Multiple Sclerosis
Overview
Multiple sclerosis is a chronic disease that affects the central nervous system, including the brain, spinal cord and optic nerves. Experts believe MS is an autoimmune disease caused by the immune system attacking and damaging the nervous system. It generally progresses gradually, with alternating periods of remission, good health and disabling flare-ups.
About 400,000 Americans, mostly young adults, suffer from MS. It occurs almost twice as frequently among women than men.
Although there is no cure, most MS patients lead active lives for many years after their diagnosis and have a normal life span. But MS can be tiring and require schedule and lifestyle adjustments. A regular exercise program that includes walking, swimming, stretching or riding a stationary bike can reduce some symptoms. Our physical therapists and staff can help you learn to cope with your condition by improving your walking ability, balance, range of motion and stamina.
Causes of Multiple Sclerosis
Multiple sclerosis damages the outer covering of nerve cells, called myelin, a fatty tissue that protects nerve cells in the same way that insulation protects electrical wiring in a house. Myelin helps nerve fibers conduct electrical impulses to and from the brain. Scar tissue, called sclerosis, accumulates when multiple areas of myelin are damaged. These damaged areas are known as plaques or lesions. Sometimes the nerve fiber itself is damaged and dies.
The exact cause of MS is not known, but factors such as disease, poisons and drug or alcohol abuse can damage the myelin sheath in children and adults. Heredity may contribute to the development of MS. About 5 percent of patients have a sister or brother who has the disease and about 15 percent have a close relative with MS.
When MS damages the protective myelin sheath of nerve cells, the sheath sometimes repairs itself and nerves work correctly again. In other cases, the myelin is so damaged that the underlying nerve can't be repaired and dies.
Our Approach to Multiple Sclerosis
Our mission is to help people with multiple sclerosis (MS) enjoy long and active lives. We create tailored treatment plans to relieve symptoms, reduce the severity and duration of MS attacks, and halt or slow progression of the disease. Our patients may also have opportunities to participate in research studies that are developing and testing new MS treatments. As part of our comprehensive care, we offer physical and occupational therapy to assist patients with their daily routines.
Awards & recognition
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Among the top hospitals in the nation
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Best in the West and No. 3 in the nation for neurology & neurosurgery
Signs & symptoms
The symptoms of multiple sclerosis depend on which particular pathway of nerve fiber is damaged. Tingling, numbness, sensations of tightness or weakness may result when myelin in the spinal cord is damaged. If nerve fibers to the bladder are affected, urinary incontinence may occur. Likewise, damage to the cerebellum portion of the brain may result in imbalance or a lack of coordination. MS patients can have a wide range of symptoms, depending on where the damage occurs in the central nervous system.
Because MS can cause a wide variety of symptoms in different people, doctors often struggle to diagnose the disease. However, common symptoms of MS include changes in sensation or sensory symptoms such as tingling and numbness, and changes in muscle function or motor symptoms such as difficulty walking, stiffness or tremors.
Some common symptoms are:
- Clumsiness or weakness
- Difficulty walking or maintaining balance
- Dizziness or vertigo
- Eye problems such as double vision or uncontrolled eye movements
- Fatigue
- Muscle spasms
- Problems with bladder or bowel control
- Stiffness
- Tremors
- Tingling or numbness
- Depression or emotional changes
- Mild intellectual change such as memory problems
- Sexual problems such as difficulty reaching orgasm, lack of vaginal sensation or erectile dysfunction
Symptoms usually appear in people between 20 and 40 years of age.
Diagnosis
When considering a diagnosis of multiple sclerosis, your doctor will be particularly interested in hearing about your symptoms, when they started and how they've eased or progressed over time.
Your diagnosis also will be based on a physical examination and tests. These tests may include:
- Blood and urine tests to help rule out other possible disorders
- Electrocardiogram (ECG or EKG) to measure electrical activity in the heart
- Magnetic resonance imaging (MRI) to look for abnormalities in the brain
- Lumbar puncture or spinal tap to determine if there are abnormalities in the cerebrospinal fluid, one of the signs of MS
- Evoked potentials test, which records electrical activity in the brain when nerves are stimulated
Medical conditions that can mimic MS include metabolic or vitamin deficiencies, unusual infections, inflammation of the blood vessels of the brain, degenerative disorders of the nervous system or cancers that have spread to the brain. This is why blood tests, X-rays, brain and spine MRIs, and spinal taps to analyze cerebrospinal fluid may be required before a diagnosis of MS can be made with certainty.
A diagnosis of MS is based upon an evaluation of your symptoms along with the results of your physical exam and tests.
Treatments
Your neurology team at UCSF Medical Center, along with your primary care physician, will design a treatment plan tailored to your medical condition, state of health and individual needs. You may need more than one kind of treatment, or a treatment requiring several visits to the Multiple Sclerosis Center. Also, you may be referred to other doctors or health professionals.
Doctors and researchers have identified four categories of treatment for patients with MS:
- Treatment that reduces the severity and duration of attacks
- Treatment to cure or eliminate the biological activity of MS in the body
- Treatment to relieve various symptoms such as incontinence, visual disturbances or fatigue
- Treatment that repairs damage caused by MS
Treatments may involve some risks or complications, which will be fully explained to you by your neurologist.
Treatments may include one of many medications such as:
- Beta interferon A family of drugs that help fight viral infection and regulate your immune system
- Glatiramer acetate A drug that doctors believe works by blocking your immune system's attack on myelin
- Immunosuppressive drugs Drugs to suppress or control the immune system
Other medications may be prescribed to treat or control symptoms such as depression, fatigue, pain, spasticity and tremors. Treatment programs and services may include exercise and physical therapy, occupational therapy to help maintain your independence in daily living, and stress reduction.
Many new treatments, such as the use of statins or cholesterol-lowering drugs, are being developed and tested. Patients who are evaluated at the Multiple Sclerosis Center have the opportunity to participate in these studies of new treatments.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
