Disease Overview
Synonyms
Subdivisions
Signs & Symptoms
Causes
Affected Populations
Disorders with Similar Symptoms
Diagnosis
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Multiple Sclerosis

This condition does not meet the definition of a rare disease in the U.S. (fewer than 200,000 Americans). There may be forms of this condition that are rare.

Last updated: 10/7/2024
Years published: 1984, 1985, 1986, 1987, 1988, 1989, 1990, 1991, 1992, 1993, 1994, 1995, 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2017, 2024

Acknowledgment

NORD gratefully acknowledges Gioconda Alyea, MD (FMG), MS, National Organization for Rare Disorders and Robert P Lisak, MD, FRCP (E), FAAN, FANA, Parker Webber Chair in Neurology, Professor of Neurology, Professor of Immunology/ Microbiology/Biochemistry, Wayne State University School of Medicine; June Halper, MSN, APN-C, MSCN, FAAN, Chief Executive Officer, Consortium of Multiple Sclerosis Centers; and the Multiple Sclerosis Coalition, for their assistance in the preparation of this report.

Disease Overview

Summary

Multiple sclerosis (MS) is a chronic autoimmune disease where the body’s immune system mistakenly attacks healthy cells, particularly the myelin in the central nervous system (CNS). Myelin is a protective sheath surrounding nerve fibers (axons) that helps transmit electrical signals between the brain, spinal cord, and the rest of the body. In MS, the immune system damages the myelin, causing inflammation and scarring, which disrupts nerve signals and leads to a variety of symptoms. Over time, MS can also damage the nerve fibers themselves, leading to permanent disability.

MS symptoms vary widely depending on which parts of the CNS are affected. Some common early symptoms include vision problems, such as double vision or optic neuritis (pain and vision loss due to optic nerve inflammation), muscle weakness or stiffness, particularly in the arms and legs, which may be accompanied by painful spasms, numbness, tingling, or pain in different parts of the body, clumsiness or difficulty walking and bladder problems and episodes of dizziness.

Other possible symptoms include fatigue, mood changes, cognitive issues (such as memory problems or difficulty concentrating) and pain, especially in the limbs or face. Some people may develop severe muscle stiffness, leading to difficulty walking or paralysis. Symptoms can worsen after heat exposure, infections or fever.

MS typically begins between the ages of 20 and 40 and affects people in different ways. Some may experience mild symptoms with minimal disability, while others might have more severe symptoms that worsen over time, leading to increased disability.

MS progresses differently for everyone, and doctors categorize the disease into different types based on how it develops:

Clinically isolated syndrome (CIS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS)
Primary progressive MS (PPMS)

MS is not a genetic disorder with a predictable inheritance pattern, but having a parent or sibling with MS increases the risk.

There is no single test to diagnose MS. Instead, doctors rely on a combination of clinical history, neurological exams and several diagnostic tests to confirm the diagnosis or rule out other conditions.

There is no cure for MS, but treatments can help manage symptoms, reduce the frequency of attacks and slow disease progression.

Introduction

Acute disseminated encephalomyelitis (ADEM), Baló concentric sclerosis, Marburg variant of multiple sclerosis, neuromyelitis optica spectrum disorder (NMOSD), pediatric multiple sclerosis (PMS), and Schilder disease are all conditions that historically have been associated with or confused with multiple sclerosis (MS) due to similarities in clinical presentation, pathology and imaging. However, recent advances in understanding these diseases have clarified their distinctions and led to more precise classifications.

Acute disseminated encephalomyelitis (ADEM) is considered to be distinct from MS.
Baló concentric sclerosis (BCS) is considered a rare variant of MS, part of the tumefactive MS spectrum.
Marburg variant MS is a fulminant, aggressive form of MS.
Neuromyelitis optica spectrum disorder (NMOSD) is considered a separate disease from MS with different immunopathology and treatment.
Pediatric multiple sclerosis (PMS) is a form of MS occurring in children, with distinct clinical features and considered a rare disease.

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Synonyms

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Subdivisions

relapsing remitting MS
secondary-progressive MS
primary progressive MS
clinical isolated syndrome
radiologically isolated syndrome
tumefactive MS
pediatric MS

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Signs & Symptoms

Multiple sclerosis (MS) is a chronic neurological disorder where the immune system mistakenly attacks healthy cells in the central nervous system (CNS), causing damage to the protective covering (myelin) of nerve fibers. The symptoms and progression of MS can vary widely from person to person, and it can be classified into different types based on how the disease progresses.

