Multiple sclerosis

Información en español Title

Not a rare disease

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Immune System Diseases

Summary Summary

Multiple sclerosis (MS) is a degenerative disorder that affects the central nervous system, specifically the brain and the spinal cord. The disorder is characterized by destruction of the myelin, the fatty tissue that surrounds and protects the nerve fibers and promotes the transmission of nerve impulses, and damage to nerve cells. The symptoms vary widely from person to person, and may include sensory disturbances in the limbs, problems with muscle control, tremors, muscle stiffness (spasticity), exaggerated reflexes (hyperreflexia), weakness, difficulty walking, poor bladder control, and vision problems. Most patients have periods during which they have symptoms (clinical attacks). The clinical attacks are typically followed by periods without any symptoms (remission). After several years, the symptoms worsen continuously. Multiple sclerosis is considered an autoimmune disorder but the exact cause is unknown. Risk factors for developing multiple sclerosis include genetic factors like changes in the HLA-DRB1 gene and in the IL7R gene and environmental factors, such as exposure to the Epstein-Barr virus, low levels of vitamin D, and smoking. The goal of treatment of MS is to decrease attacks and the inflammation within the central nervous system.^[1]^[2]^[3]

Last updated: 11/21/2015

Symptoms Symptoms

The peak age of onset is between ages 20 and 40, although it may develop in children and has also been identified in individuals over 60 years of age. The most common signs and symptoms include sensory disturbance of the limbs; partial or complete visual loss; acute and subacute motor dysfunction of the limbs; diplopia (double vision); and gait dysfunction. These signs and symptoms may occur alone or in combination, and have to be present for a minimum of 24 hours to be considered a "clinical attack." The signs and symptoms in individuals with MS are extremely variable, even among affected relatives within families.^[2] Symptoms vary because the location and severity of each attack can be different. Episodes can last for days, weeks, or months. These episodes alternate with periods of reduced or no symptoms (remissions). While it is common for the disease to return (relapse), the disease may continue to get worse without periods of remission. Because nerves in any part of the brain or spinal cord may be damaged, patients with multiple sclerosis can have symptoms in many parts of the body.^[4]

Muscle symptoms may include loss of balance, muscle spasms, numbness or abnormal sensation in any area, problems moving arms or legs, problems walking, problems with coordination and making small movements, and tremor or weakness in one or more arms or legs. Bowel and bladder symptoms may include constipation and stool leakage, difficulty beginning to urinate, frequent need or strong urge to urinate, and incontinence. Eye symptoms may include double vision, eye discomfort, uncontrollable rapid eye movements, and vision loss. There may be numbness, tingling, or pain in the face, muscles, arms or legs. Other brain and nerve symptoms may include decreased attention span, poor judgment, and memory loss; difficulty reasoning and solving problems; depression or feelings of sadness; dizziness and balance problems; and hearing loss. Individuals may also have slurred or difficult-to-understand speech, trouble chewing and swallowing, and sexual symptoms such as problems with erections or vaginal lubrication.^[4]

Last updated: 3/30/2011

The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below.

Signs and Symptoms	Approximate number of patients (when available)
CNS demyelination	-
Depression	-
Diplopia	-
Emotional lability	-
Incoordination	-
Multifactorial inheritance	-
Muscle weakness	-
Paresthesia	-
Spasticity	-
Urinary hesitancy	-
Urinary incontinence	-

Last updated: 9/1/2016

Cause Cause

Studies suggest that there are many factors that influence whether a person will develop multiple sclerosis (MS). The factors that contribute to its onset are multiple and may vary from person to person. The signs and symptoms of MS occur as a result of inflammation, loss of the protective nerve covering (myelin), and the breakdown of nerve cells.^[5]

The most widely accepted theory is that MS begins as an autoimmune disorder, where white blood cells (lymphocytes) attack healthy tissues. Later, signs and symptoms occur as a result of abnormal activity of specific cells in the brain and spinal cord (microglial cells) and progressive injury and loss of brain and spinal cord cells.^[5]

Additional theories regarding the cause of MS include chronic viral infections and genetic disease. Although many viruses, and particularly the Epstein-Barr virus, have been associated with MS, there is no specific evidence linking viruses directly to the development of MS. Still, Epstein-Barr virus infection is considered a risk factor for the disease.^[6] Certain gene changes, including ones in HLA-DRB1 are associated with an increased risk for developing multiple sclerosis. However, it is unclear exactly what role these gene changes play in the development of MS.^[5] Having a first-degree relative with MS, like a parent or sibling, does increase a persons risk for the condition (to around 2%). Learn more about gene changes and MS.

Vitamin D is another area of interest. Those who are exposed to more sunlight tend to have higher levels of naturally-produced vitamin D, which is thought to support the immune function and may help protect against immune-mediated diseases like MS.^[6]

Further information on the cause of MS is available at the National Multiple Sclerosis Society Web site.

