- Multiple Sclerosis: Why Are Women More at Risk?
- Pregnancy Concerns
- Vitamin D Deficiency
- Precision Approaches to MS
- Causes and Risk Factors of Multiple Sclerosis
- Causes of Multiple Sclerosis (MS)
- Risk Factors for Multiple Sclerosis
- The Basics of Multiple Sclerosis
- Multiple Sclerosis: Symptoms, Management & New Research
- Signs & symptoms
- Risk factors
- Treatment & medication
- Advances in multiple sclerosis research
- 12 Surprising Factors That Up Your Risk of MS
Multiple Sclerosis: Why Are Women More at Risk?
Every week in the U.S., about 200 people are diagnosed with multiple sclerosis , or MS. According to the National Multiple Sclerosis Society, four times as many women have MS as men, and more and more women are developing it. Why? Is it genetics? Is it hormones or some other aspect of being female?
Peter Calabresi, M.D., Ph.D. , is the director of the Johns Hopkins Multiple Sclerosis Center . His team, including MS expert Ellen Mowry, M.D. , is combining research with clinical treatment for a better understanding of the disease, including why it’s more common in women.
The basic cause of MS has yet to be discovered. The disease has been linked to a number of risk factors, including smoking and stress. But more studies are also pointing to the roles of female hormones, vitamin D, inflammation and even obesity.
When a condition affects women more than men, scientists are ly to take a look at the role of sex hormones such as testosterone and estrogen.
Between boys and girls, Mowry says there’s less difference in the rate of MS among children before puberty, but in older children and adults the trend changes, striking more females in adolescence and adulthood.
Pregnancy also affects MS remissions and relapses. During pregnancy, some women with MS notice a lessening of symptoms. This can be followed by a flare-up after the baby is born. Postpartum relapse is a recognized phenomenon among MS researchers and patients.
Calabresi says newly diagnosed women should consider participating in clinical trials that are homing in on new treatments and better symptom management during childbearing.
“Women with MS can give birth to healthy babies but should discuss concerns and risks carefully with their doctor,” Mowry says. “After children are born, we stress to new moms the importance of keeping kids active and at a healthy weight to lower their risk of getting MS.”
With MS, other autoimmune diseases such as lupus, your body’s immune system (which is designed to fight germs and other invaders that threaten your health) mistakenly turns against your own tissues.
In the case of MS, the body’s inflammatory defenses attack myelin, the insulation that covers and protects the nerves. a worn electrical wire, a nerve cell with faulty myelin can “short circuit” and affect the transmission of signals to and from the brain.
The condition affects nerves in the brain and spinal cord, resulting in pain, numbness and weakness striking different areas of the body. Relapsing-remitting MS (RRMS) is the most common type. With RRMS, symptoms can change, affecting different areas of the body, or disappear (remit) and then recur (relapse).
How could weight affect someone’s chances of getting MS? Inflammation plays a role in MS, and obesity is linked to inflammation.
Mowry says that the rising incidence of MS among women may relate to body fat. Obesity is epidemic in the U.S., with over a third of American adults at a body mass index of 30 or higher.
Women typically carry more fat on their bodies than men, and obesity rates are higher for women as well. Belly fat, in particular, is associated with increased inflammation.
Carrying extra body weight may be especially risky for women. Mowry says, “The inflammation chemicals in women’s bodies are different from those in men, and focusing research on these may provide clues as to why more women are affected.”
Vitamin D Deficiency
Calabresi, Mowry and their team are leading the research effort on the role of vitamin D in MS. In general, MS affects more people living farther from the equator.
The skin absorbs vitamin D from sunlight.
Researchers are looking at the relationship between low vitamin D levels and a higher risk of developing MS, increased frequency of relapses and greater negative impact of the disease on patients’ lives.
Mowry points out that higher vitamin D levels in patients with fewer relapses may also be linked to another factor, such as exercise.
It could be that patients who are outdoors exercising absorb more vitamin D, but that the exercise itself could be lessening the MS symptoms.
Conversely, Mowry says, patients who are more disabled by their MS may be spending more time indoors, which could result in less sun exposure and lower stores of vitamin D.
Mowry’s studies are exploring whether taking vitamin D supplements can help reduce the number of relapses in patients with the relapsing-remitting type of the disease.
