Individuals with multiple sclerosis can present almost any form of neurological symptom [7]. The most common problems are sensory, autonomic, visual and motor. The specific symptoms are determined by where the lesions are located within the nervous system. General presentations include the following:

• Loss of sensitivity or changes in response to sensations
• Very pronounced reflexes
• Muscle weakness
• Numbness
• Problems with swallowing or speech
• Difficulties in coordination and balance
• Visual problems 
• Acute or chronic pain
• Excessive tiredness
• Difficulties with bladder and bowel movements
• Thinking difficulties
• Depression and mood swings

• Pain

  We allowed concurrent spasm related pain if the patient was able to distinguish spasm related pain and central pain. We allowed additional pain outside the maximal pain site if pain intensity was low and distinguishable from the central pain. [bmj.com]

  The reader will be provided with current, evidence-based knowledge about the treatment of MS-related pain, and the review will take a practical approach to the various drugs for treating pain, including starting dose, titration and side effects. [informahealthcare.com]

  Conclusions: Cannabis-based medicine is effective in reducing pain and sleep disturbance in patients with multiple sclerosis related central neuropathic pain and is mostly well tolerated. [neurology.org]

  Among the acute pain syndromes the most frequently occurring pain is trigeminal neuralgia. Chronic pain are the worst, especially the dysesthetic pain in the limbs. Many patients confront the pain already in the early stages of the disease. [worldcat.org]

  As for pain, painful conditions are handled with drugs such as anticonvulsants, nonsteroidal anti-inflammatory agents, and corticosteroids. Nevertheless, management of pain in MS remains controversial and underresearched. [doi.org]

• Fatigue

  Fatigue was measured by questionnaires (i.e. Checklist Individual Strength, Modified Fatigue Impact Scale), and the dimensions subjective, physical, cognitive and psychological fatigue were distinguished. [ncbi.nlm.nih.gov]

  Hypothalamic Dysfunction and Multiple Sclerosis: Implications for Fatigue and Weight Dysregulation. Current Neurology and Neuroscience Reports, Vol. 16, Issue. 11, CrossRef Google Scholar Tur, Carmen 2016. Fatigue Management in Multiple Sclerosis. [dx.doi.org]

• Weakness

  After improvement in motor weakness, we found that the lower amplitude of the readiness field and decreased ECD strength of the MEF observed in affected hemisphere during motor weakness had recovered. [ncbi.nlm.nih.gov]

  A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. [icd9data.com]

  You may have vision problems, strange sensations, weak or clumsy movements, or trouble thinking clearly You'll have different symptoms at different times Symptoms usually come and go, and you may feel fine between episodes of symptoms MS tends to get [merckmanuals.com]

• Falling

  […] pathophysiology believed to be caused by a combination of genetic, environmental and infectious factors recent research suggests a T-cell mediated autoimmune mechanism Associated conditions orthopaedic increased fracture risk relating to increased risk of falling [orthobullets.com]

  Vitamin D and Falls among the Elderly Vitamin D status is increasingly recognized as an important factor in fall status among elderly patients. Several trials have demonstrated that vitamin D supplementation decreases the risk of falling. [dx.doi.org]

  In that case, however, people with M.S. should also have a high incidence of broken bones because of their falls. [nytimes.com]

  Falls, in turn, raise the risk of serious injuries, such as broken bones and head trauma. Falling can also lead to fear of falling, which typically causes a person to become less active, weaker, and even more prone to falling. [everydayhealth.com]

• Anemia

  Additionally, it is widely accepted that infection with this organism can result in a variety of extrapulmonary sequelae including septic arthritis, hemolytic anemia, dermatological, renal, central nervous system and cardiac complications. [uniprot.org]

  […] especially amitriptyline (Elavil), caffeine-containing products, ciprofloxacin (Cipro), ofloxacin (Floxin), omeprazole (Prilosec), rifampin (Rifadin), theophylline (Theo-Dur), and vitamins. tell your doctor if you have or have ever had blood disorders or anemia [nlm.nih.gov]

• Dysphagia

  We screened 30 patients by using the 10-item DYsphagia in MUltiple Sclerosis (DYMUS) questionnaire, and patients at risk for dysphagia underwent a clinical and fiberoptic endoscopic evaluation of swallowing (FEES). [ncbi.nlm.nih.gov]

