Multiple sclerosis (MS) is an unpredictable disease of the nervous system in which communication between the brain and other parts of the body is disrupted. Its effects can range from relatively benign in most cases to somewhat disabling to devastating. The symptoms may mysteriously occur and then disappear. In the worst cases, a person with MS may be unable to write, speak, or walk. Approximately 350,000 Americans have MS.
During an MS attack, inflammation occurs in areas of the white matter (pale-colored nerve tissue) of the central nervous system in random patches called plaques. This is followed by destruction of myelin, the fatty covering that insulates nerve cell fibers in the brain and spinal cord. Myelin allows for the smooth, high-speed transmission of electrochemical messages between the brain, the spinal cord, and the rest of the body. When myelin is damaged, neurological transmission of messages may be slowed or blocked completely, resulting in diminished or lost function.
Signs and Symptoms
MS is accompanied by the following signs and symptoms.- Weakness in motor skills and loss of muscle coordination
- Tingling, numbness, dizziness
- Blurred vision
- Pain
- Heat sensitivity
- Loss of bladder control
- Memory loss, problem-solving difficulties
- Mood disturbances
What Causes It?
The cause of MS is unknown. Theories include a childhood virus that primes the immune system for an attack against myelin in early adulthood.Who's Most At Risk?
People with the following conditions or characteristics are at risk for developing MS.- First-degree relatives with MS
- Age between 20 and 40
- Living in the northern latitudes for the first 15 years of life
- North European, North American, or Scandinavian ancestry
- Immune response genes
What to Expect at Your Provider's Office
If you or someone you care for are experiencing symptoms associated with MS, you should see your health care provider. Your provider will take a history of clinical symptoms, check for neurological problems, and refer you for lab tests, such as a cerebrospinal fluid exam and agar gel electrophoresis, and imaging procedures, such as a computed tomography scan (CT scan) and magnetic resonance imaging (MRI).Treatment Options
Treatment Plan
The primary goal of a treatment plan is to reduce the severity of attacks through the use of certain medications and to extend the individual's physical functioning for as long as possible.Drug Therapies
Your provider may prescribe the following medications.- Steroids with anti-inflammatory properties to reduce severity of attacks
- Beta interferon to decrease myelin destruction, reduce frequency and severity of attacks, and slow progression of disease
- Immunotherapy, antigen-targeting, cytokines, and remyelination are experimental therapies that may alter the course of the disease
Surgical and Other Procedures
Surgery may be used to treat severe and disabling tremors or to reduce severe spasms.Complementary and Alternative Therapies
A comprehensive treatment plan for MS may include a range of complementary and alternative therapies.Nutrition
- Eat a diet high in protein and anti-inflammatory oils (nuts, seeds, and cold-water fish); orange, yellow, and dark green vegetables; whole grains in small amounts
- Avoid food allergens such as wheat, dairy, eggs, soy, citrus, tomatoes, corn, chocolate, fish, and peanuts—eliminate these foods, then reintroduce one at a time, watching for reactions. Many individuals with MS are sensitive to foods that contain gluten.
- Eliminate refined foods, alcohol, caffeine, saturated fats (animal products), and additives (MSG and aspartame)
- Omega-6 oils (borage, evening primrose, black currant oils) 1,500 mg two to three times per day. Include zinc (30 mg per day) and selenium (200 mcg per day).
- B-complex vitamins, especially B12 (1,000 mcg per day) and B6 (100 mg per day), and minerals, such as calcium (1,000 mg per day) and magnesium (500 mg per day)
- Vitamin C (250 to 500 mg twice per day), vitamin E (400 IU per day), and coenzyme Q10 (100 mg twice a day)
Herbal remedies may offer relief from symptoms. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp per cup of water steeped for 10 minutes (roots need 20 minutes).
Use one to two of the following: hawthorn (Crataegus monogyna) 200 mg two to three times per day, ginkgo (Ginkgo biloba) 120 mg two times per day standardized extract, especially with cognitive impairment, quercetin (100 to 250 mg three times per day), especially with food sensitivities.
Combine the following herbs in equal parts to nourish the nervous system and prevent constipation: oatstraw (Avena sativa), skullcap (Scutellaria laterifolia), lavender (Lavendula angustifolia), lemon balm (Melissa officinalis), passionflower (Passiflora incarnata), and horsetail (Equisetum arvense). Drink two to three cups tea daily or take 30 to 60 drops tincture twice a day.
Homeopathy
Combination remedies may be used for fatigue, spasm, and to help rid the body of impurities.
Acupuncture
Acupuncture may be used to alleviate symptoms.
Massage
Massage is important for maintaining flexibility and reducing spasticity, as well as improving the overall sense of well-being.
Prognosis/Possible Complications
About 70 percent of patients experience attacks and remissions, and about half of these undergo a chronic, progressive worsening after about 10 years. Ten to fifteen percent of patients experience a chronic, progressive worsening of the disease from the initial onset. Fifteen to twenty percent of patients follow a benign course. Most MS patients live for 30 years or more, many still working and mobile.Following Up
Patients need lifelong monitoring, especially during flare-ups.References
Adams RD, Victor M. Principles of Neurology. 6th ed. New York, NY: McGraw-Hill; 1997: 902–921.
Amitriptyline. NMIHI. Accessed at http://www.nmihi.com/a/amitriptyline.html on November 29, 2018.
Baclofen. NMIHI. Accessed at http://www.nmihi.com/b/baclofen.html on November 29, 2018.
Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers;1995:299-300.
Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.
Fauci AS, et al. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1997: 2409–2419.
Gabapentin. NMIHI. Accessed at http://www.nmihi.com/f/gabapentin.html on November 29, 2018.
JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.
Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.
Kelley WN, et al. Textbook of Internal Medicine. 3rd ed. Vol 2. Philadelphia, PA: Lippincott-Raven; 1997: 2385–2387.
Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.
Multiple Sclerosis. NMIHI. Accessed at http://www.nmihi.com/m/multiple-sclerosis.htm on November 29, 2018.
Multiple Sclerosis. NIH. Accessed at https://nccih.nih.gov/health/multiple-sclerosis on November 29, 2018.
Multiple Sclerosis. MedlinePlus. Accessed at https://medlineplus.gov/multiplesclerosis.html on November 29, 2018.
Multiple sclerosis. Symptoms and causes. MFMER. Accessed at https://www.mayoclinic.org/ on November 29, 2018.
Scalzo R. Naturopathic Handbook of Herbal Formulas. 2nd ed. Durango, Colo: Kivaki Press; 1994: 63.
Taylor RB, et al. Family Medicine: Principles and Practice. 5th ed. Berlin, Germany: Springer; 1998: 589–591.
Rosen P, Barkin R, et al. Emergency Medicine: Concepts and Clinical Practice. Vol 3. St. Louis, MO: Mosby; 1998: 2219–2221.
Conn RB. Current Diagnosis. Philadelphia, PA: Saunders; 1991: 988–991.
Branch WT. Office Practice of Medicine. 3rd ed. Philadelphia, PA: Saunders;1994: 721, 766–767.