Multiple Sclerosis: Top Questions to Ask Your Doctor
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on March 24, 2021.
What Exactly is Multiple Sclerosis?
Multiple sclerosis (MS) is a disorder of the nervous system with symptoms of:
- vision difficulties
- muscle weakness
- problems with movement
In MS, nerve coverings (myelin sheaths) in the brain, eye and spinal cord are damaged, inflamed, and form scar tissue (sclerosis). Nerve signals to or from different parts of the body cannot be transmitted or interpreted through the damaged nerve coverings.
MS does not yet have a cure, and nerve damage is not reversible. The good news is that early treatment can:
- help delay flare-ups
- slow deterioration in the nervous system
- boost quality of life.
What Causes Multiple Sclerosis?
It is not known exactly what causes multiple sclerosis (MS), but it is believed to be an autoimmune disorder where the body inappropriately attacks it own tissues. It is thought white blood cells from the immune system may get into the brain and spinal cord and cause inflammation and damage.
Factors that may affect susceptibility to MS include gender, family history, age, geography and ethnic background.
- About 1 million people in the US are living with MS. The risk in those with a strong family history is higher. If one of your parents or siblings has had MS, you are at higher risk of developing the disease.
- MS can affect anyone; however, women are up to 3 times more likely to get it than men. Some people do have a genetic makeup that may make them more likely to get MS.
- Most people are diagnosed between 20 and 50, although MS can occur in children and older adults, too.
- A combination of environmental and genetic factors probably come into play. Lifestyle factors like cigarette smoking may also increase the risk of MS.
- Most ethnic groups can get MS, but it is more frequently diagnosed in Caucasians of northern European ancestry.
- Geography and possible triggers may have a role as well -- MS is more common in areas farthest from the equator.
How Common is MS?
- If you have been diagnosed with multiple sclerosis (MS), it is important to know that you are not alone. The MS community encompases over 2.3 million people worldwide, according to the National MS Society.
- In fact, multiple sclerosis has been reported as the leading cause of disability in young adults, age 20 to 40 years.
- The prevalence of MS in the U.S. is not exactly known as doctors are not required to report it. However, data from the Cleveland Clinic suggests that MS affects approximately 1 million individuals in the US.
Are There Different Types of MS?
Yes, there are four types of Multiple Sclerosis (MS) patterns:
- Relapsing-Remitting MS (RRMS) is the most common form of MS. RRMS has periods of worsening (also called relapses, flare-ups, or exacerbations) with a period of full recovery (remissions).
- Secondary-Progressive MS (SPMS) usually develops over time and follows RRMS; relapses can occur, but not remissions.
- Roughly 15% of people have Primary-Progressive MS (PPMS) where symptoms worsen from the beginning, and there is no obvious relapse or remission periods.
- A rare form of MS is Progressive-Relapsing MS (PRMS) where the disease slowly progresses from the onset with intermittent relapses. There may be recovery from relapses, but not remissions.
Eventually, over half of RRMS patients will advance into a progressive course.
What is a Relapsing-Remitting MS (RRMS) attack?
A relapsing-remitting MS (RRMS) attack occurs when the symptoms suddenly get worse or new symptoms appear. These symptoms last at least one full day and haven’t been present for one month or more.
For example, your vision may become blurred in one eye, or a numbness in a limb may return. Symptoms can last days, weeks or months, but eventually subside in RRMS.
Lack of rest, alcohol use, or hot weather can bring on flare-ups, so avoid these triggers. Attacks can come and go; you may go for a year or more without symptoms.
How is Multiple Sclerosis Diagnosed?
Multiple sclerosis (MS) is not an easy diagnosis. No specific symptoms, physical findings or laboratory tests can prove someone has MS.
Instead, your doctor (typically a neurologist) will rule out other causes of your symptoms and complete a thorough medical history, a physical exam of your nervous system, and various tests such as:
- magnetic resonance imaging (MRI) of the brain and spinal cord
- an evaluation of the cerebrospinal fluid (CSF)
- certain blood tests.
