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Doctors still don't know what causes MS. The destruction of myelin seems to be due to an abnormal response of the immune system in which cells that normally protect against illness react against the body's own tissues. Exposure to a virus or other toxic or infectious agent in childhood might be the trigger for this abnormal autoimmune response.

Usually, MS begins as a series of attacks followed by complete or partial remissions. This is called relapsing-remitting MS. Some individuals will experience an initial attack and then a gradual worsening of symptoms with no remission. This is called chronic progressive MS. The symptoms of both types of MS are dependent on where in the central nervous system the myelin and nerve fiber are damaged, and the extent of the damage. The first symptom of MS is often blurred or double vision, red-green color distortion, or blindness in one eye. Common symptoms include fatigue, weakness in the hands and feet, numbness, stiffness or muscular spasms, muscle and back pain, difficulties with coordination and balance, loss of bladder or bowel control, and depression. Half of all people with MS will experience cognitive impairments such as difficulties with concentration, attention, memory, and judgment.

Diagnosing MS can be a challenge. A number of diseases produce symptoms that are similar, and there is no single laboratory test that will diagnose MS. When doctors suspect a patient may have the disease, they will take a medical history and conduct a neurological examination. They may also call for imaging tests such as magnetic resonance imaging (MRI), which can reveal the presence of scarring in the brain and spinal cord, or magnetic resonance spectroscopy (MRS), which can yield information about the brain's biochemistry. Doctors may also study cerebrospinal fluid to look for the presence of specific antibodies related to MS.

Is there any treatment?
There is no cure for MS. Traditionally, anti-inflammatory corticosteroid drugs have been the principal medication since they reduce the duration and severity of attacks for most individuals. Doctors now also use a group of beta interferon drugs (such as Avonex, Betaseron, and Rebif) to delay disease progression. There are additional treatments and medications that can relieve specific symptoms such as muscle stiffness and spasms, pain, or bowel and bladder incontinence. Statin drugs have recently been shown to have anti-inflammatory and neuroprotective properties, but they have not yet been evaluated for treatment of MS in clinical trials.

What is the prognosis?
The most common type of MS, the relapsing-remitting kind, is clearly defined by flare-ups and relapses when symptoms become dramatically worse, followed by recovery or remission when symptoms go away completely or partially. A smaller group of individuals, about 15 percent, have progressive MS. Their symptoms generally do not remit and may become worse. About half of those who begin with relapsing-remitting MS develop progressive MS within the first decade after diagnosis. They may continue to have attacks and partial recovery but their symptoms and disabilities slowly become worse. Most individuals with MS have a normal life expectancy but have to learn how to handle the chronic symptoms of the disease. Most individuals will have a mild form of the disease but others will be more impaired and unable to write, speak, or talk.

What research is being done?
Scientists have learned a great deal about MS in recent years by exploring how the body's autoimmune system, infectious or toxic agents, and gene mutations play a potential role in MS. Over the years, MS investigators have studied a number of immunosuppressant treatments and techniques that can positively (if temporarily) affect the course of MS. Toxic side effects have kept them from being widely used. Trials of a synthetic form of myelin, called copolymer I (Copaxone), have been successful, leading the FDA to approve the substance for the treatment of relapsing-remitting MS. Investigators are also looking at the possibility of developing an MS vaccine that would kill the immune system cells that attack myelin.

In 2001, the National Academies/Institute of Medicine, a Federal technical and scientific advisory agency, prepared a strategic review of MS research. To read or download the National Academies/Institute of Medicine report, go to: "Multiple Sclerosis: Current Status and Strategies for the Future."