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Multiple Sclerosis (MS)

A long-term condition in which the immune system attacks the protective coating of nerves in the brain and spinal cord. Symptoms differ from person to person. There is no cure, but today’s treatments can cut relapses and slow the disease, and rehabilitation and steady habits help people live well with it.

Call 911 for sudden symptoms — don’t assume it’s your MS. Call 911 right away for sudden numbness or weakness of the face, arm or leg (especially on one side), sudden confusion or trouble speaking or understanding, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness or loss of balance, or a sudden severe headache with no known cause — these can be signs of a stroke (MedlinePlus). The NHS gives the same emergency advice on its MS page (NHS).

Call your MS team promptly if you have new or worsening symptoms, a fever or signs of infection while taking a medicine that weakens the immune system, or any new symptom your medicine’s label tells you to report (see Disease-modifying therapies below). If you are thinking about suicide, call, text or chat 988 — the 988 Lifeline is free, confidential and open 24/7 (988 Lifeline).

What is multiple sclerosis?

Multiple sclerosis (MS) is a chronic neurological disorder. It is an autoimmune disorder: the immune system, which normally protects us from germs, mistakenly attacks healthy cells (NINDS). In MS it attacks myelin, the protective coating around nerve fibers in the brain and spinal cord. Myelin helps nerves send messages quickly; when it is damaged, messages between the brain and body slow down or get blocked (MedlinePlus). The attacks leave patches of scar-like tissue, called plaques or lesions, that show up on MRI scans (NINDS). There is no cure, but treatment can help manage symptoms and slow the disease (MedlinePlus).

Who gets MS?

MS usually begins between ages 20 and 40 (NINDS) and is two to three times more common in women than in men. No one knows the exact cause; several factors seem to work together, including genes, a family history of MS, a past infection with Epstein-Barr virus (the usual cause of mono), smoking, little sun exposure and low vitamin D (MedlinePlus). Most people who catch Epstein-Barr virus never develop MS (NINDS) — see our Epstein-Barr Virus & Mono guide. People who smoke are about twice as likely to develop MS (NHS).

Types of MS

Doctors describe MS by how it behaves over time, and they also note whether it is “active” (relapses or new MRI changes) and whether it is progressing (Lublin et al., Neurology, 2014).

  • Clinically isolated syndrome (CIS): a single episode of MS-like symptoms lasting at least 24 hours. It may be an early sign of MS, but not everyone goes on to develop MS (MedlinePlus).
  • Relapsing-remitting MS: the most common type. Flare-ups of new or worsening symptoms (relapses) are followed by periods of recovery with few or no symptoms (MedlinePlus). Most people are first diagnosed with this form (NINDS).
  • Secondary progressive MS: relapsing-remitting MS can gradually turn into a form in which symptoms steadily worsen, with fewer or no relapses. Disease-modifying therapy can delay and sometimes prevent this change, but it can happen even with treatment (NINDS).
  • Primary progressive MS: less common; symptoms slowly worsen from the start, without clear relapses or recovery periods (MedlinePlus, NHS).
  • Radiologically isolated syndrome (RIS): MRI changes that look like MS in someone with no symptoms. Some people go on to develop symptoms and some do not (MedlinePlus).

Symptoms

Symptoms depend on which nerves are affected (MedlinePlus). Common ones include (NINDS, NHS):

  • Vision problems — blurred or double vision, or optic neuritis (inflammation of the optic nerve), which causes pain with eye movement and vision loss (see our Eyes guide).
  • Numbness, tingling or pain; weakness, stiffness and painful spasms (spasticity).
  • Balance and walking problems and dizziness (see Balance Problems & Fall Prevention and Dizziness & Vertigo).
  • Fatigue — physical tiredness or mental exhaustion.
  • Bladder and bowel problems such as urgency, leaking or constipation (see Bladder Problems and Bowel Problems).
  • Thinking and memory changes, depression and sexual problems.

Many people find their symptoms are worse with a fever, heat or after common infections (NINDS). These symptoms have many other causes, so having them doesn’t mean you have MS — but get them checked (NHS).

How MS is diagnosed

There is no single test for MS. A neurologist takes your history and does a detailed neurological exam, and usually orders an MRI of the brain and spinal cord to look for the typical lesions, sometimes with a contrast dye. A lumbar puncture (spinal tap) checks the fluid around the brain and spinal cord for proteins and immune cells linked with MS, and for conditions that mimic it; evoked potential tests measure how quickly nerve signals travel (NINDS). Blood tests help rule out other conditions (NHS).