  […] brain, spinal cord or optic nerves) that are separated in time and space Symptoms symptoms of disease are based on the systems involved psych fatigue, depression, mood disorders central nervous system optic neuritis, diplopia, nystagmus ENT dysarthria, dysphagia [orthobullets.com]

  MS can cause a variety of symptoms, including changes in sensation (hypoesthesia), muscle weakness, abnormal muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems in speech (dysarthria) or swallowing (dysphagia [disabled-world.com]

• Fecal Incontinence

  incontinence may occur occasionally in some patients Depression is common and unrelated to cognitive impairment although it may worsen existing cognitive difficulties Approx 10% of patients with Multiple Sclerosis will suffer severe psychotic disorders [themcfox.com]

  Jillian Marie McDowell, Susan Heather Kohut and Gillian Margaret Johnson, Trigger Point Acupuncture (Dry Needling) and Associated Fecal Incontinence in Multiple Sclerosis: A Case Report, Medical Acupuncture, 27, 4, (283), (2015). [doi.org]

  Frank urinary and fecal incontinence may occur in advanced MS. Spinal cord lesions (plaques) are a common source of neuropathic pain. Progressive myelopathy, a variant of MS, causes spinal cord motor weakness but no other deficits. [msdmanuals.com]

• Blurred Vision

  Early MS symptoms include weakness, tingling, numbness, and blurred vision. Other signs are muscle stiffness, thinking problems, and urinary problems. Treatment can relieve MS symptoms and delay disease progression. [web.archive.org]

  Female aged 16, with Relapsing Remitting Multiple sclerosis (RRMS) was reported with initial symptoms of blurred vision, severe immobility, upper and lower limb numbness and backache. [ncbi.nlm.nih.gov]

  Symptoms of MS vary among individuals but often include: Numbness or tingling in the limbs Impaired balance Change in vision such as blurred vision in one eye or double vision Fatigue Change in bowel, bladder and sexual function Stiffness or tightness [umms.org]

  Symptoms Some examples of the symptoms seen in MS include: Vision problems such as blurred vision, double vision or paralysis of eye muscles Muscle stiffness and lack of balance and co-ordination. There is loss of dexterity and fine movement. [news-medical.net]

  Common symptoms of a relapse may include: Fatigue Numbness Tingling Blurred vision, double vision or loss of vision Unsteady gait Weakness These symptoms tend to persist for days or weeks, and then disappear partially or completely on their own or with [hopkinsmedicine.org]

• Diplopia

  The patient presented with progressive decrease of visual acuity, intermittent diplopia, paresthesia of the left arm and equilibrium disturbances. [ncbi.nlm.nih.gov]

  […] episodes of neurological dysfunction (brain, spinal cord or optic nerves) that are separated in time and space Symptoms symptoms of disease are based on the systems involved psych fatigue, depression, mood disorders central nervous system optic neuritis, diplopia [orthobullets.com]

  Eye problems : In addition to the optic neuritis that comes with CIS, MS can cause: Nystagmus : involuntary eye movements Diplopia: double vision Fatigue : You may feel very tired. [webmd.com]

  […] sensation (hypoesthesia), muscle weakness, abnormal muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems in speech (dysarthria) or swallowing (dysphagia), visual problems (nystagmus, optic neuritis, or diplopia [disabled-world.com]

  Examples of common clinical features include 23,24 : brainstem and cranial nerve involvement: optic neuritis internuclear ophthalmoplegia (often bilateral) trigeminal neuralgia diplopia (e.g. due to abducens nerve palsy ) vertigo cerebellum involvement [radiopaedia.org]

• Eye Pain

  A 56-year-old man was referred by his family doctor with a 2-week history of right eye pain and decreased vision. Best-corrected visual acuity was Count Fingers on the right and 6/9-2 on the left. [ncbi.nlm.nih.gov]

  Visual disturbances, which may include eye pain, distortion or loss of vision in one eye, or impairment of color perception Difficulty walking or performing tasks that require coordination Loss of sensation Fatigue and/or weakness Loss of bowel or bladder [jamanetwork.com]

  Early MS symptoms may include: weakness/fatigue loss of balance problems with coordination tremors tingling and/or numbness blurred or loss of vision muscle stiffness/cramping thinking problems depression bowels problems facial or eye pain It is still [drfuhrman.com]

  This usually affects one eye at a time. Inflammation of the optic nerve can result in pain when the eye moves. [medicalnewstoday.com]