The symptoms of MS depend on where and how severe the damage to the myelin and nerves is. Common symptoms include:

Vision problems: Double vision (diplopia), central vision loss, or involuntary eye movements (nystagmus)
Speech difficulties: Slurred or slow speech
Numbness or tingling: Often in the limbs or face
Muscle weakness and stiffness: Difficulty walking, coordination problems and painful muscle spasms
Bladder and bowel dysfunction: Issues with controlling urination or bowel movements
Sexual dysfunction: Decreased sexual function and sensitivity
Fatigue: Extreme tiredness that does not go away with rest
Cognitive problems: Difficulty with thinking, memory or concentration
Tremors: Shaking in the limbs
Balance issues: Trouble staying steady when standing or walking
Lhermitte’s sign (an electric shock-like sensation down the spine)

While MS is rarely fatal, some people may need to use assistive devices like a cane, crutches or a wheelchair. A small number of patients may develop life-threatening complications due to the disease.

MS is categorized into different types based on how the disease progresses and how often new symptoms or attacks appear:

Relapsing-Remitting MS (RRMS), the most common form, accounts for about 85% of MS cases at onset.

Characterized by discrete attacks (also called relapses) followed by periods of partial or full recovery (remissions)
During remission, the disease is stable, but over time, the ability to fully recover from relapses decreases
New MRI lesions may be seen during relapses and many RRMS cases eventually progress to secondary progressive MS (SPMS)

Secondary-Progressive MS (SPMS) develops from RRMS over time, usually within 10 to 25 years.

Marked by gradual worsening of symptoms and increasing disability, even in the absence of relapses
Although there may still be some periods of remission or minor improvements, the disease steadily progresses
Approximately 50% of people with RRMS transition to SPMS within 10 years and up to 90% transition within 25 years

Primary-Progressive MS (PPMS), accounts for about 15% of MS cases.

Involves a steady worsening of symptoms from the beginning, without clear relapses or remissions
There may be occasional plateaus or minor improvements, but overall, the disease continues to progress
PPMS typically starts later in life (around age 40) and tends to affect mobility more quickly

Progressive-Relapsing MS (PRMS), a rare subtype, represents only about 5% of MS cases.

Like PPMS, it involves steady progression of disability but is distinguished by the presence of occasional relapses
People experience worsening symptoms with intermittent flare-ups similar to those in RRMS
Most cases are now considered part of primary progressive MS (PPMS), with occasional relapses

The following subgroups are sometimes included in RRMS:

Clinically isolated syndrome (CIS): A single episode of neurologic symptoms; not everyone with CIS will develop MS
Benign MS: MS with almost complete remission between relapses and little if any accumulation of physical disability over time

In addition, radiologically isolated syndrome (RIS) where MRI scans show brain lesions typical of MS, but the patient has no symptoms.

Some people with RIS may go on to develop CIS or another form of MS, but not everyone will develop clinical symptoms.

Acute disseminated encephalomyelitis (ADEM) is not considered a form of multiple sclerosis but rather a distinct entity under monophasic inflammatory demyelinating diseases. It typically presents as a one-time event, often following infections or vaccinations, with widespread inflammation and demyelination in the brain and spinal cord.
Baló concentric sclerosis (BCS) is currently classified as a rare variant of multiple sclerosis, specifically under tumefactive MS, which refers to a subtype of MS with large, tumor-like lesions, characterized by concentric rings of demyelination and preserved myelin. BCS shares clinical features with MS, such as relapsing-remitting or progressive neurological symptoms. Some patients with BCS can develop classic MS, while others have a more acute, severe disease course.
Marburg variant of multiple sclerosis is classified as a fulminant form of multiple sclerosis, representing a highly aggressive and acute form of the disease. It often leads to rapid and widespread neurological decline and can be fatal within months. Marburg MS has features of acute MS, with rapid, severe progression and extensive demyelination, contrasting with the slower progression typical of relapsing-remitting or secondary progressive MS. It is considered part of the multiple sclerosis spectrum, although rare.
Neuromyelitis optica spectrum disorder (NMOSD) was once considered a variant of MS due to overlapping symptoms, such as optic neuritis and transverse myelitis but has been reclassified as a distinct autoimmune disease separate from multiple sclerosis. It is caused by antibodies (usually anti-aquaporin-4 or AQP4-IgG) that target astrocytes, leading to inflammation of the optic nerves and spinal cord.
Pediatric multiple sclerosis (PMS) is classified under multiple sclerosis, with children and adolescents experiencing the same subtypes (relapsing-remitting, secondary progressive, etc.) as adults. However, it is treated as a distinct age-related form of MS due to differences in disease onset and progression. It often has more severe relapses and slower progression in the early stages. Cognitive impairments are more common in pediatric patients due to the impact of MS on the developing brain.
Schilder Disease (diffuse myelinoclastic sclerosis) is now regarded as a rare variant of multiple sclerosis. It is typically considered a form of tumefactive MS and affects children and young adults, presenting with large, plaque-like demyelination areas in the brain. Schilder disease shares some features with classic MS, such as demyelination and neurological deficits, but the large, diffuse lesions seen in Schilder disease are atypical for conventional MS. Patients may develop progressive MS later, though Schilder disease usually has a more severe early course.

