Multiple Sclerosis - Office Visit

This is a chronic neurological condition where the body reacts against its own nervous tissue (an autoimmune process).

This is a chronic neurological condition where the body reacts against its own nervous tissue (an autoimmune process).

Multiple sclerosis (MS) is a chronic disease of the central nervous system (the brain and spinal cord). It starts with patches of inflammation (plaque) that randomly develop in parts of the central nervous system. This leads to the destruction of the protective coating of the nerves (myelin sheath) and inability of the nerves to properly send signals between the brain, spinal cord, and rest of the body.

  • MS is an autoimmune process, which means that the body reacts against its own tissue (in this case, the myelin sheath surrounding nerves.)
  • MS can cause diminished or lost function in any area of the body that is served by the affected nerve fibers.
  • MS can appear at any age, but it often strikes younger people between the ages of 20 and 40.
  • The cause of MS is unclear, but it is likely that a combination of environmental and genetic factors play a role. Some experts think MS may be caused by a virus or some environmental trigger.
  • MS occurs more often in women, Caucasians, and people who have a family history of the disease. It is also more common in areas with a moderate climate (such as the Northern United States, Canada and Europe).

In most cases, multiple sclerosis (MS) can be classified as one of four types.

  • Relapsing-remitting – Symptom flare-ups are followed by periods when symptoms are less noticeable (remission) and the disease doesn't progress. This is the most common type of MS and the most treatable.
  • Primary progressive – Symptoms steadily worsen as the disease progresses. This group of patients is very challenging to treat.
  • Secondary progressive – When someone with relapsing-remitting MS develops a steady worsening of symptoms, with or without flare-ups. About half the people who have relapsing-remitting MS will develop secondary progressive MS within 10 years.
  • Progressive relapsing – When symptoms steadily worsen and are accompanied by clear flare-ups. This is the rarest type of MS. Rarely, MS symptoms progress or worsen rapidly without remissions. This is known as malignant MS.

The symptoms of MS can involve different parts of the body, vary in type and severity, and mimic other neurological diseases. They may develop quickly and resolve rapidly, or last for a long time and get progressively worse.

  • Symptoms may include vision problems; chronic fatigue and fatigue after physical activity that improves with rest; moderate to severe pain; weakness in the arms or legs; numbness or prickling sensations that may come and go; tremors, muscle spasticity and trouble with coordination; speech problems; dizziness; impaired concentration or memory; confusion; depression; sexual dysfunction; and bowel or bladder problems.
  • Bowel problems may include constipation and stool incontinence. Bladder problems may include urinary frequency, urgency, incontinence, and increased risk of urinary tract infection.
  • Symptoms of MS often become worse when body heat increases, either through exercise or due to environmental factors. Symptoms may also be triggered by fever or stress.

Contact your healthcare provider if you have any of the above symptoms. They will do a physical and neurological examination.

Because there is no single test to specifically confirm the diagnosis of MS, you may need a series of tests. These tests can also be used to rule out other conditions that mimic MS. Some of the recommended tests include lab work, an MRI, a test that measures electrical responses in your brain, and a lumbar puncture. If the examination and testing show you have MS, your specific treatment will depend on your symptoms and the type of MS you have. Some things you can do to help you feel better and control your symptoms include eating a healthy diet, exercising as recommended by your healthcare provider, limiting stress, and avoiding overheating.

Your healthcare provider may also recommend medications to help with your symptoms.

  • Steroids may be ordered to treat relapses, but are usually not recommended for long term-use due to their side effects. They will not change the progression of MS, but may limit the length and severity of attacks or relapses.
  • Muscle relaxants or tranquilizers may help relieve spasticity in the legs, especially at night.
  • Over-the-counter pain relievers may help relieve muscle and back pain. Narcotic pain medications may be prescribed in some cases.
  • Anticonvulsant medications can help relieve facial pain and antidepressants may relieve nerve pain in other areas. Antidepressants or antianxiety medications can also reduce fatigue, pain and sexual dysfunction caused by depression. An antiviral medication may be used to treat fatigue.
  • Other medications can treat bladder spasms or incontinence. Catheterization is sometimes necessary.
  • The U.S. Food and Drug Administration (FDA) has approved several other medications to reduce the frequency of MS relapses and slow the progression of the disease. These are thought to work by altering the body's immune response that causes MS.

Finally, electrical stimulation may be used to relieve pain in areas other than the back and face.

If you have symptoms of multiple sclerosis, you should see your healthcare provider.

  • Before your appointment, make a list of your medical history, including past illnesses, surgeries and hospitalizations; your medications (including over-the-counter); and any questions or concerns you want to discuss.
  • During your appointment, ask about your overall health, what symptoms you might have, when you may start to see improvement; what the follow-up plans are, if any; and what symptoms you should report before your next appointment.
  • Ask if your symptoms can be controlled with medications? If so, are there Tier 1 or Tier 2 medications on my Prescription Drug List that I should take? How long will I need to take these medications? What are the side effects of my medications?
  • After your appointment, you should know your diagnosis, what tests you might need, the reason for those tests, and if the test results will change your treatment plan. You should also understand your treatment plan, any possible alternatives, and what medications are recommended (including possible side effects).


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Multiple Sclerosis - Office Visit
Multiple Sclerosis
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