  You may also have some eye pain. It isn’t uncommon for these early symptoms to go away only to return later. You may go weeks, months, or even years between flare-ups. These symptoms can have many different causes. [healthline.com]

• Visual Impairment

  We report a case of progressive visual impairment as the dominant symptom in the transition to secondary progressive MS. [ncbi.nlm.nih.gov]

  This includes Cerebral Palsy, Cancer, Visual Impairment, Fibromyalgia, Epilepsy, ROHHAD, Multiple Sclerosis, Hydrocephalus, Neurological Conditions, Kidney Problems, Down Syndrome, Autism, Bleeding Disorders, Amputees and Wheelchair Users. [nationalcancerplatform.org.mt]

  Some people may have visual impairment (including central visual fields), double vision (diplopia), or involuntary rhythmic movements of the eyes (nystagmus). [rarediseases.org]

• Scotoma

  Ninety percent of MS patients showed central scotoma every time, but 54% in NMO (p = 0.022). In NMO patients, 33% of patients showed both central scotoma and non-central scotoma, and 13% of patients showed non-central scotoma every time. [dx.doi.org]

  Optic neuritis causes loss of vision (ranging from scotomas to blindness), eye pain during eye movement, and sometimes abnormal visual fields, a swollen optic disk, or a partial or complete afferent pupillary defect. [msdmanuals.com]

  Visual: 0 ‐ Normal, 1 ‐ Scotoma with corrected acuity >20/30, 2 ‐ Scotoma with worse eye corrected acuity 20/30 to 20/59 ..... 6 ‐ Worse eye corrected acuity < 20/200 and betetr eye 3.0 ‐ Moderate disability in 1 FS, or mild disability in 3‐4 FS. [doi.org]

• Muscle Spasm

  He obtained immediate benefit from a small dose of the drug, reporting decreased pain from muscle spasm, cessation of nocturia, and an improvement in how he felt generally. [medicalcannabis.it]

  Muscle symptoms: Loss of balance Muscle spasms Numbness or abnormal sensation in any area Problems moving arms or legs Problems walking Problems with coordination and making small movements Tremor in one or more arms or legs Weakness in one or more arms [nlm.nih.gov]

  Controlling the symptoms of MS There are medicines available that can ease muscle spasms, pain, continence problems, tiredness, depression and other symptoms. [healthdirect.gov.au]

• Back Pain

  You might experience stiff muscles or joints as well as uncontrollable, painful jerking movements of the extremities. The legs are most often affected, but back pain is also common. [healthline.com]

  Oxytrex minimizes physical dependence while providing effective analgesia: a randomized controlled trial in low back pain. J Pain 2006 ; 7: 937 - 946. Google Scholar | Medline Crabtree BL Review of naltrexone, a long-acting opiate antagonist. [dx.doi.org]

  The most common adverse events included nasopharyngitis, headache, diarrhoea, fatigue, elevated alanine aminotransferase levels, nausea, hair thinning or decreased hair density, influenza, back pain, urinary tract infection, and pain in the arms or legs [doi.org]

• Muscle Spasticity

  […] contractures neurological examination muscle spasticity increased deep tendon reflexes muscle weakness Babinski positive special tests fundoscopy MLF syndrome (Internuclear Ophthalmoplegia) Lhermitte's sign Evaluation Laboratory studies CBC, lytes, TSH [orthobullets.com]

  A significant amount of evidence suggests THC and CBD -based medications can be used for treating muscle spasticity associated with multiple sclerosis, but most studies have focused on synthetic derivatives. [leafly.com]

  The symptoms of MS are highly varied but frequently include pain, muscle spasticity, fatigue, inflammation, and depression. [frontiersin.org]

• Restless Legs Syndrome

  Secondary objectives were to investigate correlations of sleep quality and daytime sleepiness (ESS), depression (HADS-D), anxiety (HADS-A), pain (HSAL), and restless legs syndrome (RLS). [ncbi.nlm.nih.gov]

  Subsequently, we classified the patients into four subgroups: insomnia ( n = 17), restless-legs syndrome, periodic limb movement disorder and SD due to leg pain ( n = 24), obstructive sleep apnea ( n = 8) and patients without sleep disorder ( n = 17). [dx.doi.org]

• Facial Pain

  Symptoms and signs of MS are extremely variable and range from mild to severe, and may include: Problems with balance when walking Hearing loss Facial pain Weakness Muscle spasms that cause pain. [emedicinehealth.com]

