Multiple sclerosis, or MS, is an autoimmune disease that attacks the central nervous system. Specifically, the immune system mistakenly attacks myelin, the fatty substance that surrounds and insulates nerve fibers. As a result, the nerves can no longer function properly. This causes a variety of symptoms that differ in type and severity from person to person but can include blurred vision, numbness, weakness, trouble walking, fatigue, difficulty urinating, and cognitive difficulty.
Why is early diagnosis important?
MS cannot be cured, but the disease and its symptoms can be effectively managed to help you maintain or regain function and quality of life. Because permanent neurologic damage can occur even in the earliest stages of MS, it is important to be diagnosed as early as possible so that you can start appropriate treatment to avoid further damage.
There is not a specific test to determine if you have MS. If you are experiencing a symptom of MS, your primary care provider will refer you to a physician who specializes in MS, typically a neurologist. The neurologist will obtain your medical history including a review of your symptoms, conduct a neurologic exam and order various tests to rule out other possible causes for your symptoms. Your neurologist also may order a spinal fluid analysis and a magnetic resonance imaging (MRI) study of your brain and spine that are used to help confirm the diagnosis of MS.
CommonSpirit Health offers comprehensive MS treatment. Our team includes neurologists, neuropsychologists, physical medicine and rehabilitation physicians (physiatrists), and rehabilitation experts including physical, occupational, and speech therapists. Depending on your symptoms, other specialists such as urologists, gastroenterologists, and ophthalmologists are consulted and included in our comprehensive care planning.
Effective treatment options available for MS
Appropriate, effective, and ongoing care provides two important benefits:
- It decreases disease activity, reducing the frequency and/or intensity of flare-ups.
- It helps manage or reduce symptoms, which allows you to maintain or restore function and the quality of your life.
With effective and ongoing treatment, people with MS live long and fulfilling lives. In fact, those with MS have a life expectancy that is only slightly shorter than average. Earlier death in people with MS is most commonly caused by secondary complications resulting from immobility, chronic urinary tract infections, and compromised swallowing — all of which can be managed by effective treatment.
Treatment is a combination of medication and rehabilitation. The FDA has approved a variety of drugs to treat MS. Different medications are used to modify the disease course, treat relapses (also called attacks or exacerbations), or manage symptoms. These drugs fall into three categories: oral, injected, or infused. CommonSpirit Health offers short- and long-term infusion services provided by registered nurses who specialize in intravenous and injectable therapies.
Rehabilitation focuses on helping you maintain or restore your ability to perform essential activities at home and work. An important goal of rehab is energy management since fatigue is a symptom experienced by about 80 percent of people with MS. Rehabilitation can be especially useful after an exacerbation to help you get back on track.
Therapies for MS
CommonSpirit Health rehabilitation teams include physical therapists, occupational therapies, and speech/language pathologists. Intensive inpatient neurological rehabilitation as well as outpatient rehab are available. Some of the therapies that may be included in your treatment are:
- Exercise training to improve strength, flexibility, coordination, and mobility Physical therapy to retrain muscles to reduce spasticity, restore balance and sensory input, and regain function
- Speech therapy to regain lost speech and comprehension, and improve communication skills
- Swallowing therapy to help you safely eat and drink, which includes modified barium swallow studies to measure swallowing impairment, as well as electrical stimulation technology treatments
- Occupational therapy to aid with personal activities of daily living and restore your independence
In some CommonSpirit Health locations, the team may include cognitive remediation specialists and/or neuropsychologists. These specialists — along with the rehab therapists — help address any changes in your ability to think, reason, concentrate or remember. CommonSpirit Health also provides mental health services to help address depression and anxiety that can result from living with MS.
Find a Multiple Sclerosis specialist
Yes, it is highly recommended that people with MS get a COVID-19 vaccine since having MS may increase the risk of more severe COVID infection.
Yes, you can get a flu vaccine as well as a shingles vaccine. All people with MS should talk with their providers to determine which vaccines are appropriate. In addition to talking to your provider, you can obtain additional information about vaccines from the U.S. Centers for Disease Control and Prevention and the National MS Society.
Symptoms vary from person to person and are unpredictable. In general, however, the most common early symptoms are numbness of the face, body, arms or legs; weakness and coordination problems, including imbalance and difficulty walking, difficulty urinating, blurred vision or other vision problems; or dysesthesia, a sensation of being squeezed around the torso (often called an MS hug).
It’s unknown what causes MS, so doctors do not know who is at risk of developing the disease. Scientists believe it is due to a combination of environmental and genetic factors but have not yet identified those. Typically, MS develops between the ages of 20 and 50 and is two to three times more likely to occur in women. It occurs in most ethnic groups, but it is most common in white people of European descent.
For an unknown reason, the incidence of MS increases as you get farther away from the equator. This phenomenon is seen in Colorado, which has a higher incidence rate of MS than other states that are further south. A common misconception is that Colorado has the highest incidence rate in the U.S. In fact, other states further north — particularly those in the northeast — have higher rates.
There are four clinical courses of MS:
- Clinically isolated syndrome (CIS): This is the first episode of neurologic symptoms caused by inflammation or loss of the myelin that covers nerve cells. You can experience just one symptom, called a monofocal episode, or multiple symptoms, called multifocal episode. If you have experienced CIS, you may or may not develop MS. When CIS is accompanied by MRI-detected brain lesions that are similar to those seen in MS, the person has a 60 to 80 percent chance of a second neurologic event and diagnosis within several years.
- Relapsing-remitting MS (RRMS): This is the most common type of MS. Those with this type will experience exacerbations or flare-ups followed by remission. During flare-ups, you may experience new symptoms or an increase or worsening of existing symptoms. Special medications are available to treat exacerbations. Rehabilitation soon after flare-ups is particularly helpful in limiting the impact of a flare-up.
- Secondary progressive MS (SPMS): During the SPMS stage, people who have RRMS may begin feeling a steadying worsening of symptoms. The transition can be subtle, but you will gradually have longer relapse periods if you develop SPMS. This shift usually begins about 15 to 20 years after your initial diagnosis. Without proper treatment, about eight in 10 people with RRMS will develop SPMS.
- Primary progressive MS (PPMS): About 15 percent of people with MS have PPMS. In this form, symptoms continue to worsen after the initial onset without any period of relapses and remissions.
The life expectancy of those with MS in the U.S. is only slightly shorter than the national average for all people. Early deaths generally are caused by secondary health conditions that are a result of symptoms. Regular treatment with medications and rehabilitation — combined with treating secondary health issues — helps prevent early death in people with MS. Disability can also be reduced through ongoing treatment.
It cannot be cured at this time. Although sometimes it can go into remission, where there are periods of time when people have few or no symptoms. It’s possible to stay in remission for weeks, months, or even years before experiencing a relapse. Relapses — also called exacerbations, attacks, and flare-ups — are the occurrence of new symptoms or worsening of existing symptoms caused by inflammation in the central nervous system.