While scientists continue to study relapsing-remitting MS, research is also investigating treatments that slow or prevent the steady decline in function in progressive MS. In the MS-SPRINT trial, the NINDS NeuroNEXT clinical trials network tested the drug ibudilast as a potential neuroprotective drug for progressive MS and showed that the drug slowed the rate of brain shrinkage as compared to a placebo. NINDS intramural scientists are conducting proof-of-concept clinical trials on a key driver of clinical progression called the “chronic active lesion.”

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NINDS, a component of the National Institutes of Health (NIH), is the leading federal funder of research on the brain and nervous system, including research on MS. Other components of NIH are funding research on topics relevant to MS, including cognitive impairment, rehabilitation strategies, and telehealth.

Some people with MS report improvement in their symptoms from complementary or alternative approaches. These include acupuncture, aromatherapy, ayurvedic medicine, touch and energy therapies, physical movement disciplines such as yoga and tai chi, herbal supplements, and biofeedback. Learn more about research on complementary health approaches for MS.

Cognitive impairment—a decline in the ability to think, learn, and remember—affects up to 75% of people with MS. These cognitive changes may appear at the same time as the physical symptoms, or they may develop gradually over time. Sometimes, cognitive impairment in people with MS is caused by depression. It is important to rule out depression, first. If cognitive impairment is caused by depression, it can be treated. Drugs such as donepezil may be helpful in some cases.

Although researchers have not been able to identify the exact cause(s) of MS, there has been excellent progress in other areas of MS research—especially in the development of new treatments to prevent exacerbations of the disease. New discoveries are improving and expanding MS treatment options and helping to reduce MS-related disability.

MS causes a variety of symptoms that can interfere with daily activities. Fortunately, many of the symptoms of MS can usually be treated or managed. Neurologists with advanced training in the treatment of MS can prescribe specific medications to treat these problems.

All types of participants are needed—those who are healthy or may have an illness or disease—of all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.

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Sexual dysfunction can result from damage to nerves running through the spinal cord. Sexual problems may also stem from MS symptoms, including fatigue, muscle symptoms, and psychological factors. Some of these problems can be corrected with medications. Counseling (therapy) may be helpful.

NIH supports translational studies to develop therapies that will stop or reverse the course of the disease, focusing on pathways that modify immune system function in the peripheral and central nervous system, repair damaged myelin, or protect neurons from damage. Researchers are also developing improved disease models of MS in animals to more accurately predict drug response in human disease.

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Muscle weakness, stiffness, and spasms may be severe enough to affect walking or standing. In some cases, MS leads to partial or complete paralysis. The use of a wheelchair is not uncommon, particularly in individuals who are untreated or have advanced disease. Many people with MS find that their symptoms are worse when they have a fever or are exposed to heat or following common infections.

Muscle weakness and spasticity are common in MS. It is very important that people with MS stay physically active because physical inactivity can contribute to worsening stiffness, weakness, pain, fatigue, and other symptoms. Stretching and exercising muscles through water therapy, yoga, or physical therapy (PT) can help manage mild spasticity. Medications can also help reduce spasticity.

In MS, the immune system attacks myelin in the central nervous system. Myelin is a mixture of protein and fatty acids that makes up the protective cover (known as the myelin sheath) that coats nerve fibers (axons). Myelin is what gives the brain’s white matter its whitish appearance and helps with communication between neurons. The central nervous system is made up of the brain, the spinal cord, and the optic nerves, which connect the eyes to the brain

Clinical trials are studies that allow us to learn more about disorders and improve care. They can help connect patients with new and upcoming treatment options.

Clinical depression is frequent among people with MS. MS may cause depression as part of the disease process and chemical imbalance in the brain. Depression can intensify symptoms of fatigue, pain, and sexual dysfunction. It is most often treated with cognitive behavioral therapy and selective serotonin reuptake inhibitor (SSRI) antidepressant medications, which are less likely than other antidepressant medications to cause fatigue.

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Fatigue is a common symptom of MS and may be both physical (tiredness in the arms or legs) and cognitive (slowed processing speed or mental exhaustion). Daily physical activity programs of mild to moderate intensity can significantly reduce fatigue, although people should avoid excessive physical activity and minimize exposure to high temperatures. PT and OT can sometimes help manage fatigue. PT provides personalized treatments, while OT teaches ways to use energy wisely. They also help find the right changes in the person’s environment. Stress management programs or relaxation training may help some people.