  Facial pain Painful muscle spasms Tingling, crawling, or burning feeling in the arms and legs Other brain and nerve symptoms: Decreased attention span, poor judgment, and memory loss Difficulty reasoning and solving problems Depression or feelings of [nlm.nih.gov]

  Pain is a common symptom present in MS and can present acutely or as chronic pain [1]. o Acute Pain Treatment - Trigeminal neuralgia—stab-like facial pain with anticonvulsants • Carbamazepine (Tegretol) or phenytoin (Dilantin) [1] [2] - Lhermitte’s sign—stabbing [physio-pedia.com]

• Facial Numbness

  Intermittent unilateral facial numbness or pain (resembling trigeminal neuralgia), palsy, or spasm may occur. Mild dysarthria may occur, caused by bulbar weakness, cerebellar damage, or disturbance of cortical control. [msdmanuals.com]

• Euphoria

  Fatigue and psychiatric symptoms, such as depression or euphoria, can also be manifestations of MS. Symptoms (attacks) of MS need disseminated in “time and space.” [clinicaladvisor.com]

  […] patients, particularly during the early stages of the disease Males have a higher tendency to develop Primary Progressive Multiple Sclerosis (PPMS) Females tend to experience more relapses than men 5% of Multiple Sclerosis patients exhibit an inappropriate euphoria [themcfox.com]

  Transient feelings of euphoria are experienced by some patients taking nabilone. Our patient did not report such an effect, although he noticed a brief period of mild sedation after taking the active drug. [medicalcannabis.it]

  For instance, the occurrence of euphoria and depression was observed in only 2.2% and 2.9% of the patients respectively [ Robson, 2011 ]. No single case of defined cannabis withdrawal syndrome or tolerance development was verified. [ncbi.nlm.nih.gov]

  Uncoordinated movements Stiffness, unsteadiness, and unusual fatigue Intestine and bladder Problems controlling urination and bowel movements Constipation Speech Slow, slurred, and hesitant speech Mood Mood swings Inappropriate elation or giddiness (euphoria [merckmanuals.com]

• Mood Swings

  Complications People with multiple sclerosis may also develop: Muscle stiffness or spasms Paralysis, typically in the legs Problems with bladder, bowel or sexual function Mental changes, such as forgetfulness or mood swings Depression Epilepsy [mayoclinic.org]

  swings Many patients seek medical help following an initial attack of symptoms often referred to as a clinically isolated syndrome or CIS. [symptoma.com]

  swings Difficulty thinking, remembering things, paying attention, or making decisions Dizziness Problems controlling urination (peeing) or bowel movements (pooping) Symptoms may become worse if you're hot, such as on a hot day or during a fever. [merckmanuals.com]

  […] or vertigo Balance problems and problems with gait, leading to trouble walking Incontinence and dysfunctional bladder Cognitive problems such as (but not limited to) memory, language, focus and attention span Unexplained depression Irritability and mood [docdoc.com.sg]

• Loss of Libido

  The most frequent complaints are erectile and ejaculatory dysfunctions in men, vaginal lubrication in women, and a loss of libido and difficulty in achieving orgasm in both genders [ 18 ]. [bmcneurol.biomedcentral.com]

• Psychiatric Manifestation

  Psychiatric manifestations of multiple sclerosis: A review. Can J Psychiatry 1996 ; 41: 441 – 445. Google Scholar | SAGE Journals | ISI 5. Patten, SB, Svenson, LW, Metz, LM. Psychotic disorders in MS: Population-based evidence of an association. [dx.doi.org]

• Sexual Dysfunction

  However, it could not predict the extent of sexual dysfunction. Sildenafil is unlikely to help all patients with neurogenic female sexual dysfunction. References 1 : Sexual dysfunction in the United States: prevalence and predictors. [dx.doi.org]

  From 97 to 30% of the subjects reported cannabis improved (in descending rank order): spasticity, chronic pain of extremities, acute paroxysmal phenomenon, tremor, emotional dysfunction, anorexia/weight loss, fatigue states, double vision, sexual dysfunction [ncbi.nlm.nih.gov]

• Urinary Incontinence

  If nerve fibers to the bladder are affected, urinary incontinence may occur. Likewise, damage to the cerebellum portion of the brain may result in imbalance or a lack of coordination. [ucsfhealth.org]

