Multiple sclerosis (MS) is a disease that affects the . It causes and the destruction of . Myelin surrounds nerve fibers and acts like insulation on a wire, preventing "short-circuits" that divert a nerve signal from having its desired effects. The "demyelination" process interferes with nerve impulse transmission, affects muscular control, and causes a variety of sensory, motor, and psychological symptoms. Damage to the myelin usually resolves with time and symptoms subside, but repeated attacks can lead to a continual process of demyelination and remyelination, which produces nerve fiber scarring and progressive disability.

The cause of MS is unknown. It is thought to be an autoimmune process triggered by a , environmental factors, and/or a genetic predisposition. Typically, MS first appears and is diagnosed when individuals are between 20 and 50 years of age, although it can occur in young children. It affects women more frequently than men, is more common in Northern European Caucasians than other ethnic groups, and is seen in greater numbers in people who live in temperate climates than warm ones. According to the National Multiple Sclerosis Society, MS affects about 2.1 million people worldwide. It is estimated that about 250,000 to 350,000 people in the U.S. have MS, according to the National Institute on Neurological Disorders and Stroke. The risk of developing this disease is estimated to be about 1 in 750 in the general population. In families with an affected member, the risk rises to 1 in 40, and it is about 1 in 4 for the identical twin of an affected person, strengthening the notion of a genetic component to the cause.

There is no single test that can conclusively diagnose MS. Instead, health practitioners look for a combination of factors to determine if a patient has MS. The factors are described in a document called the "McDonald Criteria," named for the doctor who chaired the 2001 panel of experts charged with establisheding criteria for an accurate diagnosis. The document is updated regularly as new research improves our understanding of the disease. Physicians will consult a patient's medical history and a variety of clinical and laboratory tests to aid in their diagnosis. In applying the criteria for diagnosing MS, a health practitioner must:

Once diagnosed, an individual may be classified as having one of several types of MS, based on signs and symptoms, frequency of relapses, rate of disease progression, and the number of areas that are damaged in the CNS:

Because MS can attack any area of the , the and of MS are many and varied. They are associated with what the nerves in the affected area(s) are responsible for controlling. Symptoms of MS may come and go, and their duration may last from days to months. Some of these include:

According to the National Multiple Sclerosis Society, about 85% of those with multiple sclerosis initially have relapsing-remitting MS. They experience periodic attacks or relapses followed by healing and symptom remission. Later in the course of the disease, about half develop secondary-progressive MS. Their symptoms and disabilities worsen as they continue to have relapses but do not fully recover. About 10% of people with MS have a progressive form of the disease. They grow gradually worse without experiencing remissions.

Although there is no single test or set of tests that can establish a diagnosis of multiple sclerosis (MS), there are three tests that are generally considered useful:

Laboratory tests There are no laboratory tests that are completely specific for multiple sclerosis, but several laboratory tests are helpful in diagnosing or excluding this disease as the cause of a person's signs and symptoms. The most useful tests look for evidence of production within the central nervous system.

IgG index = [IgG (CSF) / IgG (serum)] / [Albumin (CSF) /Albumin (serum)]

An elevated IgG index indicates increased production of IgG within the central nervous system. It is found in about 90% of MS cases.

Health practitioners may also test for diseases that can cause symptoms similar to MS to determine if they may be responsible for a patient's illness. Examples include:

Non-laboratory tests

In addition to the standard MRI, there are a variety of specialized techniques that may be performed, such as functional MRI, magnetic resonance spectroscopy, and diffusion-tensor MRI. The National Multiple Sclerosis Society (NMSS) web site has more information on the use of MRI in MS.

Two other types of evoked potentials may be used, though less commonly. Brain stem auditory evoked potentials (BAEP) is a test that helps detect lesions in the brainstem causing delays in the transmission of sounds. Somatosensory evoked potentials (SSEP) is a test that applies a brief electrical stimulus to the wrist or ankle. It detects disruptions in the pathways from the arms and legs to the brain at very specific points of the central nervous system.

There is no cure for multiple sclerosis, but a variety of treatments are available that can reduce the frequency and severity of relapses.

The goals of MS treatment are to slow the progression of the disease, relieve symptoms, and minimize the effects of acute attacks. Health practitioners may prescribe corticosteroids for short periods of time to help reduce the severity of relapses as well as other medications to address specific symptoms, such as beta interferon, copolymer I, natalizumab and fingolimod, the first oral therapy approved by the U.S. Food and Drug Administration for treatment and management of MS symptoms. Fatigue and depression sometimes associated with MS may be treated with appropriate antidepressants or steroidal drugs. For more on specific medications that may be prescribed, see the Treatments page on the National MS Society web site.

MS does not significantly decrease the lifespan of those who have it, but it can frequently and intermittently affect quality of life. People with MS usually work with a team of professionals who help support and monitor their condition and address their changing needs. Current MS research is directed toward understanding the cause of MS in hopes of developing better drugs to treat, if not cure or prevent the disease.

On This Site Tests: CSF Analysis, Protein Electrophoresis Conditions: Autoimmune Disorders, Sarcoidosis, Vasculitis, Lyme Disease, Systemic Lupus Erythematosus

Elsewhere On The Web Multiple Sclerosis Foundation The National Multiple Sclerosis Society (NMSS) National Institute of Neurological Diseases and Stroke: MS Information Page Multiple Sclerosis Association of America Multiple Sclerosis Discovery Forum

Article Sources

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

(2011) National Multiple Sclerosis Society. Treatments. Available online at http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/treatments/medications/interferon-beta-1b/index.aspx through http://www.nationalmssociety.org. Accessed April 2013.

(2011) National Multiple Sclerosis Society. Diagnosing MS. Available online at http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/diagnosing-ms/index.aspx throughhttp://www.nationalmssociety.org.Accessed April 2013.

(2011) National Multiple Sclerosis Society. Diagnosis Criteria. PDF available for download at http://www.nationalmssociety.org/ms-clinical-care-network/clinical-resources-and-tools/core-curriculum/diagnosing-multiple-sclerosis/diagnostic-criteria/index.aspx through http://www.nationalmssociety.org. Accessed April 2013.

(August 14, 2012) National Institute on Neurologic Disorders and Stroke. Multiple Sclerosis. Available online at http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htm through http://www.ninds.nih.gov. Accessed April 2013.

(Updated April 2013) Luzzio C. Multiple Sclerosis. Medscape Reference. Available online at http://emedicine.medscape.com/article/1146199-overview through http://emedicine.medscape.com. Accessed April 2013.

Sources Used in Previous Reviews

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