Precision Approaches to MS
Calabresi is the director of the Johns Hopkins Precision Medicine Center of Excellence for Multiple Sclerosis , an exciting new precision medicine initiative where patients with MS can get an individualized approach to therapy while providing essential data for researchers.
“It’s important for women and men a with MS to get on the best therapy for them as early as possible,” Calabresi says.
As research reveals more about how genetics, environment and other factors increase a woman’s chances of developing MS, new ways to address the disease are ly to emerge.
Causes and Risk Factors of Multiple Sclerosis
Causes and risk factors for multiple sclerosis (MS) are complicated. Researchers don't fully understand what precisely brings about MS or why some people get it and others don't.
Several main factors have emerged that appear to play a role, including health of the immune system, infectious diseases, genetics, lifestyle, and others.
While each one can explain a piece of the MS puzzle, none can explain everything.
Though no one knows why, most researchers agree that MS is autoimmune, which means the symptoms are caused by the immune system attacking healthy parts of your body as if they were a virus or other infectious agent.
Specifically, in MS, the immune system attacks cells in the brain and spinal cord, damaging the myelin sheath, which is a layer of cells that insulate and influence the function of particular nerves.
The damage impacts how well those nerves function, which is the source of MS symptoms and associated disability. Disease-modifying treatments work by preventing your immune system from attacking the nervous system in this way.
Certain viruses are known to cause damage similar to that of MS. Some researchers believe that infections may somehow trigger the immune system to attack your nerve cells.
Basically, what they suspect is that, to your immune system, the virus or bacterium that causes an initial infection “looks” a nerve cell.
The immune system then develops specialized cells called T-cells to fight off the virus.
Those T-cells remain in your body after the infection is gone and appear to become confused when they “see” a nerve cell, mistaking it for an invader. Then they launch an attack.
One virus commonly linked to MS is the Epstein-Barr virus, which causes mononucleosis (a.k.a., mono or “the kissing disease”). This is a very common virus that infects most of us at some point in our lives.
Early exposure to Epstein-Barr may play a role in MS development, but experts simply aren't sure about its role right now .
At this time, no infectious disease (viral, bacterial, or fungal) has been found to definitively cause MS.
Researchers believe certain genetic combinations increase the lihood that you'll develop MS. In fact, scientists have isolated a number of genes that appear to be linked to the disease, most of which are located near the genes linked to your immune system.
In addition to influencing whether you'll get MS, it's possible that your genes may also predict the type of MS you have, how severe it is, and whether you respond well to disease-modifying medications.
Even so, it's important to understand that MS is not a “genetic disease”—meaning there's not a single inherited gene or set of genes that definitively means you'll end up with this illness. Instead, it appears that genes are one factor among many that determine your risk.
Because of this genetic predisposition, your chance of developing MS increases if you have a relative with MS.
The lihood of you developing MS is approximately:
- 1 in 750 if you have no relatives with MS
- 1 in 50 if you have a parent with MS
- 1 in 20 if you have a sibling with MS
- 1 in 4 if your identical twin has MS
It's interesting that identical twins do not always both have MS, even though they share 100 percent of their genetic information. This is why researchers have concluded MS is not simply a genetic disease.
Certain elements of your lifestyle can influence how ly it is that you'll develop MS, including where you live and what you put into your body.
MS is more common in regions that are farther from the equator, especially above 40 degrees latitude. Rates in these northern regions can be as much as five times higher than in other places.
If you move from a high-risk region to a low-risk region before the age of 15, your risk decreases. Researchers think that puberty hormones may somehow interact with geography to increase MS risk.
It's interesting to note that there are odd geographical clusters with higher MS rates. Researchers are studying them to learn what factors in the environment may be responsible for this, but so far, they haven't come up with much.
Sunlight may play a role in the geographical risk of MS at least in part because people in northern climes are more ly to have a vitamin D deficiency.
Higher levels of vitamin D (those greater than 75ng/mL) seem to help prevent MS, according to a study in Neurology. Maintaining a healthy vitamin D level may also protect people with MS from having relapses, as well.
Research on the role of vitamin D in human health is in its early stages, so it's still not clear exactly how much people should get in a day. However, if you're at high risk for MS, you may want to have your vitamin D levels checked and, if you're deficient, talk to your doctor about the best ways to improve your results.
Other lifestyle factors that scientists have examined as potentially playing a role in MS include:
- A high salt diet
- Obesity (especially in adolescence)
The precise role these elements might play isn't clear, but these are things to consider when trying to lower your risk.