  Other drugs can be used to relieve or control specific symptoms: Muscle spasms: The muscle relaxants baclofen or tizanidine Urinary incontinence: Oxybutynin, tamsulosin, or another drug, depending on the type of incontinence Pain due to abnormalities [merckmanuals.com]

  As a result, most people with multiple sclerosis have problems controlling their bladder, such as the following: Frequent and strong urges to urinate Involuntary passage of urine (urinary incontinence) Difficulty starting to urinate Retained urine can [msdmanuals.com]

  Urinary incontinence in neurological disease: Management of lower urinary tract dysfunction in neurological disease (CG148). London : NICE, 2012. Google Scholar 8. Uroweb. [dx.doi.org]

• Urinary Retention

  retention A constant state of tiredness or fatigue There appears to be a relationship between multiple sclerosis, higher temperatures, and the worsening of symptoms. [emedicinehealth.com]

  During 1828, he had unpleasant sensory symptoms and fatigue but continued with his military career until developing urinary retention; he became constipated, had a single episode of faecal incontinence and found himself to be impotent whilst attempting [dx.doi.org]

  retention) Muscle spasticity Incoordination of muscles Tremor Painful involuntary muscle contractions Slurred speech Fatigue There are four types of MS: Relapsing-remitting multiple sclerosis (RRMS), Secondary-progressive multiple sclerosis (SPMS), the [medicinenet.com]

  retention, and infected skin ulcers, amongst others. [en.wikipedia.org]

• Dizziness

  She has a mild fever, confusion, speech and coordination disorders, dizziness, worsening of memory, inability to walk (inferior paraparesis). Focal lesions were detected on MRI scan. The spinal fluid contained oligoclonal IgG-chains and HHV-7 DNA. [ncbi.nlm.nih.gov]

  People with MS often feel lightheaded, dizzy, or as if their surroundings are spinning (vertigo). This symptom often occurs when you stand up. [healthline.com]

  CBM was generally well tolerated, although more patients on CBM than placebo reported dizziness, dry mouth, and somnolence. Cognitive side effects were limited to long-term memory storage. [neurology.org]

  Gait and mobility changes : MS can change the way people walk, because of muscle weakness and problems with balance, dizziness, and fatigue. [medicalnewstoday.com]

  When the myelin is damaged, the nerve impulses are not transmitted as quickly or efficiently, resulting in symptoms such as numbness in the limbs, fatigue, dizziness, paralysis and/or loss of vision. [benaroyaresearch.org]

• Cognitive Impairment

  Within each atrophy group, patients with cognitive impairment and preserved cognitive function were compared and regression analyses were performed to predict cognitive impairment. [ncbi.nlm.nih.gov]

  Treatment for patients with MS and cognitive impairment should, therefore, include a DMD in combination with a pharmacological or perhaps non-pharmacological cognitive-enhancement strategy. [dx.doi.org]

• Headache

  The new onset of hypertension or headache requires careful attention in cases of long-term administration of IFN-β1b. [ncbi.nlm.nih.gov]

  These reactions include, but are not limited to, itchy skin, rash, hives, skin redness, flushing, low blood pressure, fever, tiredness, dizziness, headache, throat irritation, shortness of breath, swelling of the throat, nausea, and fast heartbeat. [web.archive.org]

• Stroke

  We narrate the case of a 28-year gentleman known to have severe mitral stenosis, who presented with history of multiple stroke-like episodes. During each episode, he had CT brain done and was labelled as having recurrent embolic strokes. [ncbi.nlm.nih.gov]

  Reich at the National Institute of Neurological Disorders and Stroke, 10 Center Dr., MSC 1400, Bldg. 10, Rm. 5C103, Bethesda, MD 20892, or at [email protected]. Article Figures/Media [dx.doi.org]

• Tremor

  Abstract Based on one patient's enthusiastic report, eight patients with multiple sclerosis, seriously disabled with tremor and ataxia, were given oral tetrahydrocannabinol. Two demonstrated improved motor coordination. [ncbi.nlm.nih.gov]

  Tetrahydrocannabinol for tremor in multiple sclerosis. Ann Neurol 1983 ; 13: 669 - 671. Google Scholar | Medline | ISI Robson P. Cannabis as a medicine: time for the phoenix to rise? BMJ 1998 ; 316: 1034 - 1035. [msj.sagepub.com]

  Tetrahydrocannabinol for tremor in multiple sclerosis. Ann Neurol 1983; 13: 669-71. 5. Petro DJ, Ellenberger C Jr. Treatment of human spasticity with delta 9-tetrahydrocannabinol. J Clin Pharmacol 1981; 21 (suppl 8-9): 413S-16S. [medicalcannabis.it]

Many patients seek medical help following an initial attack of symptoms often referred to as a clinically isolated syndrome or CIS. Some people who have a CIS do not go on to develop full multiple sclerosis and it is difficult to predict which patient will develop it and which one wouldn’t [8].

