Multiple Sclerosis

Multiple Sclerosis Overview

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 like:

  • Trouble walking
  • Feeling tired
  • Muscle weakness or spasms
  • Blurred or double vision
  • Numbness and tingling
  • Sexual problems
  • Poor bladder or bowel control
  • Pain
  • Depression
  • 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.

What Causes MS?

Doctors don’t know for sure what causes MS, but there are many things that seem to make the disease more likely. 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 — like 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.

Getting a Diagnosis

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 damagein 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, like Lyme diseaseand 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

Treatment

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:

  • Beta interferon (Avonex, Betaseron, and Rebif)
  • Copolymer-1 (Copaxone)
  • Dalfampridine (Ampyra)
  • Dimethyl fumarate (Tecfidera)
  • Mitoxantrone (Novantrone)
  • Natalizumab (Tysabri)
  • Ocrelizumab (Ocrevus)
  • Teriflunomide (Aubagio)

Your doctor may give you steroids to make your MS attacks shorter and less severe. You can also try other drugs, like 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.

What’s the Outlook for 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.

Possible Causes of Multiple Sclerosis

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.

Your Immune System Goes Awry

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 like 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 likely to get MS if you have another autoimmune condition like inflammatory bowel disease, thyroid disease, or type 1 diabetes.

The Environment Raises Your Odds

MS is more likely to affect people who live in certain places and belong to specific ethnic groups. It’s especially common in cooler climates like Scotland, Scandinavia, and throughout northern Europe — places that are farther from the equator. People who live close to the equator are least likely 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 likely 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 likely 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.

Is Multiple Sclerosis Hereditary?

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 likely 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 likely 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.

Do Sex Hormones Play a Role?

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.

Can Viruses Cause 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.

Does Age Matter?

Yes. MS can happen at any age, but most people are diagnosed between 15 and 60.

What Isn’t an MS Risk Factor?

At one point, people believed each of these might cause MS. But years of research have found no links:

  • Allergies
  • Artificial sweeteners
  • Exposure to heavy metals
  • Pets
  • Physical trauma

What Are the Different Types of Multiple Sclerosis?

In some ways, each person with multiple sclerosis lives with a different illness. Although nerve damage is always a part of the disease, the pattern is unique for everyone.

Doctors have identified a few major types of MS. The categories are important, because they help predict how severe the disease can be and how well treatment will work.

Relapsing-Remitting Multiple Sclerosis

Most people with multiple sclerosis — around 85% — have this type. They usually have their first signs of the disease in their early 20s. After that, they have attacks of symptoms (called relapses) from time to time, followed by weeks, months, or years of recovery (called remissions).

The nerves that are affected, how severe attacks are, the degree of recovery, and the time between relapses all vary widely from person to person.

Eventually, most people with relapsing-remitting MS will move on to a secondary progressive phase of MS.

Primary Progressive Multiple Sclerosis

In primary progressive multiple sclerosis, the disease gradually gets worse over time. There are no well-defined attacks of symptoms, and there is little or no recovery. In addition, MS treatments don’t work as well with this type of MS. About 10% of people with MS have this type.

A few things make it different from other types of MS:

  • People with primary progressive MS are usually older when they’re diagnosed — an average age of 40
  • Roughly equal numbers of men and women get it. In other types of the disease, women outnumber men 3 to 1
  • It usually leads to disability earlier than the most common type, relapsing-remitting MS

Secondary Progressive Multiple Sclerosis

After living with relapsing-remitting MS for many years, most people will get secondary progressive MS. In this type, symptoms begin a steady march without relapses or remissions. (In this way, it’s like primary progressive MS.) The change typically happens between 10 and 20 years after you’re diagnosed with relapsing-remitting MS.

It’s unclear why the disease makes the shift. But scientists know a few things about the process:

  • The older a person is when she’s first diagnosed, the shorter the time she has before the disease becomes secondary progressive
  • People who don’t fully recover from relapses generally move to secondary progressive MS sooner than those who do
  • The process of ongoing nerve damage changes. After the transformation, there’s less inflammation and more of a slow decline in how well the nerves work.