While these conditions share some features with MS, recent advances in immunology, genetics and imaging have allowed clearer distinctions, leading to more accurate diagnoses and tailored treatments for each condition.

The National Multiple Sclerosis Society (NMSS) has detailed information about the MS symptoms.

Although MS can cause significant disability, it is rarely fatal. The average life expectancy of people with MS is 93% of the general population, meaning most people with MS can live a normal life span. Early diagnosis and treatment can help manage symptoms and delay the progression of the disease. Complications such as severe infections or difficulty swallowing (dysphagia) can lead to life-threatening situations.

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Causes

The exact cause of multiple sclerosis (MS) remains unknown, but current research points to a combination of genetic susceptibility and environmental triggers that lead to the disease.

Many researchers agree that MS is likely an autoimmune disorder, meaning the body’s immune system mistakenly attacks healthy tissue. In MS, this attack targets myelin, the protective covering around nerve fibers, disrupting communication between the brain and the rest of the body. The immune system’s components, like antibodies and inflammatory cells (including lymphocytes and macrophages), play a role in this damaging process.

People with MS may have a genetic predisposition that increases their likelihood of developing the disease. However, genetic factors alone are not enough to cause MS. For example:

The concordance rate (probability that both twins develop the disease) for MS in identical twins is only 20%–35%, which shows that genetics play a moderate role.
Having a first-degree relative (such as a parent or sibling) with MS increases a person’s risk by 7-fold, though the lifetime risk remains relatively low at around 2.5–5%.
Several genes have been linked to MS susceptibility, particularly those in the major histocompatibility complex (MHC). A key gene involved is HLA-DRB1, which has consistently been associated with increased MS risk. Other genes may act together to increase this susceptibility.

Researchers believe that environmental factors play a crucial role in triggering MS in genetically predisposed individuals. Key environmental factors include:

Epstein-Barr Virus (EBV): One of the strongest viral associations with MS is EBV, the virus responsible for mononucleosis. Studies show a higher risk of MS in individuals who had a severe EBV infection during adolescence or early adulthood. However, it’s unclear if EBV directly causes MS or merely triggers it in those already predisposed.
Vitamin D deficiency: Low levels of vitamin D, which is essential for regulating the immune system, have been linked to a higher risk of MS. This could explain why MS is more common in regions further from the equator, where there is less sunlight exposure and lower natural production of vitamin D.
Smoking: Smoking is a known risk factor for developing MS and is associated with a more aggressive disease course. Smokers tend to have more brain lesions and faster disease progression compared to non-smokers.

There is an ongoing investigation into whether infections or bacteria might contribute to MS. While EBV is the most strongly linked virus, some studies have also suggested that Chlamydia pneumoniae, the bacterium responsible for walking pneumonia, may be involved. However, these findings are controversial and have not been consistently replicated.

One hypothesis is molecular mimicry, where the immune system attacks a foreign invader (like a virus or bacteria) but then mistakenly targets the body’s own tissues, such as myelin, because they share similar features. This theory is supported by the observation that T-cells, a type of immune cell, mistakenly attack myelin in MS.

Despite concerns raised over the years, there is no evidence linking vaccines to the development or worsening of MS. Studies, including two large ones reported in 2001, found no connection between vaccines and MS.