Last updated: 11/21/2015

Diagnosis Diagnosis

Symptoms of multiple sclerosis (MS) may be similar to those of many other nervous system disorders. The disease is made based on the person's signs and symptoms and is typically diagnosed by ruling out other conditions.^[2]^[4]

"Dissemination in time and space" are commonly-used criteria for diagnosing the relapsing-remitting form of MS (RR-MS). "Dissemination in time means" that there are at least two clinical attacks, each lasting at least 24 hours, separated by at least one month, or a slow, step-wise progressive course for at least six months. "Dissemination in space" means that there are lesions in more than one area of the brain or spinal cord. For primary progressive MS (PP-MS), there are currently no diagnostic criteria that are universally accepted.^[2]

Physicians may do many tests to evaluate an individual suspected of having MS.

Neurological Exam: May show reduced nerve function in one area of the body or over many parts of the body. This may include abnormal nerve reflexes, decreased ability to move a part of the body, decreased or abnormal sensation, and other loss of nervous system functions.

Eye Exam: May show abnormal pupil responses, changes in the visual fields or eye movements, decreased visual acuity, problems with the inside parts of the eye, and rapid eye movements triggered when the eye moves.

Other Tests: Lumbar puncture (spinal tap) for cerebrospinal fluid tests, MRI scan of the brain, MRI scan of the spine; nerve function study; and several of blood tests.^[4] The Revised McDonald Criteria, published In 2010 by the International Panel on the Diagnosis of Multiple Sclerosis, include specific guidelines for using MRI, visual evoked potentials (VEP) and cerebrospinal fluid analysis to speed the diagnostic process.^[1]

Last updated: 11/21/2015

Treatment Treatment

The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional.

Management Guidelines

GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions.

FDA-Approved Treatments

The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products.

Dalfampridine (Brand name: Ampyra) - Manufactured by Acorda Therapeutics
FDA-approved indication: Treatment to improve walking in patients with multiple sclerosis (MS)
National Library of Medicine Drug Information Portal
Interferon beta-1a (recombinant human) (Brand name: Avonex®) - Manufactured by Biogen, Inc.
FDA-approved indication: Treatment of relapsing forms of multiple sclerosis to slow the accumulation of physical disability and decrease the frequency of clinical exacerbations.
National Library of Medicine Drug Information Portal
Medline Plus Health Information
Interferon beta-1b (Brand name: Betaseron®) - Manufactured by Bayer
FDA-approved indication: In ambulatory patients with relapsing-remitting multiple sclerosis to reduce the frequency of clinical exacerbations.
National Library of Medicine Drug Information Portal
Medline Plus Health Information
Glatiramer acetate (Brand name: Copaxone®) - Manufactured by Teva Pharmaceuticals USA
FDA-approved indication: For reduction of the frequency of relapses in patients with relapsing-remitting multiple sclerosis.
National Library of Medicine Drug Information Portal
Medline Plus Health Information
Baclofen (Brand name: Lioresal® (injection)) - Manufactured by Medtronic, Inc.
FDA-approved indication: Management of severe spasticity of spinal cord origin in patients who are unresponsive to oral baclofen therapy or experience intolerable CNS side effects at effective doses.
National Library of Medicine Drug Information Portal
Medline Plus Health Information

Research Research

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

ClinicalTrials.gov lists trials that are studying or have studied Multiple sclerosis. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies.

Organizations Organizations

Nonprofit support and advocacy groups bring together patients, families, medical professionals, and researchers. These groups often raise awareness, provide support, and develop patient-centered information. Many are the driving force behind research for better treatments and possible cures. They can direct people to research, resources, and services. Many groups also have experts who serve as medical advisors. Visit their website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD. Suggest an organization to add.

Organizations Supporting this Disease

Accelerated Cure Project for Multiple Sclerosis
300 Fifth Avenue
Waltham , MA 02451
Telephone: 781-487-0008
Fax: 781-487-0009
E-mail: info@acceleratedcure.org
Website: http://www.acceleratedcure.org
American Autoimmune Related Diseases Association (AARDA)
22100 Gratiot Avenue Eastpointe
East Detroit, MI 48201-2227
Toll-free: 800-598-4668
Telephone: 586-776-3900
Fax: 586-776-3903
E-mail: aarda@aarda.org
Website: http://www.aarda.org/
Multiple Sclerosis Association of America
375 Kings Highway North
Cherry Hill, NJ 08034
Toll-free: 800-532-7667
Telephone: 856-488-4500
Fax: 856-661-9797
E-mail: MSquestions@mymsaa.org
Website: http://mymsaa.org/
Multiple Sclerosis Foundation
6350 North Andrews Avenue
Ft. Lauderdale, FL 33309-2130
Toll-free: 888-MSFOCUS (673-6287)
Telephone: 954-776-6805
Fax: 954-351-0630
E-mail: support@msfocus.org
Website: http://www.msfocus.org
National Multiple Sclerosis Society
733 Third Avenue, 6th Floor
New York, NY 10017-3288
Toll-free: 800-344-4867
Telephone: 212-986-3240
Fax: 212-986-7981
E-mail: nat@nmss.org
Website: http://www.nationalmssociety.org

Living With Living With

Living with a genetic or rare disease can impact the daily lives of patients and families. These resources can help families navigate various aspects of living with a rare disease.