Women are 2 to 3 times more ly than men to become diagnosed with MS, and rates in women are increasing faster than they are in men. A 2019 study estimated that in 2017, men accounted for 26 percent of MS cases while women accounted for 74 percent. Researchers believe that the hormonal differences in men and women account for the disparity.
In addition, most MS cases are diagnosed between the ages of 20 and 50, though both childhood and late-onset MS are possible.
The average person in the United States has a one in 750 chance of getting MS. The National Multiple Sclerosis Society has estimated that approximately 1,000,000 people in the United States have been diagnosed with MS. Estimates of the number of people living with undiagnosed MS vary widely.
The rates of MS in the United States are increasing each year, but that doesn't mean it's becoming more common. At least in part, it's ly due to better diagnostic tests—especially improved magnetic resonance imaging (MRI) scans—and an increased awareness of MS. It may be that many more cases used to go undiagnosed.
Worldwide, reliable statistics are difficult to find because MS is challenging to diagnose. Current estimates are that around 2.5 million people in the world have this disease.
Risk factors and potential causes ly intermingle to determine who gets this disease. If you're at high risk, the good news is that you can take steps to mitigate many of the risk factors, which could help you stay healthy. Also, keep in mind that there are a number of medications to treat multiple sclerosis.
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National Institute of Neurological Disorders and Stroke. Multiple Sclerosis: Hope Through Research. Updated August 13, 2019.
Guan Y, Jakimovski D, Ramanathan M, Weinstock-guttman B, Zivadinov R. The role of Epstein-Barr virus in multiple sclerosis: from molecular pathophysiology to imaging. Neural Regen Res. 2019;14(3):373-386. doi:10.4103/1673-5374.245462
National Multiple Sclerosis Society. What Causes MS?: Viruses.
National MS Society. What Causes MS?.
Alonso A, Hernán MA. Temporal trends in the incidence of multiple sclerosis: a systematic review. Neurology. 2008;71(2):129-35. doi:10.1212/01.wnl.0000316802.35974.34
Salzer J, Hallmans G, Nystrom M, Stenlund H, Wadell G, Sundstrom P. Vitamin D as a protective factor in multiple sclerosis. Neurology. 2012;79(21):2140-2145. doi:10.1212/wnl.0b013e3182752ea8
National Multiple Sclerosis Society. Who Gets MS? (Epidemiology).
National Center for Complementary and Integrative Health. Multiple Sclerosis. Updated October 24, 2018.
Causes of Multiple Sclerosis (MS)
Doctors still don't understand what causes multiple sclerosis. But ongoing research shows that from your genes, to where you live, to the air you breathe, there are many factors in play.
MS is an autoimmune condition. Doctors don’t know why, but something tells your immune system to attack your body. With MS, the focus is on myelin, a fatty substance that covers the nerve fibers in your brain and spinal cord.
Its job is to protect them the plastic that wraps around the wires in your phone charger. When myelin is messed up, your nerves can’t send messages back and forth the way they should.
Without their protective coating, your nerves can get damaged, too.
You might be more ly to get MS if you have another autoimmune condition inflammatory bowel disease, thyroid disease, or type 1 diabetes.
MS is more ly to affect people who live in certain places and belong to specific ethnic groups. It’s especially common in cooler climates Scotland, Scandinavia, and throughout northern Europe — places that are farther from the equator. People who live close to the equator are least ly to get it. In the U.S., it affects white people more than other racial groups.
If you move from a place where MS is rare to a place where it’s common before you’re a teenager, you’ll also be more ly to get it.
This suggests that something about the place you live before puberty raises your odds of getting MS. It could be the amount of sunlight in a day.
There’s evidence that vitamin D, which your body makes when it’s exposed to sunlight, helps protect you from immune-related diseases.
Are you a smoker? Then you’re also more ly to get MS. And you’ll probably have a worse case that progresses faster than cases for nonsmokers. Quitting can slow the disease down, though, whether you do it before or after you’re diagnosed.
If you smoke and you have clinically isolated syndrome — a first instance of MS symptoms that lasts for about 24 hours — you have a greater chance of a second episode and an MS diagnosis.
No. You don’t get it from your parents. But the risk factors could be in your genes. If your parents or siblings have it, you’re far more ly to get it, too.