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Affected populations

The number of people with MS has been estimated to be between 300,000 and 500,000 in the US and 2.5 million people worldwide. However, this may be an underestimate because these figures are based on data collected in the 1970’s, prior to the use of MRI for diagnosis. In 2010, a higher 10-year prevalence estimate was 309.2 per 100,000 population, representing 727,344 adults affected by MS in United States. The Centers for Disease Control and Prevention (CDC) developed the National Neurological Conditions Surveillance System (NNCSS) which currently includes multiple sclerosis.

Twice as many females as males are affected. The disorder may appear at any age, although the diagnosis is most often made between 20 and 50 years of age.

Multiple sclerosis is more common in Caucasian Americans than in Americans of African or Asian heritage, although the disease is not rare in African Americans. In a few ethnic societies (Inuits, Bantus and American Indians), multiple sclerosis is rare or absent. This may hint at a genetic link to this disorder. Multiple sclerosis seems to occur more often in the moderate regions (temperate climates).

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Disorders with Similar Symptoms

Symptoms of the following disorders can be similar to those of multiple sclerosis. Comparisons may be useful for a differential diagnosis:

Amyotrophic lateral sclerosis (ALS) is a disease of the motor neurons that send signals to the skeletal muscles. It generally affects both the upper and the lower muscle groups and results in progressive weakness and wasting away of the muscles involved. There are several varieties of ALS. The early symptoms may include slight muscular weakness, clumsy hand movements and difficulty performing fine motor tasks. Weakness in the legs may result in clumsiness and tripping and slurring of speech, difficulty swallowing and shortness of breath may also be present. Other symptoms may include muscle stiffness with increased reflexes (not seen in MS) and coughing. Sensory and autonomic problems are not part of ALS among several distinguishing features differing from MS. Sensory and autonomic systems are typically not involved in ALS, which is a key differential factor from MS.

Charcot-Marie-Tooth disease (CMT disease) is a hereditary neurological disorder characterized by muscle weakness and atrophy, primarily in the muscles of the legs. Symptoms of type I CMT disease usually begin in middle childhood or teenage years with a deformity of the foot characterized by a high arch and hyperextension of the toes. With time, CMT disease spreads to the upper extremities and produces a “stocking-glove” pattern of diminished sensitivity. There is a decrease in the sensitivity to vibration, pain and temperature. Ultimately it is the secondary changes in the axons that result in permanent disability. CMT involves peripheral neuropathy and is characterized by demyelination or axonal loss of peripheral nerves, distinguishing it from the central nervous system (CNS) demyelination in MS.

Dejerine-Sottas disease is a rare progressive hereditary disorder that causes the enlargement of the peripheral nerves and the loss of myelin. This results in a burning or tingling sensation in the limbs, generalized muscle weakness and the loss of coordination in the hands and forearms. Weakness in the back of the legs eventually spreads to the front of the legs resulting in difficulty and pain when walking. Mild vision problems may also be present. It involves progressive peripheral nerve damage, further differentiating it from MS, which is a CNS disorder.

Friedreich’s ataxia is a progressive hereditary disorder that affects the neuromuscular system. It is generally diagnosed in childhood or adolescence. There are slow degenerative changes of the spinal cord and the brain that affect speech and motor coordination. These changes may produce an unsteady walk or numbness and weakness in the arms and legs. The legs generally become progressively weaker resulting in a staggering, lurching walk or trembling when standing still. The condition often involves cardiac abnormalities and diabetes mellitus, which are not associated with MS.

Guillain-Barre syndrome (GBS) is a rare rapidly progressive polyneuropathy. Although the exact cause is not known, a gastrointestinal virus or respiratory infection precedes the onset of the syndrome in almost half the cases. In the form most common in the US and western Europe the myelin sheath that covers the nerves is damaged and results in muscle weakness (acute inflammatory demyelinating polyneuropathy; AIDP). The symptoms may include a burning or tingling sensation in the feet followed by weakness of the legs. Eventually upper limbs and face may be affected as can breathing, swallowing, and speaking. Autonomic involvement occurs commonly as well. GBS is a peripheral nervous system disorder (PNS), while MS affects the CNS.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare disorder in which there is inflammation of the nerve roots and peripheral nerves and the destruction of the covering (myelin sheath) of the nerves. This causes weakness, paralysis and impairment of motor function especially in the limbs. Symptoms may include burning, numbness or tingling of the hands and feet or the arms and legs. Reflexes are reduced or absent, and the muscles of the face may become weak. Other symptoms may include difficulty in walking and respiratory problems. CIDP is a chronic peripheral neuropathy compared to MS, which affects the central nervous system.