Since there is no definitive test for it, diagnosing multiple sclerosis is often a challenge. This is because there are many conditions that present the same symptoms as MS. For a confirmed diagnosis of multiple sclerosis, the doctor must find the following:

• Evidence of nerve damage in at least two different areas of the central nervous system (brain, spinal cord, and optic nerves)
• Evidence that the damage occurred in episodes that happened at least one month apart
• No evidence that the damage is caused by other conditions

• Brain MRI Abnormal

  These patients tend to be younger, present with positive oligoclonal bands in CSF, and develop brain MRI abnormalities during their disease course. [emedicine.com]

  Humoral immune responses to EBV are associated with brain MRI abnormalities in CIS patients at baseline We next investigated whether immune responses to candidate viral triggers of MS correlate with brain MRI-derived metrics in patients with CIS at the [ncbi.nlm.nih.gov]

  Recent studies have reported a high frequency of brain MRI abnormalities in NMO patients. However, most were nonspecific and were not considered typical of MS, and hypothalamic involvement has been emphasized [ 2 ]. [dx.doi.org]

• Abnormal Visual Evoked Potentials

  visual evoked potential MR imaging lack of viable alternative diagnosis The exact etiology is poorly known although it is believed to have both genetic and acquired contributory components. [radiopaedia.org]

• Central Scotoma

  Ninety percent of MS patients showed central scotoma every time, but 54% in NMO (p = 0.022). In NMO patients, 33% of patients showed both central scotoma and non-central scotoma, and 13% of patients showed non-central scotoma every time. [dx.doi.org]

  scotoma) Lyme titers (eg, endemic area, tick exposure, rash of erythema chronica migrans) Tuberculin skin testing, chest radiography, or QuantiFERON-TB testing (eg, tuberculosis [TB] exposure, endemic area) Fluorescent treponemal antibody (FTA) testing [emedicine.com]

• HLA-DR2

  […] swollen subacute stage plaques become paler in color ("chalky") abundant macrophages chronic stage (inactive plaques/gliosis) little or no myelin breakdown gliosis with associated volume loss appear grey/translucent Associations a strong association with HLA-DR2 [radiopaedia.org]

  There was significant benefit favoring dirucotide in HLA-DR2–positive and/or DR4-positive participants (relative rate of progression = 0.23, n = 20, P = .01). [doi.org]

  A humanized model for multiple sclerosis using HLA-DR2 and a human T-cell receptor. Nature Genet. 23: 343-347, 1999. [PubMed: 10610182] [Full Text: https://dx.doi.org/10.1038/15525] Marrosu, M. [ncbi.nlm.nih.gov]

Presently there is no cure for MS but symptoms of MS can often be eased with the right medications [9].

Treatments generally fall into four categories:

• Medicines that aim to modify the disease process.
• Steroid medication to treat relapses.
• Other medicines to help ease symptoms.
• Other therapies and general support to minimise disability.

Except on rare occasions when the disease is severe, multiple sclerosis isn’t fatal. Many people with multiple sclerosis go on live to the average life expectancy for their sex in their region of residence. Most of them die of natural causes that affect everyone else [6]. However, the symptoms of MS can negatively affect the quality of life. This is perhaps why the rate of suicide amongst patients with multiple sclerosis is higher than normal.

Most patients with multiple sclerosis do not become severely disabled. Generally, most people diagnosed of the condition remain ambulatory without need for a wheelchair 20 years from time of initial diagnosis. However, many may have to use some sort of walking aid.

As is the cases with most autoimmune conditions, the exact cause of MS is unknown. However, it is believed that a combination of environmental and genetic factors play different roles.

Although multiple sclerosis isn’t hereditary, it appears that genetic factors help in making certain individuals susceptible to the disease process that leads to this condition. The major histocompatibility complex (MHC) is where the most significant genetic link to MS occurs. The MHC is a cluster of genes found on the Chromosome 6 that are important for the functions of the immune system.