Researchers believe there’s more than one gene that boosts your odds of getting MS. Some think you’re born with something in your genes that makes you more ly to react to triggers in the world around you. Once you’re exposed to it, your immune system responds. New ways to identify genes may help answer questions about the role genetics plays in MS.
There’s growing proof that hormones, including sex hormones, can affect and be affected by your immune system. For example, estrogen and progesterone, two important female sex hormones, may suppress your immune system.
When these hormone levels are higher during pregnancy, women with MS tend to have less disease activity. Testosterone, the primary male hormone, may also suppress the immune response.
Men’s higher levels of testosterone may partly account for the fact that more than twice as many women as men have MS.
Some studies have shown that two viruses from the herpes family might be linked to MS triggers. Almost all people who have the disease have proteins in their spinal fluid also found in people with a nervous system disease caused by a virus. But doctors aren’t sure if the virus was there before the MS, or if it caused MS, or it just happened along with it.
Yes. MS can happen at any age, but most people are diagnosed between 15 and 60.
At one point, people believed each of these might cause MS. But years of research have found no links:
National Multiple Sclerosis Society: “Disproved Theories,” “What causes MS?”
Mayo Clinic: Multiple sclerosis: “Multiple sclerosis: Symptoms & causes,” “Causes.”
Multiple Sclerosis Foundation: “What Causes Multiple Sclerosis?”
© 2019 WebMD, LLC. All rights reserved. Types
Risk Factors for Multiple Sclerosis
Even though the exact cause behind multiple sclerosis (MS) is still unknown, there is increasing evidence suggesting that numerous factors may increase the risk of developing this condition. Some of the most common risk factors for multiple sclerosis include:
- Genetics: While MS is not a hereditary disorder, studies have shown that having immediate relatives such as a parent or siblings with MS may greatly increase a person’s risk of developing the condition.
- Certain infections: A variety of viruses have been found to increase the risk of developing MS. There is mounting evidence that some viruses such as Epstein-Barr virus (EBV) and human herpes virus 6 (HHV-6) may be possible co-factors in MS development.
- Smoking: Research has shown that smokers are 1.5 times more ly to develop MS than nonsmokers. It has been found that cigarette smoking not only increases the susceptibility towards MS but may also contribute to rapid disease progression.
- Obesity: People who are obese are also at an increased risk of developing MS. For example, a Canadian study found that an elevated body mass index (BMI) may influence MS susceptibility.
- Environmental factors: Environmental factors such as climate are also believed to be risk factors for MS. For example, people living in countries and regions with climates such as Canada, Northern Europe, New Zealand, and the northern U.S. are more ly to develop the disease.
- Certain autoimmune diseases: The prevalence of certain autoimmune disorders such as systemic lupus erythematosus (SLE), type 1 diabetes, autoimmune thyroid disease, psoriasis, and rheumatoid arthritis (RA) are known to slightly increase the risk of developing MS.
- Age, sex, and race: Demographic factors such as age, sex and race may increase an individual’s risk of developing MS. For example, the risk of developing MS increases with age. In addition, due to genetic variations, women are twice as ly as men to develop the condition. In terms of race, MS is more common in people of Northern European descent than people of Asian, African or Native American descent.
It is important to note that some risk factors such as smoking and obesity can be avoided by making appropriate dietary and lifestyle changes.
Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
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The Basics of Multiple Sclerosis
Multiple sclerosis, or MS, is a long-lasting disease that can affect your brain, spinal cord, and the optic nerves in your eyes. It can cause problems with vision, balance, muscle control, and other basic body functions.
The effects are often different for everyone who has the disease. Some people have mild symptoms and don’t need treatment. Others will have trouble getting around and doing daily tasks.
MS happens when your immune system attacks a fatty material called myelin, which wraps around your nerve fibers to protect them. Without this outer shell, your nerves become damaged. Scar tissue may form.
The damage means your brain can’t send signals through your body correctly. Your nerves also don’t work as they should to help you move and feel. As a result, you may have symptoms :
- Trouble walking
- Feeling tired
- Muscle weakness or spasms
- Blurred or double vision
- Numbness and tingling
- Sexual problems
- Poor bladder or bowel control
- Problems focusing or remembering
The first symptoms often start between ages 20 and 40. Most people with MS have attacks, also called relapses, when the condition gets noticeably worse. They’re usually followed by times of recovery when symptoms improve. For other people, the disease continues to get worse over time.