Leukodystrophy is the name given to a group of very rare, progressive, metabolic, genetic diseases that affect the brain, spinal cord and often the peripheral nerves. Each of the leukodystrophies will affect one of the chemicals that make up the myelin sheath that covers the nerve fibers or it may affect the white matter of the brain. Most of the leukodystrophies are present at birth but some may appear more slowly over time and even into adulthood. Leukodystrophies cause the patient to have problems with movement, vision, hearing, feeling and thinking. This can result in difficulty walking, stiffness, a “floppy” feeling in the muscles, paralysis or convulsions. MRI findings are different from MS.

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Diagnosis

Multiple sclerosis (MS) is a clinical diagnosis because, while there are many laboratory tests, there is no one definitive test that firmly establishes the certainty of the disease; therefore, it is important that this diagnosis be made by an MS specialist.

Diagnosing multiple sclerosis (MS) is a complex process that involves gathering a combination of clinical, imaging and laboratory data. Because no single test can confirm MS on its own, doctors use a series of tests and evaluations to either rule out or support the diagnosis. These tests help distinguish MS from other conditions that can mimic its symptoms.

The diagnosis of MS typically begins with a complete medical history and a thorough physical and neurological examination. This helps doctors look for patterns of neurological deficits that are characteristic of MS. Key symptoms often include muscle weakness, vision problems, coordination issues and sensory changes that last for days to weeks. Importantly, these symptoms need to occur in different areas of the central nervous system (brain and spinal cord) at different times to meet the diagnostic criteria for MS.

Traditionally, MS could only be diagnosed after two or more attacks (episodes of neurological symptoms), showing that the disease was affecting multiple areas of the nervous system. However, with advancements in diagnostic tools, the 2017 Revised McDonald criteria now allow doctors to diagnose MS even after a single attack, provided certain clinical or laboratory findings are present.

To confirm MS and rule out other conditions, doctors may recommend several tests, including:

MRI scans: One of the most important tests in diagnosing MS is an MRI of the brain and spinal cord. This test uses powerful magnets and a contrast dye to look for areas of damage (lesions) caused by MS. These lesions appear in specific parts of the brain and spinal cord and are a key indicator of the disease.
Lumbar puncture (spinal tap): In some cases, doctors may perform a lumbar puncture to collect a sample of cerebrospinal fluid (CSF) and look for oligoclonal bands—proteins that are often elevated in people with MS. This test helps support the diagnosis, particularly in cases where the MRI findings are unclear or in the early stages of the disease.
Evoked potential tests: These tests measure the electrical activity in the brain in response to stimuli, such as visual or sensory signals. They help assess how well the nervous system is functioning and whether there is damage to the pathways involved, which can occur in MS.
Optic nerve tests: Tests like optic coherence tomography (OCT) or visual evoked potentials (VEP) may be recommended to detect damage to the optic nerves (which can cause vision problems). These tests are useful since optic neuritis (inflammation of the optic nerve) may be an early sign of MS.

The 2017 McDonald Criteria guide on how doctors diagnose MS. These criteria allow for early diagnosis after just one attack if there is supporting evidence from MRI or other tests, such as the presence of CSF oligoclonal bands:

Two or more attacks with evidence of lesions: If a person has had two or more distinct attacks and the MRI shows two or more lesions in different parts of the brain or spinal cord, a diagnosis of MS can be made.
One attack with evidence of multiple lesions: If a patient has only had one attack but has two or more lesions on MRI, this demonstrates dissemination in space—meaning the disease is affecting multiple areas of the CNS.
One attack with one lesion: If there is only one attack and one lesion, doctors look for dissemination in time, which can be demonstrated by a second clinical attack, a follow-up MRI showing new lesions, or the presence of oligoclonal bands in the CSF.
Primary progressive MS: In cases of primary progressive MS, where symptoms worsen progressively from the start, diagnosis requires at least one year of disease progression, combined with findings on MRI and CSF.

Many conditions can mimic MS, such as neuromyelitis optica spectrum disorder (NMOSD), acute disseminated encephalomyelitis (ADEM) and other autoimmune or infectious diseases. These disorders can present with similar symptoms, such as optic neuritis or spinal cord inflammation, but have distinct differences in MRI or laboratory findings.

