Could you have multiple sclerosis and not know it?

About 1 million people in the United States have multiple sclerosis (MS), according to a recent study funded by the National Multiple Sclerosis Society.

Because there is no test for MS before getting an MRI, some people may have MS long before they are diagnosed. If you’re concerned that you could be one of them, there are some common symptoms you should know about.

What is multiple sclerosis?

MS is a chronic inflammatory demyelinating disease of the central nervous system. MS is an autoimmune disease, where the body’s immune system attacks normal tissues — in this case, the nervous system. The autoimmune attack in MS targets the myelin and cells that make myelin, which wraps our neurons to speed up neuronal conduction. MS causes demyelinating lesions in the central nervous system including the brain, spinal cord and optic nerve.

Because MS is a neurological disease, it can inflict a broad range of symptoms on patients. People between the ages of 20 and 40 are the most commonly diagnosed with MS, although it can affect anyone.

What are some common warning signs of MS?

Numbness or weakness in the legs, arms or one side of the body is a common symptom of what are known as discrete attacks, or relapses. Patients often recover fully from these types of attacks, and outcomes vary widely — some patients will have multiple attacks in a year, and others can go many years between relapses. Additional symptoms of a relapse include visual loss, double vision, vertigo, imbalance and difficulty walking.

One form of MS that doesn’t have relapses: progressive MS. People diagnosed with progressive MS typically have first symptoms at 40 years or older, and symptoms are slow worsening of neurological symptoms without relapses.

There are also sometimes early signs that occur before typical symptoms of MS arrive, but these symptoms occur in a variety of settings and aren’t specific to MS. These include:

• Fatigue
• Bowel and bladder symptoms
• Depression
• Cognitive fog

MS researchers are working hard to develop tests to diagnose MS early, but currently, the diagnosis of MS requires a neurological symptoms like a MS attack or progressive symptoms from MS lesions. There are established diagnostic criteria for MS called the McDonald’s criteria. These criteria include neurological symptoms, neurological exam, MRI and cerebral spinal fluid.

Talk with your doctor early about being referred to a neurologist if you notice you’re experiencing symptoms of an MS attack.

How is multiple sclerosis treated?

If you're diagnosed with MS, there are numerous treatment options that can reduce your symptoms. As with any disease, early treatment is vital.

Drugs that significantly decrease relapse rates and improve long-term prognosis are known as disease modifying therapies (DMTs), and there are more than 25 available. There's a growing body of evidence that early treatment with potent DMTs can reduce long-term disability and reduce the percentage of people that develop secondary progressive MS, a form of the disease that has slow worsening of disability and can be harder to treat with DMTs. Progressive MS is primarily driven by loss of neurons and neurodegeneration. Future therapies are being developed to target neurodegeneration and slow progression in MS.

Your neurologist can also prescribe specific drugs to treat MS symptoms, such as limb stiffness, pain, urinary symptoms and fatigue.

Research at The Ohio State University Wexner Medical Center is also helping find new treatments for MS patients. In the Department of Neurology, we're studying new therapies that promote recovery and reduce disability for people living with MS and other neurological diseases. A study is also underway to determine how aging impacts MS.

Ohio State also offers an MS Quality of Life clinic, where each patient receives a thorough examination of their MS symptoms and a comprehensive treatment plan to address them. These plans involve a broad interdisciplinary team of experts, including physical, occupational and speech therapists, sleep specialists, psychologists, cognitive specialists and urologists.