In recent years, scientists have found many new treatments that can often help prevent relapses and slow the disease’s effects.
Doctors don’t know for sure what causes MS, but there are many things that seem to make the disease more ly. People with certain genes may have higher chances of getting it. Smoking also may raise the risk.
Some people may get MS after they’ve had a viral infection — the Epstein-Barr virus or the human herpesvirus 6 — that makes their immune system stop working normally. The infection may trigger the disease or cause relapses. Scientists are studying the link between viruses and MS, but they don’t have a clear answer yet.
Some studies suggest that vitamin D, which you can get from sunlight, may strengthen your immune system and protect you from MS. Some people with higher chances of getting the disease who move to sunnier regions seem to lower their risk.
It can be hard to diagnose MS, since its symptoms can be the same as many other nerve disorders. If your doctor thinks you have it, he’ll want you to see a specialist who treats the brain and nervous system, called a neurologist. She’ll ask you about your medical history and check you for key signs of nerve damage in your brain, spinal cord, and optic nerves.
There’s no single test that can prove you have MS. Your doctor will use a few different ones to check you. These may include:
- Blood tests to rule out diseases that cause similar symptoms, Lyme disease and AIDS.
- Checks of your balance, coordination, vision, and other functions to see how well your nerves are working.
- A test that makes detailed pictures of the structures in your body, called an MRI.
- Analysis of the liquid that cushions your brain and spinal cord, called cerebrospinal fluid (CSF). People with MS usually have specific proteins in their CSF.
- Tests (called evoked potentials) that measure the electrical activity in your brain.
- OCT (Optical coherence tomography) used to detect changes in the retina which could warn of brain atrophy
There is no cure for MS right now, but a number of treatments can improve how you feel and keep your body working well.
Your doctor can also prescribe drugs that may slow the course of the disease, prevent or treat attacks, ease your symptoms, or help you manage the stress that can come with the condition.
Drugs that may slow your MS or help nerve damage include:
Your doctor may give you steroids to make your MS attacks shorter and less severe. You can also try other drugs, muscle relaxants, tranquilizers, or botulinum toxin (Botox), to ease muscle spasms and treat some of the other symptoms.
A physical therapist can teach you exercises that will keep up your strength and balance and help you manage fatigue and pain. An occupational therapist can teach you new ways to do certain tasks to make it easier to work and take care of yourself. If you have trouble getting around, a cane, walker, or braces can help you walk more easily.
Along with treatment, you can do other things to ease your MS symptoms. Get regular exercise and avoid too much heat to boost your energy. Ask your doctor about trying yoga to ease fatigue or stress.
Take care of your emotional health, too. It’s OK to ask family, friends, or a counselor for help with any stress or anxiety you may feel.
Support groups are also great places to connect with other people living with MS.
Research is giving doctors more treatment options for the condition, a better idea of what causes it, and the ability to diagnose it earlier. Stem-cell and genetic research may soon help doctors repair damaged nerves or stop the disease before it causes damage.
Scientists are also looking for new ways to treat MS in clinical trials. These trials test new drugs to see if they're safe and if they work. They're often a way for people to try new medicine that isn’t available to everyone. Ask your doctor if one of these trials might be a good fit for you.
National Multiple Sclerosis Society
National Institute of Neurological Disorders and Stroke: “NINDS Multiple Sclerosis Information Page”
MS Coalition: “Emerging Therapies Collaborative”
MS International Federation: “Complementary and Alternative Therapies”
© 2020 WebMD, LLC. All rights reserved. Causes
Multiple Sclerosis: Symptoms, Management & New Research
Multiple sclerosis (MS) is a disease that affects the central nervous system: the brain and spinal cord.
In MS, the body's immune system mistakenly attacks myelin, the protective coat surrounding nerve fibers. The destruction of myelin leads to “sclerosis,” or the formation of scar tissue.
It also impairs the ability of nerve cells to transmit signals in the form of electrical impulses.
MS is an autoimmune disorder. That means that “for some reason, your immune system is acting incorrectly and it becomes intolerant to its own central nervous system,” said Dr. Karen Blitz, director of the North Shore-LIJ Multiple Sclerosis Care Center in East Meadow, New York.
It's not known what causes this condition, which can take an unpredictable and varying course among patients. People with MS can experience a variety of neurological impairments related to the functioning of the brain and spinal cord. This includes problems with vision, muscle control and sensory issues in the limbs, according to the U.S. National Library of Medicine.