The International Advisory Committee on Clinical Trials in MS has identified several red flags—symptoms or test results that suggest an alternative diagnosis to MS. For example, extensive spinal cord lesions or severe optic nerve damage may suggest NMOSD rather than MS.

MRI and lab tests play a key role in distinguishing MS from other central nervous system (CNS) inflammatory disorders. For instance, NMOSD is associated with aquaporin-4 antibodies, which are absent in MS. Additionally, other autoimmune disorders or genetic conditions might require specific testing beyond MRI and CSF analysis.

Early diagnosis is crucial because early intervention can significantly impact the course of MS. Studies have shown that starting treatment soon after the first attack can reduce the risk of further relapses and slow the progression of the disease. Medications like interferon and other disease-modifying therapies have been proven to lower the chance of long-term disability.

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Standard Therapies

Treatment can be divided into several categories that help manage attacks, reduce disease activity and treat specific symptoms.

During an acute MS attack, fast intervention is essential:

Corticosteroids: High-dose corticosteroids, such as methylprednisolone are often used to reduce inflammation in the brain and spinal cord. They help speed up recovery from an MS attack by preventing immune cells from entering the central nervous system (CNS) shortening the duration of attacks but do not alter the long-term course of the disease. Treatment typically involves:
- IV methylprednisolone: 500-1000 mg/day for 3-7 days
- Oral steroids: Alternatives like prednisone or methylprednisolone can be used at high doses
- Side effects: Potential side effects include stomach upset, insomnia, hypertension, and mood changes
Plasma exchange: For patients with severe, steroid-resistant attacks, plasma exchange (plasmapheresis) may be used. It involves removing and replacing plasma to clear out harmful antibodies, though this is a more expensive and less commonly used option.
- Plasma exchange is particularly useful in relapsing-remitting MS (RRMS) during acute exacerbations.

Disease-Modifying Therapies (DMTs)

DMTs aim to slow disease progression and reduce the frequency of relapses (primarily in relapsing forms of MS, like RRMS and SPMS).

Injectable medications: Traditionally, first-line treatments like interferon-beta (IFN-β) or glatiramer acetate have been used. These drugs help modulate the immune system and reduce inflammation.
Oral medications: Newer oral drugs, such as dimethyl fumarate, fingolimod and teriflunomide are now available. These medications are convenient and effective for many patients.
Infusion therapy: For more severe cases, natalizumab (Tysabri) and alemtuzumab (Lemtrada) are potent options. They are typically reserved for patients who don’t respond well to other treatments.

The choice of therapy depends on factors like disease severity and patient preferences (e.g., fear of needles). First-line therapies (IFN-β, glatiramer acetate) are often used for relapsing-remitting MS (RRMS), while second-line treatments (fingolimod, natalizumab, alemtuzumab) may be recommended for more aggressive disease or after failure of first-line treatments.

Multidisciplinary care (e.g., neurologist, physical therapist, occupational therapist and other specialists as needed) plays an important role in managing MS symptoms.

The National Multiple Sclerosis Society has information about the FDA-approved medication for treating MS, which includes patient assistance program information.

In addition, MS causes a range of symptoms that can be managed with specific medications and therapies:

Spasticity (muscle stiffness and spasms):
- First-line medications: baclofen or gabapentin
- Second-line medications: tizanidine or dantrolene
- Third-line medications: benzodiazepines, like clonazepam, are used if others don’t work.
Urinary symptoms: Frequent urination or incontinence can be treated with medications like oxybutynin and amitriptyline, or in severe cases, self-catheterization
Bowel Issues: a high-roughage diet and stool softeners are helpful for constipation and bowel irregularity
Erectile dysfunction: sildenafil (Viagra) or papaverine injections can improve erectile function in men
Cerebellar tremors: clonazepam may be prescribed for tremors caused by MS-related damage to the cerebellum
Neurogenic pain and depression: amitriptyline is effective for both nerve pain and mood disturbances
Fatigue: Amantadine: 100 mg taken twice daily helps approximately 40% of patients struggling with MS-related fatigue

While there are no current therapies that promote remyelination (repairing damaged myelin) or brain repair, promising new treatments are under development. These emerging strategies aim to restore nerve function and prevent further damage to the CNS.

The National Institute of Neurological Disorders and Stroke (NINDS), a component of the National Institutes of Health (NIH), is the leading federal funder of research on the brain and nervous system, including research on MS and have information about the latest updates in multiple sclerosis.

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Clinical Trials and Studies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: [email protected]

Some current clinical trials also are posted on the following page on the NORD website:
https://rarediseases.org/living-with-a-rare-disease/find-clinical-trials/

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

For information about clinical trials conducted in Europe, contact: https://www.clinicaltrialsregister.eu/

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References

TEXTBOOKS
Compston A and Coles A. Multiple Sclerosis. In Daroff RB, Jankovic J, Mazziotta JC and Pomeroy SL (eds.). Bradley’s Neurology in Clinical Practice (8th ed.). Elsevier, 2021.

Lisak, RP and Kira, J-I , Multiple Sclerosis. In Lisak, RP, Truong, DD, Carroll, WM, Bhidayasiri, R (eds). International Neurology. Chapter 89; pp 351-364, Wiley Blackwell, Oxford, UK, 2016.

Hopkins, SE, Hacohen, Y, Narula, S, Banwell, BL, Multiple Sclerosis in children. In, Lisak, RP, Truing, DD, Carroll, WM, Bhidayasiri, R (eds). International Neurology. Chapter 90, pp361-364, Wiley Blackwell, Oxford, UK, 2016.

Oh, J, Calabresi, PA. Disease Modifying Therapies in Relapsing Multiple Sclerosis. In: Rae-Grant, Fox & Bethoux Multiple Sclerosis and Related Disorders Clinical Guide to Diagnosis, Medical Management and Rehabilitation. New York: Demos Health, 2013.

JOURNAL ARTICLES
Haki M, Al-Biati HA, Al-Tameemi ZS, Ali IS, Al-Hussaniy HA. Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment. Medicine (Baltimore). 2024 Feb 23;103(8):e37297. doi: 10.1097/MD.0000000000037297.

Reich DS, Lucchinetti CF, Calabresi PA. Multiple Sclerosis. N Engl J Med. 2018 Jan 11;378(2):169-180. doi: 10.1056/NEJMra1401483.

Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, Correale J, Fazekas F, Filippi M, Freedman MS, Fujihara K, Galetta SL, Hartung HP, Kappos L, Lublin FD, Marrie RA, Miller AE, Miller DH, Montalban X, Mowry EM, Sorensen PS, Tintoré M, Traboulsee AL, Trojano M, Uitdehaag BMJ, Vukusic S, Waubant E, Weinshenker BG, Reingold SC, Cohen JA. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018 Feb;17(2):162-173. doi: 10.1016/S1474-4422(17)30470-2.

Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, de Seze J, Fujihara K, Greenberg B, Jacob A, Jarius S, Lana-Peixoto M, Levy M, Simon JH, Tenembaum S, Traboulsee AL, Waters P, Wellik KE, Weinshenker BG; International Panel for NMO Diagnosis. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015 Jul 14;85(2):177-89. doi: 10.1212/WNL.0000000000001729.

Cross AH, Naismith RT. Established and novel disease-modifying treatments in multiple sclerosis. J Intern Med. 2014;275(4):350-363. https://www.ncbi.nlm.nih.gov/pubmed/24444048

Fragoso YD, Adoni T, Anacleto A, et al. Recommendations on diagnosis and treatment of depression in patients with multiple sclerosis. Pract Neurol. 2014;14(4):206-209. https://www.ncbi.nlm.nih.gov/pubmed/24501169

Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83(3):278-286. https://www.ncbi.nlm.nih.gov/pubmed/24871874

Achiron A, Chapman J, Magalashvili D, et al. Modeling of cognitive impairment by disease duration in multiple sclerosis: a cross-sectional study. PloS One. 2013;8(8):e71058. https://www.ncbi.nlm.nih.gov/pubmed/23936485

Menon S, Shirani A, Zhao Y, et al. Characterising aggressive multiple sclerosis. J Neurol Neurosurg Psychiatry. 2013;84(11):1192-1198. https://www.ncbi.nlm.nih.gov/pubmed/23744892

Giesser BS. Diagnosis of multiple sclerosis. Neurol Clin. 2011;29(2):381-388. https://www.ncbi.nlm.nih.gov/pubmed/21439447

Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria. Ann Neurol. 2011 Feb; 69(2):292–302. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084507/