The McDonald criteria. Neurologists use international rules called the McDonald criteria. The 2017 version looks for evidence of damage in more than one place in the brain or spinal cord and at more than one point in time, with no better explanation, and lets special antibodies in the spinal fluid (oligoclonal bands) help make the diagnosis (Thompson et al., Lancet Neurology, 2018). The 2024 revision covers relapsing and progressive MS at all ages, counts the optic nerve as a fifth area, and lets newer MRI and spinal fluid markers support the diagnosis (Montalban et al., Lancet Neurology, 2025). Getting it right matters: NINDS notes that misdiagnosis may affect up to 20% of people currently diagnosed with MS (NINDS).

What to expect over time

No one can predict how much MS will affect you: for some people it has only a small impact on daily life, while others have more severe symptoms. Treatments are improving, and most people with MS live into old age, although life expectancy is on average a few years shorter than in the general population. Your care team may include a neurologist, an MS nurse, a physical therapist and an occupational therapist (NHS).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Disease-modifying therapies (injections, pills or infusions) to cut relapses and slow the disease; steroids for serious relapses; medicines and rehabilitation for symptoms such as spasticity, walking, bladder, fatigue and mood. Physical therapy: Medicare Part B covers medically necessary outpatient PT (20% coinsurance after the deductible). Medicines, MRI and neurologist visits: cost estimate being researched. No cure, but treatment can reduce the number and severity of relapses and delay progression. Many medicines need regular blood tests or scans because of infection and other risks.
Chiropractic Spinal manipulation and soft-tissue work, sometimes sought for back or neck pain alongside MS. About $55–$100 for a self-pay follow-up visit and $90–$200 for a first visit. Medicare Part B covers only spinal adjustment for subluxation. We found little research in MS: one small 2026 pilot trial found no clinically meaningful changes. It does not treat MS. New neurological symptoms need a neurologist, not an adjustment.
Acupuncture Needle acupuncture added to standard MS care, most often studied for fatigue and quality of life. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. Small studies suggest less fatigue and better quality of life when added to medicines, but the evidence is low quality. Generally safe with a trained practitioner.
Herbal medicine No herb or supplement is proven to treat MS. Prescription cannabis-based medicines have evidence for spasticity; vitamin D only as your clinician advises. Cost estimate being researched. A cannabis-based mouth spray probably eases spasticity in the short term, but it isn’t approved in the U.S. Vitamin D and fish oil did not reduce relapses or disability in trials. Some herbs may stimulate the immune system or interact with MS medicines.
Massage therapy Gentle Swedish massage or reflexology, alongside exercise and medical care. At one national chain, memberships run about $70–$90 a month for one 60-minute session. Small studies suggest less fatigue and pain, and reflexology may ease tingling or burning sensations, but the studies are small. It does not change the course of MS. Avoid overheating.
MBHA Wellness Coach Staying active, managing heat and fatigue, quitting smoking, sticking with medicines and appointments, mood support and finding support groups. Cost estimate being researched. Supports — never replaces — your MS team. Regular exercise improves fatigue, mobility and quality of life and has not been linked with more relapses.

Approach 1 of 6

Conventional medicine (AMA)

MS treatment has three parts: treating relapses, slowing the disease with disease-modifying therapies (DMTs), and managing symptoms (NINDS, NHS). The type of treatment depends on the type of MS you have, and you’ll probably need different treatments over time (NHS).

1. Treating relapses

For a significant relapse, doctors may prescribe a short course of corticosteroids such as methylprednisolone, usually through a vein, sometimes followed by tablets. They speed recovery from an attack but don’t change the long-term outcome of the disease (NINDS). Not every flare is a relapse — see Relapses, pseudo-relapses and heat below.

2. Disease-modifying therapies

FDA-approved DMTs work by calming or suppressing the inflammation of MS. They are most effective for relapsing-remitting MS and for secondary progressive MS that still has attacks (NINDS). The American Academy of Neurology’s 2018 guideline stressed individualized decisions about starting, switching and stopping DMTs, and counseling about PML risk with several of them (AAN guideline, Neurology, 2018). The main groups are:

