Multiple sclerosis (MS) is a complex and puzzling disease. Because each person is affected differently, it can be difficult to diagnose. Northwestern Medicine Neurologist Edith L. Graham, MD , answers the most frequently asked questions and discusses the active research being conducted in the field.

What Causes MS

MS is a disease in which the immune system attacks myelin, which is the protective coating of nerves in the brain and spinal cord. This disrupts nerve signals within the brain and to the body. Because each person is affected differently by the disease, it is often mistaken for other health issues.

There are different types of MS:

• Relapsing-remitting MS, the most common type, is characterized by isolated episodes (sometimes called “attacks”) followed by periods of time where there is partial or complete recovery.
• Primary-progressive MS is a progressive worsening of symptoms over time, with no periods of recovery.
• Secondary-progressive MS occurs in some patients who have had relapsing-remitting MS for many years. Relapses become less common and instead patients experience progressive worsening over time without periods of recovery.

Although there is a genetic component, experts believe that MS is mostly caused by environmental factors. Viruses, gut bacteria, vitamin D deficiency, a lack of sunlight exposure, and smoking all seem to play important roles.

While it is more commonly diagnosed in women between the ages of 20 and 40, MS can affect anyone from childhood to later in life. “There have been increased cases of late onset, even in people aged 50 and older,” says Dr. Graham. “Although it’s previously thought to primarily affect younger patients, it is now observed across various decades of life.”

The Most Common Symptoms of MS

Symptoms of MS can vary widely from person to person, based on which areas of the nervous system are affected. Symptoms are caused by the destruction of myelin, which is replaced with hardened patches that can impact the transmission of signals between your body and brain.

Episodes are neurologic systems that last longer than 24 hours and are attributed to inflammation in the brain or spinal cord. Common types of episodes include:

• Loss of vision in one eye
• Double vision
• Trouble with balance and coordination
• Weakness or change in sensation
• Issues with bladder or bowel movements
• Changes in memory, concentration or fatigue

When to See a Physician

“We want to be cautious before jumping to any conclusions,” Dr. Graham explains. “When people seek information online, they believe symptoms like urinary frequency or brain fog could indicate MS. However, these symptoms could be due to many causes.”

If you experience ongoing symptoms that are not severe, you should mention them to your primary physician. You can discuss whether these symptoms could signal MS, another neurologic problem or unrelated concerns.

MS symptoms typically develop gradually over days to weeks and persist for an extended period. However, if you or someone near you experiences sudden onset of severe neurologic symptoms, call 911 or go to the emergency department to eliminate other possible causes, such as stroke.

Diagnosing MS

First, you will get a clinical evaluation with detailed discussion of symptoms and a thorough neurological exam. Then, your care team will perform an MRI of your brain and spinal cord. MRI is considered the gold standard imaging procedure for MS.

Several diseases and syndromes are often mistaken for MS in clinical settings. These include migraine, fibromyalgia, functional neurological disorder, neuromyelitis optica, MOG antibody disorder, among other causes.

“If we are unsure, we will use more detailed diagnostics such as a lumbar puncture, visual diagnostic testing or detailed neuropsychological evaluations to get more information,” says Dr. Graham. “It’s important to be as specific as possible to get the right diagnosis.”

Treatment Options for MS

Although there is no cure for MS, once a diagnosis has been made, specialists can help you choose the right disease-modifying therapy, manage your symptoms and improve quality of life. “Over the last decade, the number of FDA-approved treatments for MS has doubled,” explains Dr. Graham. “Now, we have many highly effective infusions, injectables and oral medications.”

Treatment options vary based on the type of MS, and it can help patients recover after an attack, prevent MS relapses and manage ongoing symptoms. “Given the likelihood of future relapses within the next few years, starting disease-modifying therapy is typically recommended to mitigate the risk and provide long-term management for the condition,” explains Dr. Graham. Scientists are actively researching options for promoting remyelination and repair, as well as therapy for progressive forms of MS.

In addition to various medications, people with MS may also benefit from physical therapy, as well as diet and lifestyle modifications, to help manage their disease and symptoms.

“The benefits of MS treatment extend beyond symptom management,” says Dr. Graham. “They empower patients to maintain independence, engage in meaningful activities and pursue their goals with confidence.”