Multiple sclerosis - أ.د.عمرو حسن الحسني أستاذ المخ و الأعصاب

What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is an autoimmune disease. With these conditions, your immune system mistakenly attacks healthy cells. In people with MS, the immune system attacks cells in the myelin, the protective sheath that surrounds nerves in the brain and spinal cord.

Damage to the myelin sheath interrupts nerve signals from your brain to other parts of your body. The damage can lead to symptoms affecting your brain, spinal cord and eyes.

There are four types of multiple sclerosis:

Clinically isolated syndrome (CIS): When someone has a first episode of MS symptoms, healthcare providers often categorize it as CIS. Not everyone who has CIS goes on to develop multiple sclerosis.
Relapsing-remitting MS (RRMS): This is the most common form of multiple sclerosis. People with RRMS have flare-ups -- also called relapse or exacerbation -- of new or worsening symptoms. Periods of remission follow (when symptoms stabilize or go away).
Primary progressive MS (PPMS): People diagnosed with PPMS have symptoms that slowly and gradually worsen without any periods of relapse or remission.
Secondary progressive MS (SPMS): In many cases, people originally diagnosed with RRMS eventually progress to SPMS. With secondary-progressive multiple sclerosis, you continue to accumulate nerve damage. Your symptoms progressively worsen. While you may still experience some relapses or flares (when symptoms increase), you no longer have periods of remission afterward (when symptoms stabilize or go away).

How common is multiple sclerosis (MS)?

Nearly 1 million adults in the U.S. are living with multiple sclerosis. MS commonly affects more women than men. Most people with MS receive a diagnosis between the ages of 20 and 40.
Symptoms and Causes
What causes multiple sclerosis (MS)?

Experts still don’t know for sure what causes multiple sclerosis. Research is ongoing to help identify what causes the disease. Factors that may trigger MS include:

Exposure to certain viruses or bacteria: Some research suggests that being exposed to certain infections (such as Epstein-Barr virus) can trigger MS later in life.
Where you live: Your environment may play a role in your risk for developing MS. Certain parts of the world have significantly higher rates of the disease than others. Areas farther from the equator have higher rates of MS. That may be because these regions receive less intense sun. People who get less sun have lower levels of vitamin D, a risk factor for developing MS.
How your immune system functions: Multiple sclerosis is an autoimmune disease. Researchers are working to figure out what causes some people’s immune cells to mistakenly attack healthy cells.
Gene mutations: Having a family member with MS does increase your risk of the disease. But it’s still unclear exactly how and which genes play a role in triggering multiple sclerosis.

What are the symptoms of multiple sclerosis?

Vision problems — such as optic neuritis (blurriness and pain in one eye) — are often one of the first signs of multiple sclerosis. Other common symptoms include:

Changes in gait.
Fatigue.
Loss of balance or coordination.
Muscle spasms.
Muscle weakness.
Tingling or numbness, especially in your legs or arms.

What are the complications of multiple sclerosis?

If MS progresses, worsening symptoms may lead to complications such as:

Difficulty walking that may result in needing a cane, walker or wheelchair.
Loss of bowel or bladder control.
Memory problems.
Sexual difficulties.

Diagnosis and Tests
Who diagnoses multiple sclerosis (MS)?


If your primary care provider suspects you may have MS, you will need to see a neurologist. A neurologist is a doctor who specializes in treating conditions that affect the nervous system, which includes your brain and spinal cord.
How is multiple sclerosis diagnosed?

No one test can provide a definitive MS diagnosis. To understand what’s causing symptoms, your healthcare provider will do a physical exam. You may also have blood tests and imaging tests, such as MRI. An MRI looks for evidence of lesions (areas of damage) in the brain or spinal cord that indicate multiple sclerosis. Lesions develop as a result of damage to the myelin sheath surrounding the nerves. A spinal tap (lumbar puncture) may also need to be done.

If these tests don’t provide a clear answer, your neurologist may recommend an evoked potentials test. This test checks your nerve function by measuring electrical activity in the brain and spinal cord.

Management and Treatment
How is multiple sclerosis (MS) managed or treated?

Disease-modifying therapies (DMTs): Several medications have FDA approval for long-term MS treatment.
Relapse management medications: If you have a severe attack, your neurologist may recommend a high dose of corticosteroids.
Physical rehabilitation: