Editing Multiple sclerosis (section)

{{Short description|Disease that damages the myelin sheaths around nerves}}
{{More medical citations needed|date=July 2022|references that do not meet [[WP:MEDRS|Wikipedia's guidelines for medical content]], or are excessively dated, are contained in this article}}
{{Use dmy dates|date=March 2023}}
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{{Infobox medical condition (new)
| name          = Multiple sclerosis
| image         = MS Demyelinisation CD68 10xv2.jpg
| caption       = [[CD68]]-stained tissue shows several [[macrophages]] in the area of a demyelinated lesion caused by MS.
| field         = [[Neurology]]
| synonyms      = Multiple cerebral sclerosis, multiple cerebro-spinal sclerosis, disseminated sclerosis, encephalomyelitis disseminata
| symptoms      = Involving [[autonomic nervous system|autonomic]], visual, motor, and sensory systems, almost any central or [[Peripheral neuropathy|peripheral neurological symptom]].<ref name="pmid1897097722"/>
| onset         = Age 20–50<ref name=Milo2010 />
| duration      = Long term<ref name=NIH2015 />
| causes        = Unknown<ref name="Nak20122">{{cite journal | vauthors = Nakahara J, Maeda M, Aiso S, Suzuki N | title = Current concepts in multiple sclerosis: autoimmunity versus oligodendrogliopathy | journal = Clinical Reviews in Allergy & Immunology | volume = 42 | issue = 1 | pages = 26–34 | date = February 2012 | pmid = 22189514 | doi = 10.1007/s12016-011-8287-6 | s2cid = 21058811 }}</ref>
| risks         =
| diagnosis     = Based on symptoms and medical tests<ref name="Tsang20112"/>
| treatment     = {{Plain list|
* Disease-modifying therapies<ref name="Liu_2021">{{cite journal | vauthors = Liu Z, Liao Q, Wen H, Zhang Y | title = Disease modifying therapies in relapsing-remitting multiple sclerosis: A systematic review and network meta-analysis | journal = Autoimmunity Reviews | volume = 20 | issue = 6 | pages = 102826 | date = June 2021 | pmid = 33878488 | doi = 10.1016/j.autrev.2021.102826 | s2cid = 233325057 }}</ref>
* Physiotherapy<ref name="Alphonsus_20192">{{cite journal | vauthors = Alphonsus KB, Su Y, D'Arcy C | title = The effect of exercise, yoga and physiotherapy on the quality of life of people with multiple sclerosis: Systematic review and meta-analysis | journal = Complementary Therapies in Medicine | volume = 43 | pages = 188–195 | date = April 2019 | pmid = 30935529 | doi = 10.1016/j.ctim.2019.02.010 | s2cid = 86669723 }}</ref>
* Occupational therapy<ref name="Alphonsus_20192"/>
}}
}}

'''Multiple sclerosis''' ('''MS''') is an [[autoimmune disease]] resulting in damage to [[myelin]]{{snd}}the insulating covers of [[nerve cells]]{{snd}}in the brain and [[spinal cord]].<ref name=NIH2015>{{cite web|title=NINDS Multiple Sclerosis Information Page|url=http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htm|website=National Institute of Neurological Disorders and Stroke|access-date=6 March 2016|date=19 November 2015|url-status=dead|archive-url=https://web.archive.org/web/20160213025406/http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htm|archive-date=13 February 2016}}</ref> As a [[demyelinating disease]], MS disrupts the nervous system's ability to [[Action potential|transmit signals]], resulting in a range of [[signs and symptoms]], including physical, [[cognitive disability|mental]], and sometimes psychiatric problems.<ref name="pmid1897097722">{{cite journal | vauthors = Compston A, Coles A | title = Multiple sclerosis | journal = Lancet | volume = 372 | issue = 9648 | pages = 1502–1517 | date = October 2008 | pmid = 18970977 | doi = 10.1016/S0140-6736(08)61620-7 | s2cid = 195686659 | author1-link = Alastair Compston }}</ref><ref name="pmid119555563">{{cite journal | vauthors = Compston A, Coles A | title = Multiple sclerosis | journal = Lancet | volume = 359 | issue = 9313 | pages = 1221–1231 | date = April 2002 | pmid = 11955556 | doi = 10.1016/S0140-6736(02)08220-X | s2cid = 14207583 }}</ref><ref>{{cite book |vauthors=Murray ED, Buttner EA, Price BH |chapter=Depression and Psychosis in Neurological Practice |veditors=Daroff R, Fenichel G, Jankovic J, Mazziotta J|title=Bradley's neurology in clinical practice.|year=2012|publisher=Elsevier/Saunders|location=Philadelphia, PA|isbn=978-1-4377-0434-1|edition=6th }}</ref> Symptoms include [[double vision]], vision loss, eye pain, muscle weakness, and loss of [[Sensation (psychology)|sensation]] or coordination.<ref name=NIH2015 /><ref name="Piryonesi-2021">{{cite journal | vauthors = Piryonesi SM, Rostampour S, Piryonesi SA | title = Predicting falls and injuries in people with multiple sclerosis using machine learning algorithms | journal = Multiple Sclerosis and Related Disorders | volume = 49 | pages = 102740 | date = April 2021 | pmid = 33450500 | doi = 10.1016/j.msard.2021.102740 | s2cid = 231624230 }}</ref><ref>{{cite journal | vauthors = Mazumder R, Murchison C, Bourdette D, Cameron M | title = Falls in people with multiple sclerosis compared with falls in healthy controls | journal = PLOS ONE | volume = 9 | issue = 9 | pages = e107620 | date = 25 September 2014 | pmid = 25254633 | pmc = 4177842 | doi = 10.1371/journal.pone.0107620 | doi-access = free | bibcode = 2014PLoSO...9j7620M }}</ref> MS takes several forms, with new symptoms either occurring in isolated attacks (relapsing forms) or building up over time (progressive forms).<ref>{{cite journal | vauthors = Baecher-Allan C, Kaskow BJ, Weiner HL | title = Multiple Sclerosis: Mechanisms and Immunotherapy | journal = Neuron | volume = 97 | issue = 4 | pages = 742–768 | date = February 2018 | pmid = 29470968 | doi = 10.1016/j.neuron.2018.01.021 | s2cid = 3499974 | doi-access = free }}</ref><ref name="pmid8780061">{{medical citation needed|date=July 2022}}{{cite journal | vauthors = Lublin FD, Reingold SC | title = Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis | journal = Neurology | volume = 46 | issue = 4 | pages = 907–911 | date = April 1996 | pmid = 8780061 | doi = 10.1212/WNL.46.4.907 | s2cid = 40213123 | author1-link = Fred D. Lublin }}</ref> In relapsing forms of MS, symptoms may disappear completely between attacks, although some permanent neurological problems often remain, especially as the disease advances.<ref name="pmid8780061" /> In progressive forms of MS, bodily function slowly deteriorates once symptoms manifest and will steadily worsen if left untreated.<ref>{{cite journal | vauthors = Loma I, Heyman R | title = Multiple sclerosis: pathogenesis and treatment | journal = Current Neuropharmacology | volume = 9 | issue = 3 | pages = 409–416 | date = September 2011 | pmid = 22379455 | pmc = 3151595 | doi = 10.2174/157015911796557911 }}</ref>

<!-- Cause, pathophysiology, and diagnosis -->
While its cause is unclear, the underlying mechanism is thought to be due to either [[Autoimmune disease|destruction by the immune system]] or inactivation of myelin-producing cells.<ref name="Nak20122"/> Proposed causes for this include immune dysregulation, [[genetics]], and environmental factors, such as [[viral infection]]s.<ref name="Ward 988–1005">{{cite journal |vauthors=Ward M, Goldman MD |date=August 2022 |title=Epidemiology and Pathophysiology of Multiple Sclerosis |journal=Continuum |volume=28 |issue=4 |pages=988–1005 |doi=10.1212/CON.0000000000001136 |pmid=35938654 |s2cid=251375096}}</ref><ref name="Aloisi20222">{{cite journal | vauthors = Aloisi F, Cross AH | title = MINI-review of Epstein-Barr virus involvement in multiple sclerosis etiology and pathogenesis | journal = Journal of Neuroimmunology | volume = 371 | issue =  | pages = 577935 | date = October 2022 | pmid = 35931008 | doi = 10.1016/j.jneuroim.2022.577935 | s2cid = 251152784 }}</ref><ref name="pmid119555563"/><ref name="Ascherio_2007">{{cite journal | vauthors = Ascherio A, Munger KL | title = Environmental risk factors for multiple sclerosis. Part I: the role of infection | journal = Annals of Neurology | volume = 61 | issue = 4 | pages = 288–299 | date = April 2007 | pmid = 17444504 | doi = 10.1002/ana.21117 | s2cid = 7682774 | doi-access = free }}</ref> The [[McDonald criteria]] are a frequently updated set of guidelines used to establish an MS diagnosis.<ref>{{Cite web |date=31 May 2023 |title=The McDonald criteria |url=https://www.mssociety.org.uk/about-ms/diagnosis/the-tests-for-ms/mcdonald-criteria |access-date=November 26, 2024 |website=MS Society UK |archive-date=2 December 2024 |archive-url=https://web.archive.org/web/20241202055738/https://www.mssociety.org.uk/about-ms/diagnosis/the-tests-for-ms/mcdonald-criteria |url-status=live }}</ref>

<!-- Treatment, prognosis -->
There is no cure for MS.<ref name="NIH20152">{{cite web |date=19 November 2015 |title=NINDS Multiple Sclerosis Information Page |url=http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htm |url-status=dead |archive-url=https://web.archive.org/web/20160213025406/http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htm |archive-date=13 February 2016 |access-date=6 March 2016 |website=National Institute of Neurological Disorders and Stroke}}</ref> Current treatments aim to mitigate inflammation and resulting symptoms from acute flares and prevent further attacks with disease-modifying medications.<ref name="pmid119555563"/><ref name="McGinley_2021">{{cite journal | vauthors = McGinley MP, Goldschmidt CH, Rae-Grant AD | title = Diagnosis and Treatment of Multiple Sclerosis: A Review | journal = JAMA | volume = 325 | issue = 8 | pages = 765–779 | date = February 2021 | pmid = 33620411 | doi = 10.1001/jama.2020.26858 | s2cid = 232019589 }}</ref> [[Physical therapy]]<ref name="Alphonsus_20192"/> and [[occupational therapy]],<ref>{{cite journal | vauthors = Quinn É, Hynes SM | title = Occupational therapy interventions for multiple sclerosis: A scoping review | journal = Scandinavian Journal of Occupational Therapy | volume = 28 | issue = 5 | pages = 399–414 | date = July 2021 | pmid = 32643486 | doi = 10.1080/11038128.2020.1786160 | hdl-access = free | s2cid = 220436640 | hdl = 10379/16066 }}</ref> along with patient-centered symptom management, can help with people's ability to function. The long-term outcome is difficult to predict; better outcomes are more often seen in women, those who develop the disease early in life, those with a relapsing course, and those who initially experienced few attacks.<ref name="pmid80178902">{{cite journal | vauthors = Weinshenker BG | title = Natural history of multiple sclerosis | journal = Annals of Neurology | volume = 36 | issue = Suppl | pages = S6-11 | year = 1994 | pmid = 8017890 | doi = 10.1002/ana.410360704 | s2cid = 7140070 }}</ref>

<!-- Epidemiology and history -->
MS is the most common [[immune disorder|immune-mediated disorder]] affecting the [[central nervous system]] (CNS).<ref name="pmid24746689">{{cite journal | vauthors = Berer K, Krishnamoorthy G | title = Microbial view of central nervous system autoimmunity | journal = FEBS Letters | volume = 588 | issue = 22 | pages = 4207–13 | date = November 2014 | pmid = 24746689 | doi = 10.1016/j.febslet.2014.04.007 | bibcode = 2014FEBSL.588.4207B | s2cid = 2772656 }}</ref> In 2020, about 2.8 million people were affected by MS globally, with rates varying widely in different regions and among different populations.<ref name="Lane2022">{{cite journal |vauthors=Lane J, Ng HS, Poyser C, Lucas RM, Tremlett H |title=Multiple sclerosis incidence: A systematic review of change over time by geographical region |journal=Mult Scler Relat Disord |volume=63 |issue= |pages=103932 |date=July 2022 |pmid=35667315 |doi=10.1016/j.msard.2022.103932 |s2cid=249188137 |doi-access=free }}</ref> The disease usually begins between the ages of 20 and 50 and is twice as common in women as in men.<ref name="Milo2010">{{cite journal | vauthors = Milo R, Kahana E | title = Multiple sclerosis: geoepidemiology, genetics and the environment | journal = Autoimmunity Reviews | volume = 9 | issue = 5 | pages = A387-94 | date = March 2010 | pmid = 19932200 | doi = 10.1016/j.autrev.2009.11.010 }}</ref> MS was first described in 1868 by French neurologist [[Jean-Martin Charcot]].<ref name="Charcot1" />

<!-- Etymology -->
The name "multiple [[Sclerosis (medicine)|sclerosis]]" is short for '''multiple cerebro-spinal sclerosis''', which refers to the numerous [[glial scar]]s (or sclerae – essentially plaques or lesions) that develop on the [[white matter]] of the brain and spinal cord.<ref name="Charcot1">{{cite journal | vauthors = Clanet M | title = Jean-Martin Charcot. 1825 to 1893 | journal = International MS Journal | volume = 15 | issue = 2 | pages = 59–61 | date = June 2008 | pmid = 18782501 }}<br />* {{cite journal |vauthors = Charcot J |year=1868 |title=Histologie de la sclerose en plaques |journal=Gazette des Hopitaux, Paris |volume=41 |pages=554–5 }}</ref>
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