As part of a larger effort to develop and validate effective biomarkers (signs that may indicate risk of a disease or be used to monitor its progression) for neurological disease, NINDS is supporting two definitive multicenter MS studies:

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There is no cure for MS, but there are treatments that can reduce the number and severity of relapses and delay the long-term progression of the disease.

Studies have found that people who smoke are more likely to develop MS and have a more aggressive disease course. They also tend to have more brain lesions and brain shrinkage than non-smokers.

Other studies aim to develop better neuroimaging tools, such as more powerful MRI methods, to diagnose MS, track disease progression, and assess treatments. Investigators are also using MRI to study the natural history of MS and to help define the mechanism of action and cause of side effects of disease modifying therapies.

NINDS and other NIH Institutes have a very active MS intramural research program among scientists working at NIH (known as “intramural” research). Together, they have:

In addition to NINDS, other NIH Institutes fund research on multiple sclerosis. Find more information on NIH research efforts through NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies. RePORTER also includes links to publications and patents citing support from these projects.

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Having a parent or sibling with MS increases the likelihood of a person getting MS, although MS itself is not an inherited disorder. Research suggests that hundreds of genes and gene variants combine to create vulnerability to MS. Some of these genes have been identified, and most are associated with functions of the immune system. Some of the known genes are similar to those that have been identified in people with other autoimmune diseases, such as inflammatory bowel disease, celiac disease, type 1 diabetes, rheumatoid arthritis, or lupus.

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Women are more likely to get MS than men. People of all races and ethnicities can get MS, but it is most common in White people.

There is no single test used to diagnose MS. Doctors use different tests to rule out or confirm the diagnosis. In addition to a complete medical history, physical examination, and a detailed neurological examination, a doctor may recommend MRI scans of the brain and spinal cord to look for the characteristic lesions of MS. A special dye or contrast agent may be injected into a vein to enhance the brain images.

Inappropriate and involuntary expressions of laughter, crying, or anger—called pseudobulbar symptoms—are sometimes associated with MS, although this is not as common as in some other neurological disorders. These expressions are often incongruent with mood; for example, people with MS may cry when they are actually happy or laugh when they are not especially happy. The combination treatment of the drugs dextromethorphan and quinidine can treat pseudobulbar affect, as can other drugs such as amitriptyline or citalopram.

Many people with MS have difficulty with balance and walking. The most common walking problem is ataxia—unsteady, uncoordinated movements—due to damage to the areas of the brain that coordinate muscle balance. People with severe ataxia generally benefit from the use of a cane, walker, or other assistive device. Physical therapy can also reduce walking problems. Occupational therapy (OT) can help people learn how to walk using an assistive device or in a way that saves physical energy. The FDA has approved the drug dalfampridine to improve walking speed in people with MS.

Because of the risk of interactions between alternative and conventional therapies, people with MS should discuss all the therapies they are using with their doctor, especially herbal supplements. Herbal supplements have biologically active ingredients that could have harmful effects on their own or interact harmfully with other medications.

Sclerosis is a medical term for the distinctive areas of scar-like tissue (also called plaques or lesions) that result from the attack on myelin by the immune system. These areas are visible on an MRI (magnetic resonance imaging). The patches of scar-like tissue can be as small as the head of a pin or as large as a golf ball.

Several viruses have been found in people with MS, but the virus most consistently linked to the development of MS is the Epstein-Barr virus (EBV) which causes infectious mononucleosis. Almost everyone has been infected by EBV at some point in their lives. Only about 5% of the population has not been infected, and these individuals are at a lower risk for developing MS than those who have been infected. People who got EBV during childhood are at a lower risk of getting MS than people who infected with EBV in adolescence or adulthood. However, the vast majority of people who get infected with EBV are not going to develop MS.

Genetic research funded by NINDS is exploring the roles of "susceptibility genes"—genes that are associated with an increased risk for MS. Several candidate genes have been identified and researchers are studying their function in the nervous system to discover how they may lead to the development of MS.