Sormani MP, Li DK, Bruzzi P, et al. Combined MRI lesions and relapses as a surrogate for disability in multiple sclerosis. Neurology. 2011;77(18):1684-1690. https://www.ncbi.nlm.nih.gov/pubmed/21975200

Tarrants M, Oleen-Burkey M, Castelli-Haley J, Lage MJ. The impact of comorbid depression on adherence to therapy for multiple sclerosis. Mult Scler Int. 2011;2011:271321. https://www.hindawi.com/journals/msi/2011/271321/

Gold R, Wolinsky JS, Amato MP, Comi G. Evolving expectations around early management of multiple sclerosis. Ther Adv Neurol Disord. 2010;3(6):351-367. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002639/

Patti F. Optimizing the benefit of multiple sclerosis therapy: the importance of treatment adherence. Patient Prefer Adherence. 2010;4:1-9.https://www.ncbi.nlm.nih.gov/pubmed/20165593

Langdon D, Benedict R, Wicklein EM, Fredrikson S. Report of Cognitive Difficulties by Clinically Isolated Syndrome Patients and Careers: The Multiple Sclerosis Neuropsychological Questionnaire Data from the CogniCIS Baseline Cohort; Abstract P406. Dusseldorf: 25th Congress of the European Committee for the Treatment and Research in Multiple Sclerosis (ECTRIMS); 2009.

Tremlett H, Yousefi M, Devonshire V, Rieckmann P, Zhao Y, UBC Neurologists. Impact of multiple sclerosis relapses on progression diminishes with time. Neurology. 2009;73(20):1616-1623. https://www.ncbi.nlm.nih.gov/pubmed/19890070

Amato MP, Goretti B, Ghezzi A, et al. Cognitive and psychosocial features of childhood and juvenile MS. Neurology. 2008;70(20):1891-1897. https://www.ncbi.nlm.nih.gov/pubmed/18474844

Kalb R. The emotional and psychological impact of multiple sclerosis relapses. J Neurol Sci. 2007;256 Suppl 1:S29-S33. https://www.ncbi.nlm.nih.gov/pubmed/17350045

INTERNET
Online Mendelian Inheritance in Man (OMIM). The Johns Hopkins University. Multiple Sclerosis, Susceptibility to; MS. Entry No: 126200. Last Edited 09/01/2022. Available at: https://omim.org/entry/126200 Accessed Oct 3, 2024.

Common Questions. Multiple Sclerosis Foundation. Reviewed: November 2016. Available at: https://msfocus.org/Get-Educated/Common-Questions Accessed Oct 3, 2024.

Tumefactive multiple sclerosis. Genetic and Rare Diseases Information Center. Last updated: 5/18/2016. https://rarediseases.info.nih.gov/diseases/5885/tumefactive-multiple-sclerosis. Accessed Oct 3, 2024.

Rutatangwa AK. Pediatric Multiple Sclerosis. Medscape. Updated: Jan 03, 2022. https://emedicine.medscape.com/article/2091406-overview. Accessed Oct 3, 2024.

International Pediatric MS Study Group https://www.ipmssg.org/home.html Accessed Oct 7, 2024.

Luzzio C. Multiple Sclerosis. Medscape Reference. Mar 12, 2024. https://emedicine.medscape.com/article/1146199-overview Accessed Oct 7, 2024.

Types of MS. National Multiple Sclerosis Society (NMSS). 2024. https://www.nationalmssociety.org/understanding-ms/what-is-ms/types-of-ms Accessed Oct 7, 2024.

Multiple Sclerosis. National Institute of Neurological Disorders and Stroke (NINDS). September 19, 2024. https://www.ninds.nih.gov/health-information/disorders/multiple-sclerosis Accessed Oct 7, 2024.

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Programs & Resources

RareCare^® Assistance Programs

NORD strives to open new assistance programs as funding allows. If we don’t have a program for you now, please continue to check back with us.

Additional Assistance Programs

MedicAlert Assistance Program

NORD and MedicAlert Foundation have teamed up on a new program to provide protection to rare disease patients in emergency situations.

Learn more https://rarediseases.org/patient-assistance-programs/medicalert-assistance-program/

Rare Disease Educational Support Program

Ensuring that patients and caregivers are armed with the tools they need to live their best lives while managing their rare condition is a vital part of NORD’s mission.

Learn more https://rarediseases.org/patient-assistance-programs/rare-disease-educational-support/