt a diagnosis. CIS can fully resolve, and a person can have a single episode without any future episodes.
If you have more than one lesion or positive oligoclonal bands (OCBs) in your spinal fluid at the time of a spinal tap, then you might be more likely to eventually be diagnosed with RRMS. If you have evidence of a previous lesion, you might be diagnosed with RRMS during the evaluation for CIS.
If these lesions are absent or your spinal fluid does not show OCBs, you are less likely to receive an MS diagnosis.
Relapsing-remitting MS (RRMS)
Relapsing-remitting MS (RRMS) involves clear relapses of disease activity followed by remissions. During remission periods, symptoms are mild or absent, and there’s mild to moderate disease progression.
RRMS is the most common form of MS at diagnosis and accounts for about 85% of all initial MS diagnoses, according to the NMSS.
Primary progressive MS (PPMS)
If you have primary progressive MS (PPMS), neurological function becomes progressively worse from the onset of your symptoms.
However, short periods of stability can occur. The terms “active” and “not active” are sometimes used to describe disease activity with new or enhancing brain lesions.
Secondary progressive MS (SPMS)
Secondary progressive MS (SPMS) occurs when RRMS transitions into the progressive form. In addition to disability or gradual worsening of function, you may still have noticeable relapses.
If you have MS, the protective layer of myelin around some of the nerve fibers of your brain, optic nerve, and spinal cord become damaged.
See illustrations that show these physiological changes.
Experts think that this damage may result from an autoimmune process in which the immune system targets myelin. While more research is needed, an environmental trigger, such as a virus or toxin, may set off this process.
As your immune system damages the myelin, demyelination occurs. This can go into remission as new layers of myelin form, but chronic inflammation can lead to scar tissue, which can result in lasting neurological impairment.
MS is not hereditary, but having a parent or sibling with MS raises your risk slightly. Scientists have identified some genes that seem to increase susceptibility to developing MS, according to a review of studies published in 2011.
Experts do not know why some people develop MS. However, several risk factors may increase the risk.
These include:
- having a close relative with MS
- obesity
- certain infections
- smoking
- certain autoimmune disorders, such as type 1 diabetes and rheumatoid arthritis
No cure is currently available for MS, but treatment options can limit relapses or slow progression. Other medications and therapies can help manage specific symptoms.
Disease-modifying therapies (DMTs)
DMTs help slow the progression of MS and reduce your relapse rate.
Self-injectable disease-modifying medications for RRMS include glatiramer acetate (Copaxone) and beta interferons, such as:
- Avonex
- Betaseron
- Extavia
- Plegridy
- Rebif
In 2020, the Food and Drug Administration (FDA) approved Kesimpta for treatment. Kesimpta is an injectable monoclonal antibody treatment that can be self-administered.
Oral medications for RRMS include:
- dimethyl fumarate (Tecfidera)
- fingolimod (Gilenya)
- teriflunomide (Aubagio)
- cladribine (Mavenclad)
- diroximel fumarate (Vumerity)
- siponimod (Mayzent)
- ozanimod (Zeposia)
- monomethyl fumerate (Bafiertam)
- ponesimod (Ponvory)
Intravenous (IV) infusion treatments for RRMS include:
- alemtuzumab (Lemtrada)
- natalizumab (Tysabri)
- mitoxantrone (Novantrone)
- Ocrelizumab (Ocrevus)
In 2017, the Food and Drug Administration (FDA) approved the first DMT for people with PPMS. This infusion drug, ocrelizumab (Ocrevus), can also be used to treat RRMS.
Another drug, ozanimod (Zeposia), has recently been approved for treating CIS, RRMS, and SPMS.
Not all MS medications are available or appropriate for every person. Talk with your doctor about which drugs are most appropriate for you and the risks and benefits of each.
Other medications
A doctor can prescribe corticosteroids, such as methylprednisolone (Medrol) or Acthar Gel (ACTH), to treat relapses.
Other treatments may also be targeted at easing specific symptoms to help improve your quality of life, such as helping to treat pain or bladder urgency.
Because MS is different for everyone, treatment depends on your specific symptoms.
Progressive types of MS generally advance faster than RRMS. People with RRMS can be in remission for many years. A lack of disability after 5 years is usually a good indicator for the future.
Most people with MS don’t become severely disabled and continue to lead full lives.
Your quality of life with MS will depend on your symptoms and how well you respond to treatment. But even though MS can change course without warning, it’s rarely fatal.
Most people with MS find ways to manage their symptoms and function well.
Medications
Having MS means you’ll need a doctor experienced in treating MS.
If you take one of the DMTs, you’ll need to adhere to the recommended schedule. Your doctor may prescribe other medications to treat specific symptoms.
Diet and exercise
Regular physical activity, such as exercise, supports your overall health, physically and mentally.
If physical movement is difficult, swimming or exercising in a swimming pool can help. Some yoga classes are designed just for people with MS.
A well-balanced diet that’s high in nutrients and fiber can also help you manage your overall health.
Your diet should mainly consist of:
- a variety of fruits and vegetables
- lean sources of protein, such as fish and skinless poultry
- whole grains and other sources of fiber
- nuts
- legumes
- low fat dairy products
- adequate amounts of water and other fluids
The more nutritious your diet, the better it supports your overall health. You’ll not only feel better in the short term, but you’ll also be laying the foundation for a healthier future.
It’s important that you try to limit or avoid:
- saturated fat
- trans fat
- red meats
- foods and beverages high in sugar
- foods high in sodium
- highly processed foods
If you have other medical conditions, ask your doctor if you should follow a special diet or take any dietary supplements.
It’s helpful to learn how to read food labels properly. Foods that are high in calories but low in nutrients will not help you feel better or maintain a weight that works for you.
Other complementary therapies
Although studies regarding the effectiveness of complementary therapies are scarce, that does not mean these methods can’t help in some way.
The following therapies
MS lesions can appear anywhere in your CNS and have wide-ranging effects. Many people with MS also have:
- depression
- anxiety
- some degree of cognitive impairment
- muscle spasticity or stiffness
- muscle atrophy or thinning
If you have other medical conditions, MS can have a more substantial impact on your overall health.
If you have mobility issues, falling may increase your risk of bone fractures. Other conditions, such as arthritis and osteoporosis, can complicate matters. Mobility issues can lead to a lack of physical activity, which can cause other health problems. Fatigue and mobility issues may also have an effect on mental health.
The National Institutes of Health (NIH) reports that around
Other things you should know:
- NMSS reports that most people diagnosed with RRMS are between ages 20 and 50 at the time of their diagnosis.
- Overall, research indicates that MS is
more common in females than males. NMSS reports that RRMS specifically isthree times more common in females than males. PPMS rates in females and males are roughly equal. - Research shows that people who relocate to a new location before age 15 years generally acquire the MS risk factors associated with the new location, compared with those relocating after age 15 years. Canada has one of the highest rates of MS in the world. Rates of MS tend to be lower in places closer to the equator. This may be due to sunlight and vitamin D exposure.
MS is a lifelong condition. You’ll face unique challenges that can change over time.
It’s helpful for you to discuss your concerns with your doctor. Doing so, enables you to learn all you can about MS and to discover what makes you feel your best.
Many people with MS even choose to share their challenges and coping strategies through in-person or online support groups.
You can also try Healthline’s free MS Buddy app to share advice and support in an open environment. Download it for iPhone or Android.