Multiple sclerosis (MS) is a chronic, neurologic disease that affects nearly one million Americans, according to the National Multiple Sclerosis Society.

It is autoimmune in nature, meaning that somebody’s immune system is inappropriately attacking and damaging the coverings of parts of the neurons in the brain and spinal cord, said Carolyn Goldschmidt, DO, a neuroimmunologist and an MS specialist with Endeavor Health.

“Multiple sclerosis means multiple scars, so that’s what we see on the imaging,” she said.

While there is a genetic component to MS as well as a genetic predisposition to autoimmune diseases in general, for the most part MS is not hereditary, she said.

“There are a number of environmental risk factors that increase the risk of MS, such as low vitamin D levels, exposure to secondhand smoke in childhood, and it’s more common in females than males,” Dr. Goldschmidt said.

The average age of onset for MS is in the 20s and 30s, although it can be found in teenagers as well as seniors.


MS often presents as an acute event. People come to the emergency room for an event like painful vision loss in one eye, which is caused by inflammation of the nerve in the back of one eye, she said. Or, they present with acute inflammation of the spinal cord so they’re having numbness or weakness in an arm or a leg, she said.

Double vision, an inability to walk because of leg weakness or incoordination, and urinary problems are all signs as well. Then there are vague symptoms like trouble balancing, numbness or tingling in the limbs and severe fatigue or weakness, Dr. Goldschmidt said.


MS is diagnosed by history, exam and MRI of the brain and spinal cord, where doctors look for lesions and their size, shape and location. Sometimes, clinicians will do a lumbar puncture and test the spinal fluid for inflammation.

People with MS do not have a shortened life span, there are no issues with fertility, it does not necessarily mean that someone is going to need a cane or a walker or a wheelchair in the future,” Dr. Goldschmidt said. “The medications we have now are very highly effective, especially if we start them early in the disease course.

According to Dr. Goldschmidt, everybody’s MS is different. There is a wide range from very mild, where some people can live their whole lives off medication and have very few symptoms or issues, to more severe situations with paralysis and difficulty walking. Others may have more of a progressive course, where year-to-year they become weaker and more disabled. “But it is certainly not a death sentence and inherently does not shorten somebody’s life span,” she said.


While bouts of acute inflammation require high-dose steroids, long-term care for MS is varied.

“We use what we call disease-modifying therapies, or DMT,” Dr. Goldschmidt said. “At this point, there are over 25 approved disease modifying therapies for multiple sclerosis. Mostly for the relapsing form of MS and some that are approved for the progressive forms of MS as well.”

DMT can include a daily pill, an injection or IV infusions twice a year.

“The newer ones tend to be very effective in shutting down disease activity and are overall safe and well-tolerated,” Dr. Goldschmidt said.

In addition, other treatments and therapies are used to treat symptoms of MS, she said.

“We use a lot of co-management with other specialties like urology, psychology for any depression or anxiety; physical medicine and rehab as well,” she said. “It’s definitely a team-based approach, treating these patients.”

There’s no specific diet that’s proven to be beneficial to treating symptoms of MS, so doctors recommend patients follow a healthy diet and get regular exercise.

“People with MS generally tend to be a group of otherwise healthy patients. They tend to be very active in their own care.”


There are some common misconceptions about MS, Dr. Goldschmidt said.

“Some of the misconceptions are that people will become disabled or will need a wheelchair in 10 years. And that was more often the case 20 years ago before we had these really good medications for MS,” she said. “Now that we have really good medications and we’re catching the disease earlier in people and treating it more aggressively, we’re really trying to prevent this future disability.”

Another misconception is regarding conception.

“It’s diagnosed in young women often of the childbearing age so people are often worried, ‘Can I have kids? Should I get pregnant?” she said. “Absolutely. This doesn’t affect fertility. And you’re not necessarily going to pass this on to your children. Our goal as MS neurologists is for people to live their normal, healthy life and to treat any symptoms or relapses or disability as they come up.”

Dr. Goldschmidt was familiar with MS at a young age, having grown up with an uncle with MS. Throughout her college and training, she was interested in neurology; specifically, neuroimmunology. Neuroimmunologists treat MS and other neurological diseases that are autoimmune in nature. “I find that set of diseases very interesting,” she said. “It’s changed so much in the last 10, 20 years.”

If it seems like you’re hearing more about MS, that could be because there is more reporting of the disease and more people talking about it, she said, perhaps because of celebrities like Christina Applegate, Selma Blair and Jack Osborne opening up about their diagnoses.

“The data does show that it is increasing in prevalence, but is that because it is actually increasing or are we getting better at diagnosing it? But it does seem like autoimmune diseases in general have been on the rise,” she said.

“Also, people are definitely a lot more open about it, there’s a lot more press about it. The MS community in general works really hard. The National MS Society is a great resource that has a lot of good information and good support.”