Multiple Sclerosis (MS): What Happens

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What Happens

Generally, MS follows one of four courses:

• Relapsing-remitting, where symptoms may fade and then recur at random for many years. The disease does not advance during the remissions.
• Secondary progressive, which initially follows a relapsing-remitting course. Later on, it becomes steadily progressive.
• Primary progressive, where the disease is progressive from the start. This course of MS can be devastating.
• Progressive relapsing, where steady deterioration of nerve function begins when symptoms first appear. Symptoms appear and disappear, but nerve damage continues. Few people have this course of MS.

Many people with MS do not follow one of these patterns exactly. The course is often hard to predict. Not only does it vary from person to person, but the pattern may change in an individual over time. MS may be more severe in men than women, particularly in middle-aged men who develop the disease.

MS usually progresses with a series of relapses that occur over many years (relapsing-remitting MS). In many people the first MS attack involves just a single symptom. It may be weeks, months, or years before you have a relapse. As time goes by, symptoms may linger after each relapse so you lose the ability to fully recover from the relapse. New symptoms often develop as the disease damages other areas of the brain or spinal cord .

Events that can indicate you may have a more severe progression of MS include:

• Frequent relapses during the first few years of the disease.
• Incomplete recovery between attacks.
• Early, lasting motor problems that affect movement.
• Many lesions that show up on an MRI early in the disease.

The duration of the disease varies. Most people who get MS live with it for decades. While people with MS often become disabled over time, the disease itself is rarely life-threatening and may not directly reduce your natural life span.

The majority of people who develop MS have a relapsing-remitting course; after about 10 years, approximately half of these people develop secondary progressive MS.

Some people have a few mild attacks from which they recover entirely. This is called benign MS.

Although rare, a small number of people die within several months of the onset of MS. This is called malignant or fulminant MS.

Pregnancy and MS

Since most people diagnosed with MS are women in their child-bearing years, questions about having children are common. Research shows that most couples in which one partner has MS are able to have children without MS affecting the pregnancy, labor, or delivery. Plus, MS does not increase the risk of miscarriage, birth defects, or low birth weight. Some women have fewer MS symptoms during pregnancy, then a temporary relapse after delivery. But pregnancy, delivering a baby, and early motherhood do not increase the risk of being disabled by MS over time.^{2, 3}

People with MS who want to have children should talk to their doctor before trying to become pregnant and should consider the following:

• Men with MS may need help to overcome erectile or ejaculatory problems.
• Some medicines used to treat MS should not be used during pregnancy, and some should not be used during breast-feeding. If you are taking medicine for MS, use reliable birth control until you decide to try to become pregnant. Talk to your doctor about when to stop taking the medicine. In some cases, your doctor may suggest that you wait to start trying to get pregnant until a relapse has ended and you are not taking medicine.
• Some symptoms common in pregnancy and after the baby's birth can be made worse by MS. These include depression and fatigue. Plan for any help you may need to manage your work, household, and other children during pregnancy and for the first few months after the baby is born.
• The baby may be slightly more likely to develop MS later in life than a child born to parents who do not have MS.²
• Think clearly, and talk with your partner and doctor about the future. Some people with MS become disabled over time. Because of this, some couples decide not to have children or to have fewer children than they might have otherwise. Other couples don't change their plans for a family once they learn about MS.
• Find an obstetrician to care for you through your pregnancy and delivery who is willing to work closely with the doctor who helps you manage your MS. Because fatigue, depression, and medication use during breast-feeding are all issues to think about after the baby is born, you may also want the pediatrician you choose for your baby to be aware of your MS.

Complications of MS

Complications that may result from MS include:

• Urinary tract infections (UTIs). People with MS often have bladder problems, such as the inability to control or release urine. These problems increase the risk of UTIs.
• Constipation. Weakness and spasms in the bowel and a low level of physical activity are common in people with MS and can lead to constipation.
• Pressure sores. These can develop when a person has to sit or lie in bed for long periods of time, especially if the person is unable to change positions.
• Reduced ability to move and walk, which makes it necessary to use a wheelchair some or all of the time.

MS should not interfere with most routine health care procedures, such as dental anesthesia, general anesthesia (except if you have respiratory problems), and vaccinations, including flu shots. However, it is not clear whether the nasal spray flu vaccine (flu mist) is safe to use when you have MS. The nasal spray vaccine should not be used by people who are taking medicines that suppress the immune system (immunosuppressants), such as mitoxantrone, cyclophosphamide, or methotrexate; people who have problems with their immune systems; or people with long-term health problems.

If you are thinking about donating blood, talk to your doctor about whether it is safe for you to give blood, and about local blood donation guidelines.

Because MS may affect the ability to move and walk, it can place limits on your daily living, particularly as you age. Many people with MS have some disability, but it is not always severe or constant. On average, people diagnosed with MS live another 30 years or more. A few people have a severe course of MS and die earlier.

If you or someone in your family has MS, talk to your doctor about how MS may affect daily living. Knowing what to expect will help you plan for the future.

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Last updated:	March 23, 2006
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	Kathleen Romito, MD - Family Medicine, Barrie J. Hurwitz, MD - Neurology
Editors:	Kathleen M. Ariss, MS, Pat Truman