In many ways, the inflammatory attack in the central nervous system (CNS) of MSers is like a twisted ankle. The main difference between a twisted ankle and an MS brain is that the brain is trapped in a rigid box (called the skull) that is noncompliant (meaning that it cannot stretch like the skin around a twisted ankle). Because of the continuous, low-lying, microscopic, inflammatory, demyelinating disease that is going on in the CNS of MSers, there is a constant, elevated interstitial pressure (pressure within the brain tissue) that has nowhere to go and winds up pushing upon the adjacent, compressible, jellylike nerves in the brain, brain stem, and spinal cord, which causes a significant number of them to not work properly.

Happily though, we do have medications (like disease modifying therapies and steroids) that work on a microscopic level that can reduce this pressure.


  1. MS causes a constant, covert, elevated pressure in interstitial spaces (the spaces between the nerve cells) of the CNS.
  2. This elevated intracerebral pressure comes from the WBCs that are demyelinating nerves and the inflammatory fluid that accompanies them in the CNS.
  3. Elevated pressure can cause global, as opposed to focal, deficits since it affects the entire CNS.
  4. The constant, elevated pressure in the CNS of people with MS causes changes in behavior and cognition that cannot be appreciated just by looking at the MSer. This is the invisible MS. It is potentially reversible with therapies that reduce the elevated interstitial pressure.
  5. The constant, elevated pressure in the CNS of people with MS also causes a variable worsening of the visible, physical problems caused by focal demyelination and nerve cell loss.

If a person can accept the idea that elevated interstitial pressure causes a global lesion that worsens nerve functioning, then it becomes a lot easier to understand what has been described, until now, as the “hidden MS.” Symptoms associated with the hidden MS are hidden because they are products of something no one can see—the mind. Our frontal lobes integrate the data that other parts of the brain collect. They get input from almost everywhere else in the brain and then make the decision about what action to take based on the information received. One of the responsibilities of frontal lobe processing is to govern behavior. If a percentage of the nerves in the frontal lobes have stopped working, because of the effects of pressure, temperature, and/or demyelination, then the processor cannot produce the behaviors the way it did before. The symptoms include troubles with:

  1. Initiative – trouble getting out of bed or getting off the couch
  2. Concentration – trouble with paying attention and staying on task
  3. Emotional control – going from laughing to crying to laughing, moment to moment
  4. Coital activity – the human sexual response cycle starts with Desire which comes form the frontal lobes
  5. Urinary control – the frontal lobes are what automatically inhibit urination when it is not appropriate to urinate (i.e. when you are not in the bathroom)
  6. Behavior that is socially appropriate – the “gatekeeper” in our frontal lobes is what stops us from saying things that we are thinking but are not appropriate to say aloud.

These symptoms have been the bane of my time with MS, which has been the majority of my life. I call them the MS ICE CUBe or The MS ICE for short.

You can read more about the causes of and treatments for The MS ICE CUBe in my book Multiple Sclerosis From Both Sides of the Desk .

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