  • Injectables: interferon beta and glatiramer acetate. Interferons are now rarely used; they can cause flu-like symptoms, depression and raised liver enzymes (NINDS), and the Avonex label says to report depression or suicidal thoughts right away (FDA label). The Copaxone (glatiramer) label has a boxed warning that life-threatening allergic reactions can happen at any time, even years after starting (FDA label).
  • Anti-CD20 antibodies (ocrelizumab, ofatumumab, ublituximab) target immune B cells. Ocrelizumab (Ocrevus) is approved for relapsing forms of MS and for primary progressive MS in adults, and for relapsing-remitting MS in some children aged 10 and older (FDA label); NINDS calls it the only FDA-approved DMT for primary progressive MS (NINDS). Ofatumumab (Kesimpta) and ublituximab (Briumvi) are approved for relapsing forms in adults; their labels warn of serious infections (FDA label, FDA label). The Ocrevus label also lists PML and requires hepatitis B screening first (FDA label).
  • Natalizumab (Tysabri) carries a boxed warning for PML, a rare brain infection that usually leads to death or severe disability; risk rises with JC virus antibodies, longer treatment and past immune-suppressing medicines, and it is available only through a restricted safety program (FDA label). Regular JC virus antibody tests help manage the risk (NINDS).
  • Alemtuzumab (Lemtrada) has a boxed warning for serious autoimmune conditions, infusion reactions, stroke and cancers, needs monthly checks for years, and is generally reserved for people who haven’t responded to two or more MS drugs (FDA label).
  • S1P receptor modulators (fingolimod, siponimod, ozanimod) are pills. Their labels warn of a slowed heart rate when starting, infections, PML, swelling at the back of the eye, and a severe increase in disability after stopping — so don’t stop on your own (Gilenya label, Mayzent label, Zeposia label).
  • Fumarates (dimethyl fumarate, diroximel fumarate) are pills that commonly cause flushing and stomach upset and can lower white blood cells (NINDS); the Tecfidera label lists PML and shingles (FDA label).
  • Teriflunomide (Aubagio) has a boxed warning for serious liver injury and harm to an unborn baby (FDA label). Cladribine tablets (Mavenclad) have one for cancer risk and birth defects (FDA label).

Choosing a DMT means weighing benefit against risks, how it is taken, the monitoring it needs and your pregnancy plans. We don’t list doses — your neurologist will.

3. Treating symptoms

  • Spasticity: stretching and exercise through water therapy, yoga or physical therapy help mild stiffness, and medicines can help too (NINDS).
  • Walking: dalfampridine (Ampyra) is approved to improve walking in adults with MS; it can cause seizures (FDA label).
  • Bladder and bowel: bladder treatments are available, and constipation can be helped by a high-fiber diet, laxatives and stool softeners (NINDS).
  • Mood and thinking: depression is common and usually treated with cognitive behavioral therapy (CBT) and SSRI antidepressants; uncontrolled laughing or crying and thinking problems can also be treated (NINDS). See our Depression and Anxiety guides.
  • Pain, sexual and vision problems have their own treatments (NHS). A separate MBHA guide to Pain is on the way.

What it costs

  • Physical therapy: Medicare Part B helps pay for medically necessary outpatient PT, including therapy to maintain your current function or slow decline; you pay 20% of the Medicare-approved amount after the deductible (Medicare.gov).
  • DMTs, MRI scans, neurologist visits and other medicines: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care is not a treatment for MS, and we found little research on it in people with MS. NINDS’s list of complementary approaches that some people with MS use does not include chiropractic (NINDS).

What the research says

  • A 2026 pilot trial in 21 people with relapsing-remitting MS compared mid-back manipulation plus trigger point therapy with a sham. It looked mainly at inflammation markers in the blood; changes in symptoms and function were small and below the level considered clinically meaningful (pilot trial, Front Rehabil Sci, 2026).
  • A 2024 case report described a chiropractor who ordered an MRI for a man’s arm weakness and tingling, found MS in the spinal cord and referred him to a neurologist (case report, Cureus, 2024). The lesson is the referral, not the adjustment.

Safety and practical tips

  • Mild soreness, stiffness or headache often follows spinal manipulation and usually passes within 24 hours. Serious problems are very rare, but neck manipulation has been linked to rare artery tears that can lead to stroke (NCCIH).
  • New numbness, weakness or vision changes need your MS team (or 911 if sudden). MBHA suggests avoiding neck manipulation while you have new neurological symptoms.

What it costs

About $55–$100 for a self-pay follow-up visit and about $90–$200 for a first appointment (The Pricer). Medicare Part B covers only adjustment of the spine by a chiropractor to correct a subluxation, and you pay 20% of the approved amount after the deductible (Medicare.gov).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Some people with MS report that acupuncture helps their symptoms (NINDS). NCCIH says only a few studies have looked at it, and those that found a benefit have been criticized for less rigorous methods (NCCIH).

What the research says

Acupuncture has not been shown to change the course of MS. Think of it, at most, as an add-on for symptoms such as fatigue.

Safety and practical tips

  • Acupuncture is considered safe when done by a trained practitioner (NCCIH). Problems have come from non-sterile needles and poor technique; the FDA requires needles to be sterile and single-use (NCCIH).
  • If your MS medicine weakens your immune system, ask your neurologist before starting, and make sure your practitioner knows which medicines you take.