Secondary progressive MS is tough to treat, and the disease can be hard to handle day to day. Symptoms get worse at a different rate for each person. Treatments work moderately well, but most people will have some trouble using their body like they used to.

Progressive Relapsing Multiple Sclerosis

Progressive relapsing multiple sclerosis is the least common form. Relapses or attacks happen every so often. But symptoms continue and get worse between relapses.

This type is rare enough that doctors don’t know much about it. Probably around 5% of people with multiple sclerosis have this form. In many ways, it seems similar to primary progressive MS.

What Causes Multiple Sclerosis?

No one knows. Tantalizing clues have sparked research in many areas, but there are no definite answers. Some theories include:

Geography​:​ People in colder parts of the world get MS more often than those in the warmer parts. Researchers are looking into how vitamin Dand sunlight might protect against the disease.
Smoking . Tobacco may raise the risk slightly. But it’s not the whole story.

Genetics​:​ Genes do play a role. If an identical twin has MS, the other twin has a 20% to 40% chance of getting it. Siblings have a 3% to 5% chance if a brother or sister has it.

Vaccines​:​ Extensive research has essentially ruled out vaccines as a cause of MS.

Epstein-Barr virus exposure​:​ Some research has shown that people who develop MS have antibodies to the EBV in their bodies. That means they have been exposed to the virus. It has also shown that the risk of developing MS is much higher in people who have been ill with EBV.

Multiple sclerosis is probably an autoimmune disease. Like lupus or rheumatoid arthritis, the body creates antibodies against itself, causing damage. In MS, the damage occurs in the covering, or myelin, of nerves.

Relapsing-Remitting Multiple Sclerosis

Most people with multiple sclerosis (MS) have a type called relapsing-remitting MS (RRMS). It usually starts in your 20s or 30s.

If you have RRMS, you may have attacks when your symptoms flare up. These are called relapses.

An attack is followed by a time of recovery when you have no few or no symptoms, called remission. It can last weeks, months, or longer. The disease doesn’t get worse during these breaks.

After 10 to 20 years, RRMS usually changes to a different type of MS called secondary progressive multiple sclerosis. You won’t have relapses as often, but the disease gets gradually worse.

Symptoms of Relapsing-Remitting MS

No two people with MS are likely to have the same symptoms in the same way. Some may come and go or appear once and not again. The symptoms you have depend on the area of your brain or spinal cord that the disease has damaged. They can include:

  • Eye pain and vision problems such as double vision or jumpy vision. These problems may be the first sign you have RRMS
  • Numbness and tingling
  • Sensitivity to heat
  • Pain that runs down the spine, like a mild electrical shock, when you bend your neck
  • Dizziness
  • Bowel or bladder problems
  • Sexual problems, like trouble getting aroused or climaxing
  • Stiff muscles and trouble moving your body
  • Feeling weak and tired
  • Problems with balance and coordination
  • A hard time thinking clearly
  • Depression

An RRMS attack can last anywhere from 24 hours to several weeks. It can involve:

  • One or many symptoms
  • An existing problem that gets worse
  • A new symptom

Tell your doctor about signs of a relapse as soon as possible. If you treat it quickly, you might be able to reduce lasting damage and disability.

Treatment

Most people with RRMS manage the disease with:

  • Medication
  • Physical therapy, occupational therapy, and other forms of rehab
  • Healthy habits

For most people with RRMS, it’s best to start treatment as soon as they’re diagnosed to avoid lasting nerve damage.

RRMS Medication: Disease-Modifying Drugs

Some medications for RRMS fight the disease by turning down the body’s immune system so that it doesn’t attack nerves. These are called disease-modifying drugs (DMDs). Doctors might also call them immunotherapy or disease-modifying therapy (DMT).

These drugs make relapses happen less often and make them less severe. They may keep the disease from getting worse for a while.

You can take some DMDs by injection. These drugs include:

  • Glatiramer (Copaxone)
  • Interferon beta-1a (Avonex, Rebif)
  • Interferon beta-1b (Betaseron)
  • Peginterferon beta -1a (Plegridy)

You’ll need to take some DMDs through an IV at a clinic or hospital. These include:

  • Alemtuzumab (Lemtrada)
  • Mitoxantrone (Novantrone)
  • Natalizumab (Tysabri)
  • Ocrelizumab (Ocrevus)

Three types of DMDs come in pill form. They are:

  • Dimethyl fumarate (Tecfidera)
  • Fingolimod (Gilenya)
  • Teriflunomide (Aubagio)

DMDs have side effects. You and your doctor will weigh the pros and cons of each drug. And your doctor will watch your symptoms closely during treatment.