Also, multiple sclerosis is most common in specific geographical regions in the world especially areas that are most far off from the equator (northern Europe and northern American countries). With the cluster of Multiple Sclerosis in this region, researchers have continued to investigate the role played by toxins, infections, deficiency in certain vitamins like the Vitamin D may be playing a major role in triggering MS in individuals that are susceptible genetically [3].

The number of individuals with multiple sclerosis around the world has been put at 2.5million approximately meaning that 30 out of every 100,000 people develop the condition. However, the rates vary greatly in based on regions [4]. It has been estimated that 18,000 deaths are recorded each year as a result of this condition. In America, incidence is 8.3 per 1000,000, in Europe 80 per 100,000. In South East Asia incidence is 2.8 per 100,000 people while in Africa rates are less than 0.5 cases per 100,000.

Rates of multiple sclerosis may appear to be increasing but this can be put down to better diagnosis available across board today.

The disease is seen mostly in adults in their late twenties or early thirties and rarely in childhood or after 50 years of age. Primary progressive multiple sclerosis is mostly seen in people in their late 50s. Also, as is the case with most autoimmune disorders, the disease is more common in women and the trend has continued to increase. In rare cases where children are affected, more females than males are affected.

The three major characteristics of MS are the formation of lesions or plaques in the central nervous system, destruction of the myelin sheath of neurons and inflammation [5]. These interact in a complex manner that is not yet understood till date to initiate the disintegration of the nerve tissue and in turn, bring about the signs and symptoms of the disease. Damage is believed to be caused at least in part by attack on the nervous system by the individual's immune system.

There is no way to prevent multiple sclerosis and its attacks.

Also known as disseminated sclerosis or encephalomyelitis disseminata, multiple sclerosis (MS) is an inflammatory disease that damages the insulating covers of the nerve cells in the brain and the spinal cord [1]. This damage disrupts the ability of parts of the nervous system to communicate with the body and this brings about a wide range of symptoms which may cause psychiatric, mental or physical problems for the affected individual.

Multiple sclerosis takes several forms with each new symptom building up over a period of time (progressive forms) or occurring in relapsing forms (isolated attacks). Between the various attacks, some of the symptoms of MS disappears but it is possible to see permanent neurological problems as the disease continues to progress [2].

Multiple sclerosis is a disease that turns your immune system against the protective sheath covering your nerves (known as the myelin sheath).

When this happens, the communication between your brain and other parts of your body is affected. At the end of the day the nerves affected may deteriorate. This process is not reversible yet. 

The signs and symptoms of this condition varies widely as it is dependent on the amount of damage done to the nerves and what particular nerves were affected. In severe cases, people with this condition lose their ability to walk independently and in some instances, the individual may not see development of any new symptoms. 

Currently, there is no cure for multiple sclerosis but with treatments, the patient can recover properly from attacks and the symptoms of the condition can be managed. The treatments can also help in modifying the course of the disease.

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2. Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol. Mar 1983;13(3):227-31. 
3. Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology. Apr 1996;46(4):907-11.
4. McDonald WI, Compston A, Edan G, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol. Jul 2001;50(1):121-7. 
5. Sanford M, Lyseng-Williamson KA. Subcutaneous recombinant interferon-ß-1a (Rebif®): a review of its use in the treatment of relapsing multiple sclerosis. Drugs. Oct 1 2011;71(14):1865-91
6. Calabresi P. Multiple sclerosis and demyelinating conditions of the central nervous system. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 419.
7. Farinotti M, Simi S, Di Pietrantonj C, McDowell N, Brait L, Lupo D, Filippini G. Dietary interventions for multiple sclerosis. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004192.
8. Kappos L, Freedman MS, Polman CH, Edan G, Hartung HP, Miller DH, et al. Effect of early versus delayed interferon beta-1b treatment on disability after a first clinical event suggestive of multiple sclerosis: a 3-year follow-up analysis of the BENEFIT study. Lancet. 2007 Aug 4;370(9585):389-97.
9. Kappos L, Radue EW, O'Connor P, Polman C, Hohlfeld R, Calabresi P, et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010 Feb 4;362(5):416-26. Epub 2010 Jan 20.
10. Khan F, Ng L, Turner-Stokes L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007256002819.