MS affects 400,000 Americans and about 2.5 million individuals globally, according to the National Center for Complementary and Integrative Health. Patients are typically diagnosed between ages 20 and 40, and the disease tends to affect women more often than men.
Diagnosing MS is often difficult and requires clinical detective work. “We get a history from the patient, we examine the patient, and then we do some testing,” Blitz said. Looking at symptoms or test results by themselves cannot conclusively point to MS, according to the National Multiple Sclerosis Society.
Tests for MS include neurologic exams (to test nerve function, sensation and reflexes) and Magnetic Resonance Imagining (MRI).
An MRI identifies scarring or lesions in the brain and spinal cord.
One of the key aspects of diagnosing MS is to determine whether nerve damage is present in more than one spot, and whether that damage occurred at different times.
In 2017, the International Panel on the Diagnosis of Multiple Sclerosis published new guidelines — The Revised MacDonald Criteria — on the use of MRIs and cerebrospinal fluid analysis for speedy diagnosis of MS.
Blood tests may be done to rule out diseases that can mimic MS. “There are many such diseases, but some examples include Lyme disease, vasculitis, thyroid dysfunction, B12 deficiency and migraine headaches,” Blitz said. “Then you put all these pieces together to come up with a clinical diagnosis.”
Signs & symptoms
Symptoms of MS can differ in each patient, depending on which nerve fibers are affected. According to the Mayo Clinic, the symptoms include:
- Numbness or weakness, which can occur on one side of the body, or the legs and trunk.
- The sensation of an “electric shock” upon moving the neck, also known as Lhermitte's sign.
- Lack of coordination or unsteady walking.
- Blurred or double vision. Also, partial or total vision loss in one eye at a time, usually with pain during eye movement
- Pain or tingling in different areas of the body.
- Dizziness and fatigue.
- Slurred speech.
- Problems with bowel, bladder or sexual function.
MS causes the immune system to attack the myelin that surround nerve fibers, preventing the proper function of nerve cells. (Image credit: Shutterstock)
Each patient's MS symptoms may progress differently. Patients usually face one of the four following disease courses, according to the U.S. National Library of Medicine:
Relapsing-Remitting: Marked by attacks of MS symptoms (relapses), followed by periods without symptoms (remissions). The attacks do not worsen over time. About 80% of patients are diagnosed with relapsing-remitting MS.
Secondary-Progressive: After about 10 years of experiencing relapsing-remitting MS, the pattern can change into secondary-progressive MS. The attacks progressively worsen, with no periods of remission.
Primary-Progressive: This is the second most common form of MS. With no relapses or remissions, this type is marked by constant and steadily worsening symptoms. About 10-20% of patients have primary-progressive MS.
Progressive-Relapsing: Initially marked by constant, steadily worsening symptoms, similar to primary-progressive MS. However, this rare type also includes attacks of more severe symptoms.
While most MS patients experience one of the disease courses listed above, fulminant MS is another rare form of the disease, which mostly affects children and young adults, according to Cedars-Sinai. It is similar to remitting-relapsing MS, but progresses very rapidly.
Anyone can develop MS. While there is no known cause, according to the Mayo Clinic, several factors may increase the risk of developing the disease. These include:
- Gender. Women are two to three times more ly to develop relapsing-remitting MS.
- Family history. Having a parent or sibling with MS puts you at higher risk of developing the disease.
- Certain infections. Many viral infections are linked to MS. This includes the Epstein-Barr virus, which causes infectious mononucleosis.
- Race. White people, are at highest risk of developing MS. In particular, those of Northern European descent. At the lowest risk, are those of Asian, African or Native American descent.
- Climate. MS is more common in countries farther from the equator, including southern Canada, the northern United States, New Zealand, southeastern Australia and Europe. MS is less common in countries closer to the equator. Lower levels of vitamin D and low exposure to sunlight are also risk factors.
- Certain autoimmune diseases. Having thyroid disease, Type 1 diabetes or inflammatory bowel disease may put one at a slightly higher risk of developing MS.
For people who have MS, certain lifestyle factors have also been linked to the outcome of the disease. For example, people with MS who smoke are more ly than nonsmokers to develop a more severe form of the disease, Blitz said. Additionally, “there is good data now that exercise is another piece of the puzzle,” she said. Patients who exercise seem to do better than those who don't.
