Multiple sclerosis (MS) is a disease of the central nervous system (CNS) white matter that causes clinical symptoms and signs by eliciting inflammation, local edema, and demyelination in the brain, spinal cord, and optic nerves. The disease afflicts persons almost worldwide, although, with considerable epidemiological variation in incidence and prevalence rates. Women are more often affected than men, with ratios varying from 3:2 to 2:1 in various series (1,2). Young adults most frequently develop MS, but the disease may become evident at virtually any age.

The course of MS is highly variable. When disability results, it is most often a consequence of gait disturbance, impaired sphincteric function, and fatigue. The potential influence of a variety of factors on the natural history of the illness is discussed in this chapter.

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