What it costs

Published cash prices run about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer). Medicare covers acupuncture only for chronic low back pain, not for MS (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Many people with MS try special diets and dietary supplements (NCCIH), but there is no evidence that any supplement is effective for MS (NCCIH). Herbal supplements contain active ingredients that can cause harm on their own or interact with other medicines, so tell your doctor about everything you take (NINDS).

Cannabis and cannabinoids

  • A 2022 Cochrane review of 25 trials (3,763 people) found that nabiximols, a cannabis-based mouth spray with equal parts THC and CBD, probably reduces how severe people feel their spasticity is in the short term. Effects on nerve pain were uncertain, and cannabinoids may increase nervous-system and psychiatric side effects (Cochrane review, 2022).
  • The AAN’s 2014 guideline said clinicians might offer certain cannabis extracts for spasticity symptoms and some pain, but warned that unstandardized cannabis extracts vary in quality (AAN guideline, Neurology, 2014).
  • No marijuana-derived medicine is FDA-approved for MS; nabiximols (Sativex) is approved in Canada and some European countries. It is unknown whether smoking marijuana helps MS, and marijuana can be addictive (NCCIH). Over-the-counter CBD products may contain more or less CBD than the label says, may contain THC, and CBD has been linked with liver injury and drug interactions (NCCIH).

Supplements that haven’t helped

Fish oil has not been shown to help MS, ginkgo did not improve thinking, and bee venom therapy seems to have no effect and risks a life-threatening allergic reaction (NCCIH). Cranberry did not reduce urinary tract infections in studies of people with MS (NCCIH). For vitamin D, see Vitamin D and diet below.

Herbs that may work against you

NCCIH notes that Asian ginseng may worsen autoimmune disorders, and that cat’s claw might make the immune system more active and may interact with immunosuppressant medicines (NCCIH). MS is an autoimmune disease and many MS medicines act on the immune system, so check with your neurologist or pharmacist before trying any herb. See our Medication Safety & Interactions guide.

Approach 5 of 6

Massage therapy

Massage won’t change the course of MS, but small studies suggest it may ease some symptoms. NINDS lists touch therapies among complementary approaches some people with MS report helpful (NINDS).

What the research says

Safety and practical tips

  • The risk of harm from massage appears low, but rare serious side effects such as blood clots, nerve injury or fractures have been reported, some with vigorous techniques like deep tissue massage (NCCIH). Reflexology is generally considered safe (NCCIH).
  • Because heat can temporarily worsen MS symptoms (see Relapses, pseudo-relapses and heat), MBHA suggests asking for a cool room and skipping hot stones, saunas and hot tubs.
  • If you have numb areas, tell your therapist — you may not feel when pressure is too firm.

What it costs

At one national chain, memberships currently run about $70–$90 a month for one 60-minute session (about 50 minutes hands-on), with a 12-month first term (The Pricer).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you turn your MS team’s advice into daily habits. A coach doesn’t diagnose or treat, never changes your medicines, and works alongside your neurologist.

Staying active

Staying physically active is very important in MS, because inactivity can worsen stiffness, weakness, pain and fatigue (NINDS). Exercise can be prescribed in people with MS without harm, may reduce fatigue, and wasn’t linked with more relapses in trials (Cochrane review, 2015). A coach can help you build a routine your physical therapist designs, and stick with it — see Rehabilitation and staying active below.

Managing fatigue and heat

Mild-to-moderate daily activity can reduce fatigue, but avoid overdoing it and limit exposure to high temperatures (NINDS). A coach can help you plan your day around your energy, schedule exercise for cooler times, and keep a simple symptom diary. Stress management or relaxation training may help some people (NINDS). Fatigue in MS is not the same as ME/CFS, where exertion can make symptoms worse — see our Chronic Fatigue & ME/CFS guide and ask your clinician if you’re unsure.

Quitting smoking

People who smoke tend to have a more aggressive course of MS, with more brain lesions and brain shrinkage (NINDS). A coach can help you plan to quit.

Sticking with treatment

The AAN guideline includes monitoring whether people take their DMT as prescribed (AAN, 2018). A coach can help you set reminders, track the blood tests and scans your medicine needs, and bring your questions to appointments.

Mood and support

Depression is common in MS and can worsen fatigue and pain (NINDS). Support from other people with MS, through local or online groups, can help (NHS). A coach can help you notice when it’s time to reach out — see our Depression guide, and call or text 988 in a crisis.

Another approach

Relapses, pseudo-relapses and heat

Not every bad day is a relapse. Knowing the difference helps you decide whom to call.