Genetics Resources

To find a medical professional who specializes in genetics, you can ask your doctor for a referral or you can search for one yourself. Online directories are provided by GeneTests, the American College of Medical Genetics, and the National Society of Genetic Counselors. If you need additional help, contact a GARD Information Specialist. You can also learn more about genetic consultations from Genetics Home Reference.

Financial Resources

Good Days provides help to patients with life-altering conditions. Assistance includes help with the cost of medications and travel.
Patient Access Network Foundation (PAN Foundation) has Assistance Programs for those with health insurance who reside in the United States. The disease fund status can change over time, so you may need to check back if funds are not currently available.
The Assistance Fund provides various services, including education and financial aid, to help patients with a chronic or serious illness cover the cost of FDA-approved medications. Patients must be U.S citizens or permanent residents.

Learn More Learn More

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

Genetics Home Reference contains information on Multiple sclerosis. This website is maintained by the National Library of Medicine.
MedlinePlus was designed by the National Library of Medicine to help you research your health questions, and it provides more information about this topic.
The Merck Manuals Online Medical Library provides information on this condition for patients and caregivers.
The National Institute of Neurological Disorders and Stroke (NINDS) collects and disseminates research information related to neurological disorders. Click on the link to view information on this topic.
The National Organization for Rare Disorders (NORD) has a report for patients and families about this condition. NORD is a patient advocacy organization for individuals with rare diseases and the organizations that serve them.

In-Depth Information

Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
Online Mendelian Inheritance in Man (OMIM) is a catalog of human genes and genetic disorders. Each entry has a summary of related medical articles. It is meant for health care professionals and researchers. OMIM is maintained by Johns Hopkins University School of Medicine.
PubMed is a searchable database of medical literature and lists journal articles that discuss Multiple sclerosis. Click on the link to view a sample search on this topic.

Press Releases

On August 13, 2007, The National Institutes of Health (NIH) posted an article titled Genes Linked to Multiple Sclerosis, which discusses 2 genes that influence the risk of developing multiple sclerosis. Click on the name of the article to read more.

News & Events News & Events

Other Conferences

!LINK!, April 19, 2013 - April 20, 2013
Location: Froedtert and Medical College of Wisconsin, Milwaukee, WI
Description: The aim of this NIH workshop is to break the stalemate and facilitate interdisciplinary collaboration by creating functional clinical research teams on the national level who can then create a momentum for progress in this area of substantial unmet need and high promise. The CIBMTR infrastructure, which is currently cancer-focused, can be easily adapted to collect AID-specific data

Related Diseases Related Diseases

The following diseases are related to Multiple sclerosis. If you have a question about any of these diseases, you can contact GARD.

Tumefactive multiple sclerosis

GARD Answers GARD Answers

Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know. Submit a new question

My brother has been diagnosed with MS recently. As far as we know, there is no family history of this disease. I've looked all over the web, and I still cannot believe there are NO known causes, at all. Are there at least some hypotheses, even educated guesses? The only hint I got was that there is genetic susceptibility, but as I've already said, we have no family history. See answer
Hi, My donor has MS (relapsing-remitting). What are the potential risks for my child? Thank you. See answer
I have multiple sclerosis (MS). Several other members of my family also have this condition. My doctor wants to treat me with Tarceva. Do you have information related to the use of this medication for MS? See answer
My husband was diagnosed with multiple sclerosis (MS) in 1999, and now with a second opinion he was diagnosed with possible primary lateral sclerosis (PLS). How does MS differ from PLS? How are MS and PLS diagnosed? See answer

References References

What is Multiple Sclerosis?. National MS Society Web site. http://www.nationalmssociety.org/What-is-MS. Accessed 11/20/2015.
Stüve O, Oksenberg J. Multiple Sclerosis Overview. GeneReviews. May 11, 2010; http://www.ncbi.nlm.nih.gov/books/NBK1316/. Accessed 11/20/2015.
Multiple Sclerosis. Genetics Home Reference. April 2013; http://ghr.nlm.nih.gov/condition/multiple-sclerosis.
Zieve D. Multiple Sclerosis. PubMed Health. August 5, 2010; http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001747/. Accessed 3/30/2011.
Olek MJ, Mowry E. Pathogenesis and epidemiology of multiple sclerosis. In: Gonzalez-Scarano F ed.,. UpToDate. Waltham, MA: UpToDate; Last updated June 2, 2015; Accessed 9/3/2015.
What Causes MS?. National Multiple Sclerosis Society. http://www.nationalmssociety.org/What-is-MS/What-Causes-MS. Accessed 9/3/2015.