What Treatments Options Are There for Relapsing Forms of MS?
There are many different treatment options for multiple sclerosis (MS) patients.
Anti-inflammatory agents like prednisone are often used for acute flares in MS to lower nerve inflammation.
Although there are no strict guidelines for first-line, disease-modifying treatment in RRMS, beta interferon preparations such as:
- Avonex (interferon beta-1a)
- Betaseron (interferon beta-1b)
- Extavia (interferon beta-1b)
- Rebif (interferon beta-1a)
are often the first therapy chosen by many doctors to help delay flare-ups. Peginterferon beta-1a (Plegridy) was approved in 2014 and has a longer duration of action; therefore, it is only given once every 14 days. Copaxone is also used as an initial and effective treatment.
A "branded generic" version of Copaxone called Glatopa was approved (20 mg/mL only) by the FDA in April 2015.
From 2010 to present, many novel oral treatments have been FDA-approved for use in MS and can help to lessen the injection burden. These include: Gilenya, Aubagio, Tecfidera, Mayzent, Mavenclad, Zeposia and Ponvory.
Vumerity (diroximel fumarate) from Biogen was approved in October 2019. Vumerity, a twice-daily oral fumarate prodrug offers an improved gastrointestinal (GI) profile compared to Tecfidera.
In April 2020, Bafiertam (monomethyl fumarate) was cleared by the FDA as a bioequivalent agent to Tecfidera (dimethyl fumarate).
What's Available for Advancing MS?
Tysabri (natalizumab) and Lemtrada (alemtuzumab) are options for relapsing patients who cannot tolerate or have had a poor response to other multiple sclerosis (MS) drugs. They are not usually considered first-line agents. Tysabri, given as an intravenous infusion, can be associated with a rare, but often fatal brain disease known as progressive multifocal leukoencephalopathy (PML).
Lemtrada, also given as an intravenous infusion, has a novel dose regimen of only 2 treatment courses, but contains a boxed warning for serious side effects: autoimmune conditions, infusion reactions, and risk of cancer.
In March 2017 Ocrevus (ocrelizumab), a monoclonal antibody designed to selectively target CD20-positive B cells, was FDA approved. It was the first treatment approved for primary progressive multiple sclerosis (PPMS). It's also used for relapsing MS (including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease).
Kesimpta (ofatumumab) was approved in August 2020. It is classified as CD20-directed cytolytic IgG1 antibody used to treat relapsing forms of multiple sclerosis (MS) in adults, to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease. It's intended for patient self-administration at home by once-monthly subcutaneous injection. The most common side effects include upper respiratory tract infections, headache, and injection site reactions.
Recent Oral Novel Approvals: Active Secondary Progressive Disease
In March 2019, the FDA approved Mayzent (siponimod) tablets to treat adults with relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome (CIS), relapsing remitting disease, and active secondary progressive MS (SPMS). Mayzent is classified as a sphingosine-1-phosphate (S1P) receptor modulator. It was the first oral treatment approved for active secondary progressive multiple sclerosis (SPMS).
Also in March 2019, the FDA cleared Mavenclad (cladribine) tablets for relapsing-remitting disease and active secondary progressive disease. This was the second approval for SPMS. Mavenclad is classified as a purine antimetabolite.
In March 2020, Zeposia (ozanimod) was approved for adults to treat relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease. Zeposia is a sphingosine-1-phosphate (S1P) receptor modulator from Bristol-Myers Squibb.
Ponvory (ponesimod) from Janssen was cleared for adults in March 2021. It's a once-daily oral agent for treatment of relapsing forms of multiple sclerosis, to include clinically isolated syndrome, relapsing remitting disease, and active secondary progressive disease. Ponvory is classified as a S1P-1 modulator that binds with high affinity to S1P receptor 1.
Will I Still Be Able to Walk with MS?