Steroid Treatment for Flare-ups

The symptom flares of RRMS happen when the brain and spinal cord get inflamed. Reducing the inflammation is key to treating a relapse.

Mild flares may not need treatment. If you have severe symptoms, your doctor may recommend steroids. You can take some of these medications through an IV and others by mouth.

A short-term, high-dose course of steroids can help:

  • Reduce inflammation
  • Make the relapse shorter and less severe

Your doctor may prescribe other types of drugs to treat different RRMS symptoms. For example, you might take:

  • Antidepressants
  • Pain relievers
  • Drugs to fight fatigue

Maintaining a Healthy Lifestyle

A healthy lifestyle is an important way to feel your best. Be sure to:

  • Eat a nutritious diet
  • Keep a healthy weight

It’s also important to be active when you have MS. Exercise can help you:

  • Stay mobile
  • Control your weight
  • Boost your mood and energy levels

Try different types of exercise, including activities to get your heartpumping, like walking or swimming, and moves that strengthen your muscles and stretch your body. When you make an exercise plan, keep in mind:

  • Start slowly, even with 5 to 10 minutes of activity
  • Avoid getting overheated if you are sensitive to temperature
  • Ask a physical therapist to help you build an exercise program

Primary Progressive Multiple Sclerosis

If you have primary progressive multiple sclerosis (PPMS), you probably first saw a doctor because your legs were weak or you had trouble walking. Those are the most common symptoms of this type of MS.

Once it starts, PPMS gets worse over time. How fast that happens or how much disability it will cause varies a lot, so it’s hard to predict. Unlike some other types of MS, you won’t have relapses or remissions.

Only 10% to 15% of people with multiple sclerosis have this form. Those that do are usually diagnosed later in life than people with other types.

It can be hard for doctors to diagnose PPMS. This complex disease is different for everyone who has it. You may have symptoms for a few years, but no major flares, before doctors can tell you’re getting worse.

Symptoms of Primary Progressive MS

This disease mainly affects the nerves in your spinal cord. The main symptoms often involve:

  • Problems walking
  • Weak, stiff legs
  • Trouble with balance

Other common symptoms include:

  • Speech or swallowing issues
  • Vision problems
  • Fatigue and pain
  • Bladder and bowel trouble

What Causes Primary Progressive MS?

Doctors think MS — no matter which type you have — happens when your body attacks itself. This is what’s called an autoimmune disease. In MS, your immune system damages myelin, the protective coating around the nerves in your brain and spinal cord. This causes inflammation.

But in PPMS, there’s little inflammation. Nerve damage is the main problem. Areas of scar tissue (your doctor will call them lesions), form along the damaged nerves in your brain and spinal cord. They can’t send and receive signals the way they should. This causes MS symptoms.

Primary Progressive MS Treatment

There is a medication called ocrelizumab (Ocrevus) that’s approved to treat PPMS. It’s a first-line medication, which means you don’t have to try other therapies before you can take it. It lowers the number of cells in your blood that cause your immune system to go into overdrive and attack the myelin around your nerves. It slows the progress of primary progressive MS. You take it as an infusion into a vein every 6 months. The most common symptoms are itchy skin, rash, sore throat, and a flushed face or fever. You might be more likely to get infections. More serious side effects are rare, but the drug has been linked to cancer, brain infections, and hepatitis B.

Your doctor will also focus on helping you manage your symptoms. You’ll take medications to help you with:

  • Tight muscles
  • Bladder and bowel problems
  • Pain
  • Fatigue

You’ll also get rehabilitation, such as physical, occupational, or speech therapy. It can help with:

  • Speech trouble
  • Swallowing problems
  • Daily activities at home and at work

Take Care of Your Body

It’s important to stay healthy overall no matter which type of MS you have. There are no specific eating plans that help with MS, but a nutritious diet is always best. You should also try to stay at a healthy weight.