Exercise can help ease the symptoms of multiple sclerosis. (Image credit: Shutterstock)
Treatment & medication
The cause of MS is unknown and there's no cure for the disease. However, there are a number of treatments and medications available to treat the symptoms and disease progression. Several FDA-approved drugs can slow the course of MS, reduce the number of relapses and help manage major symptoms. Here are the most commonly used ones.
Corticosteroids: These reduce inflammation associated with relapse and are the most common MS drugs, according to the Mayo Clinic. Oral prednisone and intravenous methylprednisolone are two corticosteroids used.
Interferons: These medications slow the progression of MS symptoms, though they can result in liver damage. Examples include Betaseron, Avonex and Rebif (none of which comes in the generic form).
Glatiramer: Also known as the brand name Copaxone, this IV drug can hinder the immune system's attack on myelin. Side effects can include shortness of breath and flushing, according to the Mayo Clinic.
Natalizumab: Also known as Tysabri, this is used if other drugs don't work or aren't well-tolerated. It impedes potentially damaging immune cells from migrating from the blood to the central nervous system.
Mitoxantrone: Also known as Novantrone, this immunosuppressant is typically used only in advanced MS because of risks to the heart.
For MS sufferers who find it difficult to tolerate the side effects from injections, or who want the convenience of a pill, there are three oral medications approved by the FDA: Tecfidera (dimethyl fumarate), Aubagio (teriflunomide) and Gilenya (fingolimod).
Other MS therapies manage symptoms or address disabilities caused by the condition. Physical and occupational therapists can demonstrate flexibility- and strength-increasing exercises as well as the use of adaptive devices that help patients perform daily tasks, according to the Mayo Clinic.
According to the National Center for Complementary and Integrative Health, some complementary health practices can help to ease MS symptoms. For instance, yoga and tai chi can help with improving fatigue and mood.
THC and cannabinoids may help with spasticity and pain. Marijuana-derived medications are not approved by the FDA at this time.
However, Canada and some European countries have approved Sativex, a prescription mouth spray for muscle control.
Advances in multiple sclerosis research
In 2018, the FDA approved the use of ocrelizumab to treat both relapsing-remitting and primary-progressive MS. In clinical trials, it was shown to significantly slow disease progression in both forms.
In MS patients, B-cells (a type of white blood cell) have been shown to accumulate in lesions, or areas of scarring. The drug, which is an antibody, targets and destroys specific types of B-cells in the body.
As of January 2019, other promising drugs are in late-stage clinical trials, according to a 2019 review published in the journal Lancet. Ibudilast is a drug for the treatment of progressive MS. In Phase 2 trials it reduced the rate of brain atrophy by about 48%. Researchers are also conducting clinical trials with pediatric MS patients to test drugs approved for use in adults.
The review reported that much of current research on treating MS is focused on identifying new biomarkers for the disease, particularly those that can indicate the degeneration of neurons.
This article is for informational purposes only and is not meant to offer medical advice. This article was updated on May 24, 2019, by Live Science Contributor Aparna Vidyasagar.
12 Surprising Factors That Up Your Risk of MS
Experts don't know what causes multiple sclerosis, but both genes and environment seem to play a role
- Multiple sclerosis (MS) is pretty quirky as far as diseases go. Some of the nuances surrounding who gets it and when continue to baffle experts.
- Here’s what they know for sure: MS is an autoimmune disease that occurs when the body misfires against its own central nervous system.
- What sets off the process is unknown, but is thought to be a combo of genes plus environment. Here are 12 things linked to a higher risk of MS.
- Montel Williams and a few other high profile male celebs have been diagnosed with MS, but by and large, MS disproportionately strikes women, says Nancy L. Sicotte, M.D., the director of the Multiple Sclerosis Program at Cedars-Sinai Medical Center in Los Angeles. The gender gap is growing.
- “It used to be two women to every one man, but several new studies suggest it is approaching 4:1,” she says.
- Even though women are more ly to develop MS, the disease tends to be more severe in men, adds John Rose, M.D., a professor of neurology at the University of Utah in Salt Lake City.
People who live closer to the earth’s poles (Think: Australia, New Zealand, parts of North America, Canada, and Iceland) are at higher risk for MS than those who live closer to the equator. This is true in the U.S. too.