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Multiple sclerosis (MS) is a chronic neurological disorder. It is an autoimmune disorder, meaning that in MS the immune system—which normally protects us from viruses, bacteria, and other threats—mistakenly attacks healthy cells. MS symptoms usually begin in young adults, between the ages of 20 and 40.

MS affects people differently. A small number of people with MS will have mild symptoms with little disability, whereas others will experience worsening symptoms that will lead to increased disability over time. Most people with MS have short periods of symptoms that resolve fully or partially after they appear. These periods are followed by long stretches without noticeable symptoms. Most people with MS have a normal life expectancy.

Tremor, or uncontrollable shaking, develops in some people with MS. Assistive devices are sometimes helpful for people with tremor. Deep brain stimulation and medications may also help.

Current therapies approved by the U.S. Food and Drug Administration (FDA) for MS are designed to modulate or suppress the inflammatory reactions of the disease. They are most effective for relapsing-remitting MS or secondary-progressive MS with residual attacks. They are also effective in some cases of radiologically isolated syndrome to prevent development of clinical MS. Radiologically isolated syndrome is a condition in which a person has abnormal MRI results that look like MS, but doesn’t have MS symptoms.

Corticosteroids, such as methylprednisolone, are prescribed over for three to five days and are usually injected into a vein. Corticosteroids quickly and potently suppress the immune system and reduce inflammation. They may be followed by a tapered dose of oral corticosteroids. Clinical trials have shown that these drugs hasten recovery from MS attacks but do not alter the long-term outcome of the disease.

Problems with bladder control and constipation may include problems with frequency of urination, urgency, or the loss of bladder control. A small number of individuals retain large amounts of urine. Medical treatments are available for bladder-related problems. Constipation is also common and can be treated with a high-fiber diet, laxatives, and stool softeners.

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Pain is rarely the first sign of MS, but pain often occurs with optic neuritis and trigeminal neuralgia. Painful limb spasms and sharp pain shooting down the legs or around the abdomen can also be symptoms of MS.

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Consider participating in a clinical trial so clinicians and scientists can learn more about MS and related disorders. Clinical research with human participants helps researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease.

Research indicates that people who spend more time in the sun, and those with relatively higher levels of vitamin D, are less likely to develop MS than those who do not. Additionally, people with MS who spend significant time in the sun and/or have higher vitamin D levels have a less severe course of disease and fewer relapses. Bright sunlight helps human skin produce vitamin D. Researchers believe that vitamin D may help regulate the immune system in ways that reduce the risk of MS and autoimmune disorders in general. People from regions near the equator, where there is a great deal of bright sunlight, generally have a much lower risk of MS than people from temperate areas such as the U.S. and Canada, where sunshine is highly variable throughout the year.

For information about participating in clinical research visit NIH Clinical Research Trials and You. Learn about clinical trials currently looking for people with MS at Clinicaltrials.gov.

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In addition to causing damage to the myelin sheath, MS also damages the nerve cell bodies, which are found in the brain's gray matter, as well as the axons themselves. As the disease progresses, the outermost layer of the brain, called the cerebral cortex, shrinks. This process is known as cortical atrophy. The way that cortical atrophy happens in MS may connect it with some neurodegenerative disorders.

NINDS-supported research projects cover a wide range of topics. These include co-occurring conditions, mechanisms of cognitive impairment, blood-brain barrier breakdown in MS, the role of sleep and circadian rhythms, rehabilitation strategies, and telehealth. Other topics include:

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The course of MS is different for each person, which makes it difficult to predict how an individual will do with the disease. While many different courses or progressions of MS have been used over the years, these are changing as the scientific and medical community better understands different ways the disease can progress.

Eye and vision problems are common in people with MS but rarely result in permanent blindness. Symptoms may include blurred or grayed vision, temporary blindness in one eye, loss of normal color vision, issues with depth perception, or loss of vision in parts of the visual field. Uncontrolled horizontal or vertical eye movements (nystagmus), “jumping vision" (opsoclonus), and double vision (diplopia) are common in people with MS. Vision therapy exercises, special eyeglasses, and resting the eyes may be helpful.

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Clinical trials have shown that cladribine, diroximel fumarate, and dimethyl fumarate decrease the number of relapses, delay the progression of physical disability, and slow the development of brain lesions.