Exercise is also good for all types of MS. It can help you:

  • Stay active and mobile
  • Manage your symptoms
  • Control your weight

Exercise can also give you more energy and boost your mood. Try different types of physical activity, such as:

  • Brisk walking, swimming, or other gentle activities that get your heartpumping
  • Exercises to improve your range of motion
  • Stretching and strengthening moves

Start slowly. If you’re sensitive to temperature, be careful not to get overheated. And never exercise until you’re totally exhausted because it will take much longer to recover.

No matter which type of MS you have, ask your doctor to refer you to a physical therapist or physiotherapist. He can help you build an exercise program that’s right for you.

Take Care of Your Mind

Besides the effects on your body, PPMS can take a toll on how you feel about yourself and the world around you.

Given all that you’re going to deal with, it’s not surprising that half of people with PPMS in one study had major depression at some point after their diagnosis. Sometimes it’s caused by the disease itself, or it might be the result of what’s been going on in your life.

A counselor or other mental health professional can help you work through the emotional struggles of living with MS, like navigating shifting relationships; coming to terms with grief, anger, guilt, worry, and loss; and finding the upside of challenging circumstances.

Practice being in the moment and appreciating what you have rather than stressing about what may come.

Just knowing you’re not alone can make a big difference, too. Support groups can connect you with others who can relate to what you’re going through. Check with your MS doctor for recommendations, or try the National MS Society.

With the right frame of mind, you can find and thrive in a new normal.

What’s the Outlook?

Over time, this disease will affect your entire body. You might notice:

  • Both legs are stiff
  • Fuzzy thinking
  • Memory problems
  • You’re tired all the time
  • Stiff muscles
  • Numbness or tingling

You’ll need to be mentally prepared for things you used to do with ease to get harder. Plan ahead — look into transit options before you can’t drive. Find out what your insurance will cover. Be careful of what you drink and schedule bathroom breaks if you have bladder trouble.

Thanks to treatment breakthroughs, health care advances, and lifestyle changes, people are living longer than ever with MS. Doctors think the disease may shorten your life by a few years, compared with people who don’t have it. The biggest risk isn’t from MS, but from complications like heart disease and stroke. But these are easier to prevent with healthier food and more activity.

Secondary Progressive Multiple Sclerosis

People with secondary progressive multiple sclerosis(SPMS) start out with another type of MS — relapsing-remitting multiple sclerosis.

If you’ve been diagnosed with SPMS you may have had relapsing-remitting MS for a decade or more. That’s when you may begin to feel a shift in your disease.

The changes are often not easy to recognize. But you may notice that your relapses may not seem to fully go away.

Most people with relapsing-remitting MS — about 80% — eventually get secondary progressive MS. The relapses and remissions that used to come and go change into symptoms that steadily get worse. The shift typically begins 15 to 20 years after you’re first diagnosed with MS.

Because multiple sclerosis is such a complex disease, it can be hard to spot the changes that signal SPMS, even for health professionals. Doctors often wait at least 6 months before they diagnose SPMS.

Symptoms of Secondary Progressive MS

Relapsing-remitting MS can be unpredictable, but there’s usually a pattern of clear attacks followed by times of recovery. With SPMS, relapses tend to be less distinct. They may happen less often or not at all. When you do have relapses, recovery is not as complete.

Along with these signs, there are other symptoms that might show you’re shifting to SPMS:

  • More weakness and more trouble with coordination
  • Stiff, tight leg muscles
  • Bowel and bladder problems
  • A harder time with fatigue, depression, and problems thinking

Your doctor can only diagnose SPMS by comparing your symptoms over time. So it’s important that you tell her about any changes in your symptoms.

Causes

It’s not clear why people progress from relapse-remitting to secondary progressive MS.

Some scientists think it may be an aftereffect of nerve injury that happened early in the disease. But they need more research to understand what’s behind the shifts in the disease.

Treatment

It’s often harder to treat secondary progressive MS than relapsing-remitting MS.

The main type of drugs for MS, called disease-modifying drugs (DMDs), make relapses happen less often and symptoms less severe. For people with SPMS who still have relapses, DMDs can still help. But for those whose symptoms just get gradually worse, the drugs don’t really work.

