What is multiple sclerosis?

MS is a chronic disease of the central nervous system, which is made up of the brain and spinal cord. MS is unpredictable and can range from benign to disabling. Some people with MS may be mildly affected. Others may lose the ability to write, speak, or walk.

What causes multiple sclerosis?

Many things may cause MS, including viruses, autoimmune disorders, environmental factors, and genetic factors. But, all of the possible causes share the common feature that the body's immune system attacks its own nervous tissue. In MS, the immune system attacks the layer of protein called myelin that surrounds the nerve fibers in the central nervous system. Myelin insulates the electrical signals the nervous system uses to communicate. When this insulation is destroyed, communication is interrupted. Parts of the nervous system become permanently damaged.

What are the symptoms of multiple sclerosis?

Symptoms of MS are erratic. They may be mild or severe, and of long duration or short. They may appear in various combinations, depending on the area of the nervous system affected. Throughout the course of the illness, you may have any or all of these symptoms:

• Muscle weakness in the arms and legs

• Trouble with coordination

• Impaired walking or standing

• Partial or complete paralysis

• Spasticity (involuntary increased tone of muscles leading to stiffness and spasms)

• Fatigue (may be triggered by physical activity, may ease with rest, or may be constant and persistent)

• Loss of sensation, tingling or numbness

• Speech difficulties

• Tremor

• Dizziness

• Hearing loss

• Loss of vision or changes in vision

• Loss of bowel and bladder control

• Sexual dysfunction

• Pain

• Emotional changes

• Changes in reflexes

MS may also cause cognitive effects. The effects may be mild, often found only after thorough testing. They may include problems with:

• Concentration

• Attention

• Memory

• Judgment

The symptoms of multiple sclerosis may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

How is multiple sclerosis diagnosed?

Your healthcare provider will do a thorough medical history and a physical exam as the first steps toward diagnosis of MS. You will be asked about all of your symptoms, how often they occur, and how long they last.

You will likely have an MRI (magnetic resonance imaging). This test can detect the unique scars in the central nervous system.

In some cases, you may need lab tests or a lumbar puncture to confirm the diagnosis.

How is multiple sclerosis treated?

There is no cure for multiple sclerosis, however there are disease-modifying therapies available that can slow the progression of the disease and improve symptoms. These include:

• Beta-interferons

• Glatirimer acetate

• Monoclonal antibodies

• Dimethyl fumarate

• Fingolimod

There are also treatments to help manage symptoms, treat flare-ups or relapses, improve your function and safety, and provide much needed emotional support.

Rehabilitation therapies, including physical therapy, occupational therapy, speech and swallowing assistance, cognitive therapy, or the use of assistive devices like splints may also be helpful.

Living with multiple sclerosis while pregnant

Fortunately, pregnancy does not appear to speed up the course or worsen the effects of MS. However, if you have unrecognized MS you may be more likely to start having symptoms during pregnancy. Some studies have found that MS symptoms decrease in pregnancy and increase after delivery.

The disabling effects of the disease may make it physically hard to carry a pregnancy. Muscle weakness and coordination problems may increase the likelihood for falls. Fatigue may worsen. Wheelchair dependence may increase the risk for urinary tract infections. There is no evidence that MS causes infertility. Studies have shown that pregnancy, delivery, and rate of birth defects are not significantly different in women with MS compared with those without MS.

During pregnancy, you will need close monitoring to keep track of the disease and the health of the fetus. You may need more frequent prenatal visits. There is no established treatment that alters the course of MS. But, you may be given medicines such as steroids and anti-inflammatory drugs. A procedure called plasmapheresis (a method for removing toxic elements from the blood) has been used in trials for treatment of MS. Consult your doctor for more information.

Supportive treatment and rehabilitation for MS are especially important during pregnancy. Rehabilitation varies depending on your symptoms but may help with the following:

• Doing normal activities of daily living (ADLs)

• Maintaining independence

• Getting family involved

• Using assistive devices (for example, canes, braces, and walkers)

• Setting an appropriate exercise program to promote muscle strength, endurance, and control

• Re-establishing motor skills

• Improving communication skills if you have trouble speaking because of weakness or lack of coordination of face and tongue muscles

• Managing bowel or bladder incontinence

• Providing cognitive retraining

• Adapting the home environment for safety and usability

During labor, you may not have pelvic sensation, and may not feel pain with contractions. This may also make it hard to tell when labor starts. Delivery of the baby may be more difficult if you have MS. While labor itself is not affected, MS can affect the muscles and nerves needed for pushing. For this reason, you may need Cesarean delivery, or delivery with the help of forceps or vacuum.

When should I call my healthcare provider?

Call the doctor if you have several of the classic symptoms of MS so that treatment can begin right away.

If you have MS and want to get pregnant, discuss the benefits and risks of a pregnancy with your MS specialist before becoming pregnant.

If you are pregnant and having the symptoms of MS, tell your doctor as soon as possible.

If you have MS and you are pregnant, let you doctor know as soon as possible.

Key points about multiple sclerosis during pregnancy

• Although not usually curable, there are many ways to help slow the progression of MS and manage symptoms.

• With MS, you may have long periods of remission of your symptoms.

• Pregnancy is not ruled out just because you have MS. Pregnancy doesn't seem to speed up or worsen MS.

• MS can make carrying a pregnancy harder and may make labor and delivery more difficult.