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Understanding Multiple Sclerosis

This devastating neurological disease impacts health throughout the body. Learn more — including symptoms and treatment.

The Multiple Sclerosis Foundation estimates that more than 400,000 people in the United States suffer from multiple sclerosis, or MS. Approximately 200 new cases are diagnosed in the U.S. weekly. The disease affects the central nervous system and there is currently no cure.

Jacqueline Marcus, MD, is a neurologist at the Kaiser Permanente San Francisco Medical Center and the director of the Multiple Sclerosis Program, where 6,000 Kaiser Permanente members receive advice and assistance in receiving specialized care.

As an expert dedicated to MS, please tell us more about the disease.

Dr. Jacqueline Marcus

MS is an autoimmune disease in which the body’s immune system mistakenly attacks normal tissues, specifically the brain and spinal cord. The result can include problems with muscle control and strength, bladder and bowel, vision, balance, speech, feeling, and thinking.

Patients may present with one or several symptoms. On average, it first appears in a person’s 20s or 30s. That said, I have seen newly diagnosed patients from 4 years old to into their late 60s. Currently, MS affects 1 in 1,000 people. It seems to be on the rise in women, but is diagnosed in either gender and any ethnicity.

We think that there are some environmental factors that increase risk of disease, such as a vitamin D deficiency. Your chances for MS are much higher if you live far north (or far south) of the equator for the first 15 years of your life. Also, research is incomplete, but there seems to be some genetic predisposition.

How does the disease first appear?

The first symptoms can run the gamut, depending upon which part of the nervous system gets affected. It’s a tricky disease because it can have so many symptoms as well as different degrees of progression, from steady to a sort of stop and start. At Kaiser Permanente, patients are most often first seen by a primary care physician, then referred to a neurologist. That doctor oversees the MS care and makes referrals to other subspecialists as needed.

While there is no cure, there has been a lot of research on MS. There’s a much greater understanding of how to treat the disease now versus 25 years ago. We are seeing that an early introduction of therapies suppressing the immune system and shutting down the disease is typically the best approach. Research shows there is a shortened life expectancy for people with MS, since they may be immobile and thus more susceptible to pneumonia and other byproducts of the disease.

What are some things that are less understood about this complex disease?

One of the hardest things for patients to accept is that the medications prescribed will not fix or cure them. Patients are used to getting a course of antibiotics and then an infection goes away. But MS medications are intended to prevent or decrease new inflammatory or neurological activity rather than take away what has already happened to the nervous system.

Additionally, with MS there may be multiple issues to juggle. For example, one person may be coping all at once with dizziness, insomnia, constipation, and medication side effects. As such, patients will have different priorities in just what to focus on, when, and how. Thus, it’s especially important for physicians and patients to partner on treatment.

What do you recommend for improving quality of life for sufferers?

My mother has MS and is also an instrumental music teacher. As a result, I’ve seen how music can relax and bring joy to MS sufferers. Physical therapy is also important to help people with diminished mobility. I recommend stretching to avoid spasticity, as well as eating well. With MS, the focus is on helping patients to be comfortable and treating their various symptoms.