The FDA has approved one disease-modifying drug called mitoxantrone (Novantrone) to treat SPMS. But it still mainly works to treat relapses.

Mitoxantrone has serious side effects, including heart problems and leukemia. So there’s a limit to how much people can use it in their lifetimes. It’s usually for people with disease that gets worse quickly when other treatments don’t work.

Another drug called methotrexate, often used to treat rheumatoid arthritis, may improve symptoms in people with SPMS.

Managing Your Symptoms

There are drugs that can ease a lot of the symptoms you might have with SPMS. For example, there are medications to relive pain, bladderproblems, fatigue, and dizziness.

Lifestyle changes can also make a difference. Doctors recommend sticking to a healthy diet and trying to keep your weight under control.

Exercise is also good for SPMS and other types of the disease. Try activities that get your heart pumping a bit, like brisk walking or swimming, and those that help you stretch and strengthen your muscles and improve your range of motion. They’ll give you more energy and boost your mood. It’s also a good way to control your weight.

Progressive Relapsing Multiple Sclerosis

If you have progressive relapsing multiple sclerosis (PRMS), you’ll have distinct attacks of symptoms, called relapses. You may or may not fully recover after these flares. Between relapses, the disease continues to get worse slowly.

PRMS is the least common type of multiple sclerosis. It affects about 5% of people with the condition.

You may not be able to reverse the disease, but there are treatments that can ease your symptoms and make your relapses less severe and happen less often.

Symptoms of Progressive Relapsing MS

No two people are likely to have the same set of MS symptoms in the same way. Some problems may come and go or happen once and not again. The way MS affects you depends on which areas of your brain or spinal cord have damage from the disease.

Symptoms of PRMS may include:

  • Eye pain and vision problems, such as double vision or jumpy vision
  • Numbness and tingling
  • Sensitivity to heat
  • Pain that runs down your spine, like a mild electrical shock, when you bend your neck
  • Dizziness
  • Bowel or bladder problems
  • Sexual problems, like trouble getting aroused or climaxing
  • Trouble moving and muscle stiffness
  • Weakness and fatigue
  • Problems with balance and coordination
  • A hard time thinking clearly
  • Depression

A relapse can last anywhere from 24 hours to several weeks. You might feel new symptoms or have old ones get worse for a time. Unlike other types of MS, you won’t have any remissions or times where you have few or no symptoms.

Tell your doctor about any signs you’re having a relapse as soon as possible. If you treat it quickly, you might reduce permanent damage and disability.

Treatment With Disease-Modifying Drugs

People with PRMS take medications called disease-modifying drugs (DMDs). These drugs help you have fewer relapses and make your symptoms less severe during these attacks.

DMDs, also called immunotherapy or disease-modifying therapy (DMT), may slow down the disease. They’re the cornerstone of treatment for most types of MS.

You take some DMDs through injections, which you can do on your own. These include:

  • Glatiramer acetate (Copaxone)
  • Interferon beta-1a (Avonex)
  • Interferon beta-1b (Betaseron)
  • Peginterferon (Plegridy)

For other DMDs, you’ll get it through an IV at a clinic or hospital. These drugs include:

  • Mitoxantrone (Novatrone)
  • Natalizumab (Tysabri)
  • Ocrelizumab (Ocrevus)

There are three types of DMDs that come in pills:

  • Dimethyl fumarate (Tecfidera)
  • Fingolimod (Gilenya)
  • Teriflunomide (Aubagio)

All of these drugs have side effects, some more severe than others. Your doctor will want to keep close track of your symptoms while you’re taking them. Together, you’ll weigh the risks and benefits of each drug.

Treating Flare-ups With Steroids

You may not need treatment for a mild flare. But for more severe symptoms that make it hard to do day-to-day tasks, steroids can help.

A high-dose, short-term course of steroids (in pills or through an IV) helps reduce inflammation and makes relapses shorter and less severe.

Besides steroids, you can also take other drugs to ease specific MS symptoms, such as pain, bladder problems, fatigue, or dizziness. Options can include:

  • Antidepressants
  • Pain relievers
  • Medications to reduce fatigue

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