MS is twice as prevalent in North Dakota than Florida, for example. “We have always been puzzled by this,” says Dr. Rose. The ly culprit is vitamin D or lack thereof.
Our bodies make vitamin D in response to sunlight, so people far from the equator make less, especially during the long, dark winter months.
Vitamin D deficiency has been linked to a host of illnesses—including MS. But before you go thinking you have a handle on it, there are MS hot spots in locations that do get lots of sunlight including parts of Greece and Italy.
“We think migration patterns and environmental aspects may have something to do with this,” says Dr. Rose.
This is strange, but true. “If your mother was pregnant with you through the winter, you are at greater risk for MS,” Dr. Rose says.
“It’s a curious phenomenon, but if you are born in spring or late spring, your mom’s levels of vitamin D during pregnancy may have been low which could explain it.”
Finnish researchers found that spring babies are at higher risk of MS.
According to this study, an April birth was linked to a 9.4% higher MS risk, while those born in November had an 11.1% lower risk.
MS is more common in whites, particularly those with Northern European ancestry. Some groups—people with African, Asian, Hispanic, and Native American ancestry—seem to be at lower risk, although they can still get the disease.
MS is almost unheard of among some groups according to the
National Multiple Sclerosis Society, including the Inuit, Australian Aborigines, and New Zealand Maoris.
If you move as a child, your risk of MS will change to match your new homeland, whether you move from a low risk to high risk area for MS or vice versa.
However, this is true only if you moved before roughly the ages of 12 to 15; after puberty, such a move doesn’t seem to matter.
“If your parents came to the U.S. from the Orient, they seem protected, as do their children,” Dr. Rose says. “The second generation—i.e.
their grandchildren—may be at a higher risk for developing MS.“ This suggests that environmental factors may play a role, he says.
We all know that smoking is bad news, and that it increases the risk of lung cancer and heart attack. But few know that it's a well established risk factor for MS too.
Smokers and ex-smokers are more ly to be diagnosed with MS than people who never smoked and the more cigarettes you smoke the higher the risk (5-fold greater risk at more than 4 packs a day).
While you can't go back and unsmoke cigarettes from the past (we wish), it can help to quit if you're still puffing away. Research suggests that MS may
progress more quickly in current smokers.
MS can be diagnosed at almost any age, from childhood right on up to your years as a senior citizen. However, it’s more ly to occur in people ages 20 to 50.
“MS is not an all comers disease, “ says Carrie Lyn Sammarco, a nurse practitioner at the Multiple Sclerosis Comprehensive Care Center of New York University Langone Medical Center.
“We don’t tend to see it in children, although it can occur,” she says.
Many germs have been studied as possible MS triggers, but the results have been mixed. There is, however, a growing body of evidence for Epstein-Barr virus (EBV), which causes mononucleosis. (Mono symptoms are fever, sore throat, and swollen glands.
A Journal of the American Medial Association study found higher levels of EBV antibodies in people with MS. (About 95% of people are infected with EBV at some point, but not all get symptoms.) Wayne State University researchers found that a history of EBV is more common in people with MS.
While no cause and effect has been established, “a relationship is clearly present,” they concluded.
Autoimmune diseases tend to cluster. This means that if you have one, you may also develop others.
So that means if you have type 1 diabetes or inflammatory bowel disease, you may have a slightly higher risk of being diagnosed with MS too.
However, the link isn't as strong with other autoimmune diseases, such as lupus and rheumatoid arthritis, says Dr. Rose.
“Genes seem to set up the haywire autoimmune system,” he says.
While the environment has an impact on MS risk, so too, does genetics. “If a mom has MS, her children have a 5% risk of having MS, and if a dad does, his daughters also have a 5% risk, but his sons have less of a risk,” says Dr. Rose.
It’s usually a combo of factors—genes and environmental triggers—that result in MS, even within families.
For example, the MS risk is 1 in 750 for most people, 1 in 40 for those with close family members with the disease, and 1 in 4 for those with an identical twin with it.
Stress can worsen MS symptoms and some research suggests that it can even increase the risk of developing MS in the first place.
One study found that parents of children who died were more ly than other parents to develop MS in the next decade, and the risk seemed even higher—twice as ly—if the death was unexpected (such as an accident).
“We are still trying to figure out how much and what type of stress could lead to flare ups, worsening disease or even cause MS,” Dr. Rose says.