A relapse

A relapse (also called an attack or exacerbation) is a flare-up of new or worsening symptoms (MedlinePlus, NINDS) caused by new inflammation in the brain or spinal cord (Frohman et al., Nat Rev Neurol, 2013). Call your MS team if new symptoms appear or old ones clearly worsen.

A pseudo-relapse

Symptoms can also flare temporarily without new MS damage. In one UK relapse clinic, only 16% of attendees turned out to have a true relapse with new activity on MRI, while pseudo-relapses were more common (19%) — which is why a proper assessment matters before steroids (relapse clinic study, 2025). Infections are a common trigger: in a survey of nearly 3,000 people with MS, recent infections were linked with higher odds of both relapses and pseudo-relapses (registry study, Neurol Clin Pract, 2025).

Heat sensitivity (Uhthoff’s phenomenon)

An estimated 60–80% of people with MS have a temporary worsening of symptoms when they get hot (review, J Appl Physiol, 2010). These short, reversible episodes are called Uhthoff’s phenomena. They can be triggered by exercise, fever, infection, hot weather, the days around a period and stress. Unlike relapses, they come from heat slowing signals in already-damaged nerves, not from new immune attacks (Frohman et al., 2013).

  • Cool down and wait. Symptoms usually ease once your body temperature comes back down (2013). If they don’t settle, call your MS team.
  • Cooling garments such as cooling vests improved walking and mobility and reduced fatigue in a 2023 review of 13 studies, with no harms reported (meta-analysis, Mult Scler Relat Disord, 2023).
  • Don’t give up exercise because of heat. Plan cooler times and places, and pre-cool before workouts if your therapist suggests it.

Remember: sudden one-sided weakness, sudden vision loss or sudden trouble speaking needs 911 first. Don’t assume it’s heat or MS (MedlinePlus).

Another approach

Rehabilitation and staying active

Rehabilitation is a core part of MS care at every stage. A 2019 overview of 15 Cochrane reviews (more than 10,000 people) found moderate-quality evidence that exercise and physical activity improve mobility, muscle strength, fatigue and quality of life, and that structured multidisciplinary rehabilitation programs lead to longer-term gains. It suggested that people with all types of MS may benefit from regular specialist review of their rehabilitation needs (Cochrane overview, 2019).

Therapeutic riding (hippotherapy) has also been studied in MS — see our Horses & Health guide.

Another approach

Pregnancy and family planning

MS often starts in young adulthood (NINDS), so many people with MS think about pregnancy. Talk with your neurologist before trying to conceive, because several MS medicines can harm an unborn baby.

  • Relapses during and after pregnancy. In a European study of 254 women, relapses became less frequent during pregnancy, especially in the third trimester, rose in the first three months after birth, and then returned to the pre-pregnancy rate. Breastfeeding and epidural pain relief did not increase relapses or disability (Confavreux et al., NEJM, 1998).
  • Medicines with pregnancy warnings. Teriflunomide and cladribine carry boxed warnings for birth defects and must not be used in pregnancy (Aubagio label, Mavenclad label). Fingolimod has been linked with more major birth defects in registry data (Gilenya label), and the ofatumumab label advises effective contraception during treatment and for months afterward (Kesimpta label). Some of these drugs take months to leave the body, so plan ahead.
  • A separate MBHA guide to Pregnancy is on the way.

Another approach

Vitamin D and diet: what the evidence says

Vitamin D

People who get more sun or have higher vitamin D levels are less likely to develop MS, and people with MS who have higher levels have fewer relapses and a less severe course (NINDS). But that link doesn’t prove that taking vitamin D helps. A 2018 Cochrane review of 12 trials (933 people) found very low-quality evidence of no benefit: vitamin D did not change relapses, disability or MRI lesions, and effects on fatigue and quality of life were unclear (Cochrane review, 2018). Too much vitamin D can be harmful and even life-threatening (NCCIH). Ask your clinician whether to check your level. We don’t list doses.

Diet

Special diets are popular in MS, such as the Swank diet, which is low in saturated fat (NCCIH). A 2020 Cochrane review of 30 trials found that omega-3 and other polyunsaturated fat supplements probably make little or no difference to relapses or disability, and there isn’t enough evidence to say whether antioxidants or other dietary changes affect MS; every trial had risk-of-bias problems (Cochrane review, 2020). Researchers are still studying the role of diet and the gut microbiome in MS (NINDS).

The honest bottom line: no diet has been proven to change MS. Eating healthy foods is still part of living well with MS (MedlinePlus), and a high-fiber diet helps with constipation (NINDS). Be wary of any plan that asks you to stop your prescribed treatment.

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