Not everyone who gets multiple sclerosis (MS) will develop severe symptoms.
In fact, about 20% to 40% of patients with MS still do not have severe disability after a decade of having MS. Roughly 75% of people can still walk, although some will need a cane, a walker, or a wheelchair because walking can lead to a large expenditure of energy with fatigue and unsteadiness.
Ampyra (dalfampridine) is a potassium channel blocker that was FDA-approved to improve walking in patients with MS. Ampyra is thought to improve nerve function, and in clinical trials it improved walking speed. However, you shouldn't use Ampyra if you have a history of seizures or kidney disease.
Should I Do Physical Therapy or Exercise?
Yes, if your doctor gives you the go-ahead, exercise is an important adjunct therapy in multiple sclerosis (MS).
- Physical therapy and exercise can strengthen your muscles and improve your mental outlook.
- Exercise also increases fitness, mobility, and can promote independence.
- Physical movement can keep bowel patterns normal and improve sleep.
Occupational therapy may be needed if you lose your ability to do certain daily tasks such as eating, dressing, writing or bathing. Speech therapy may be helpful if you have difficulties with speaking or swallowing.
MS: Is Research Promising?
Researchers are getting closer to identifying the cellular and molecular processes responsible for multiple sclerosis (MS).
The recent discovery of additional genetic variants (genes) involved in MS will help to pinpoint specific biological targets for new drug treatment discoveries.
And new patients populations are gaining options: In 2018, Gilenya also received the first FDA approval of a drug to treat MS in pediatric patients age 10 and older.
There is still no cure for MS, but great advances are being made for future drug therapies every day. Current medications can reduce the number of relapses and delay MS progression, and advancement in research that can lead to a cure is promising.
What About Alternative Therapies?
Complementary and alternative medicine (CAM) in multiple sclerosis (MS) can include a wide variety of treatments, and may include:
- special diets
- vitamin supplements
- use of cannabinoids or medical marijuana
- magnetic therapy
- herbal treatments
Some MS patients may use these techniques to complement their traditional prescription medicine.
The American Academy of Neurology has released a guideline on the use of complementary and alternative medicine (CAM) in MS which provides evidence-based recommendations. If you are interested in CAM, be sure to discuss these options with your doctor to weigh the available evidence.
Is There a MS Community to Join?
Multiple Sclerosis (MS) is not considered a fatal disease, and most people with MS live a normal life expectancy. Networking with other people who share your same concerns, questions, and daily challenges is important for any chronic disorder. Having support of not only a healthcare team, but also a team of friends, family and loved-ones is paramount to your progress. Your caregiver may face challenges and stresses, too.
Drugs.com has a comprehensive MS support group where you can ask questions, find support, and keep up with the most recent research and news. Ask your doctor to be frank with you about living with MS, and what you can expect going forward.
Learn More: Join the Multiple Sclerosis (MS) Support Group
What other MS resources are available?
Other reliable websites you can access for up-to-date MS information include:
The National Multiple Sclerosis Society
The National Institute of Neurological Disorders and Stroke.
You can also review additional Drugs.com slideshow information on MS:
Finished: Multiple Sclerosis: Top Questions to Ask Your Doctor
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- Hersh C, Fox R. Multiple Sclerosis. April 2018. The Cleveland Clinic. Accessed March 24, 2021 at https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/multiple_sclerosis/
- Multiple sclerosis FAQs. National Multiple Sclerosis Society. Accessed March 24, 2021 at https://www.nationalmssociety.org/What-is-MS/MS-FAQ-s
- Olek MJ, et al. Clinical features of multiple sclerosis in adults. Up To Date. April 18, 2018 at https://www.uptodate.com/contents/manifestations-of-multiple-sclerosis-in-adults
- Patient Resources. Mellen Center for Multiple Sclerosis. Cleveland Clinic. Accessed March 24, 2021 at https://pages.clevelandclinic.org/multiple-sclerosis-ohio-index.html
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.