What Causes MS? Understanding Multiple Sclerosis Triggers

Multiple sclerosis (MS) is a condition where the immune system mistakenly attacks the protective myelin sheath around nerve fibers, disrupting communication between the brain and the body. While the exact cause of MS remains unknown, certain risk factors and triggers have been identified. At WHAT.EDU.VN, we aim to provide clear and accessible information to help you understand this complex condition and manage its symptoms effectively. Understanding the factors that increase your risk and potential triggers for MS can empower you to make informed decisions about your health and well-being, and you can also ask for free consultancy on WHAT.EDU.VN. The potential risk factors include genetics, infections, environmental factors, and lifestyle choices.

1. What Is the Primary Cause of Multiple Sclerosis (MS)?

The exact cause of multiple sclerosis (MS) is unknown. However, MS is considered an autoimmune disease where the body’s immune system attacks its own tissues, specifically the myelin sheath that protects nerve fibers in the brain and spinal cord. This damage disrupts communication between the brain and the body.

1.1 What Factors Contribute to the Development of MS?

Several factors are believed to play a role in the development of MS:

Genetic Predisposition: MS is not directly inherited, but individuals with a family history of the disease have a higher risk.
Environmental Factors:
- Vitamin D Deficiency: Low levels of vitamin D and reduced exposure to sunlight are associated with an increased risk of MS and more severe disease progression.
- Geographic Location: MS is more prevalent in regions farther from the equator, such as Canada, the northern US, New Zealand, southeastern Australia, and Europe.
Infections: Certain viral infections, such as the Epstein-Barr virus (EBV) that causes mononucleosis, have been linked to an increased risk of MS.
Lifestyle Factors:
- Smoking: Smoking is associated with more relapses, worse disease progression, and increased cognitive symptoms in people with MS.
- Obesity: Being overweight increases the likelihood of developing MS and is linked to more severe disease and faster progression.
Autoimmune Conditions: Having other autoimmune diseases, such as thyroid disease, type 1 diabetes, or inflammatory bowel disease, may slightly increase the risk of MS.
Age and Sex: While MS can occur at any age, it typically appears between 20 and 40 years old. Women are two to three times more likely to develop relapsing-remitting MS than men.
Ethnic Background: White people, especially those of Northern European descent, have the highest risk of developing MS. People of Asian, African, and Native American ancestry have the lowest risk.

1.2 How Does Myelin Damage Lead to MS Symptoms?

Damage to the myelin sheath, known as demyelination, disrupts the transmission of nerve signals. This can lead to a wide range of symptoms, including:

Vision Problems: Optic neuritis, causing blurred vision, double vision, or vision loss in one eye.
Motor Impairment: Muscle weakness, stiffness, spasms, and difficulty with coordination and balance.
Sensory Changes: Numbness, tingling, pain, and burning sensations.
Fatigue: Overwhelming tiredness that is not relieved by rest.
Cognitive Dysfunction: Problems with memory, concentration, and information processing.
Bowel and Bladder Issues: Incontinence, frequent urination, and constipation.
Sexual Dysfunction: Decreased libido, erectile dysfunction, and difficulty reaching orgasm.
Depression: Feelings of sadness, hopelessness, and loss of interest in activities.

2. What Role Does Genetics Play in MS Development?

Genetics play a complex but significant role in the development of multiple sclerosis. While MS is not considered a directly inherited disease like cystic fibrosis or Huntington’s disease, having a family history of MS does increase an individual’s risk of developing the condition. This suggests that certain genes may predispose individuals to MS, but these genes alone are not sufficient to cause the disease.

2.1 How Does Family History Affect MS Risk?

The risk of developing MS in the general population is about 0.5%. However, if a parent, sibling, or child has MS, the risk increases to approximately 1-3%. This increase indicates a genetic component, but the risk is still relatively low, suggesting that environmental factors and other triggers also play a crucial role.

2.2 What Genes Are Associated with MS?

Researchers have identified several genes that are associated with an increased risk of MS, most of which are involved in the immune system. The most significant genetic association is with the human leukocyte antigen (HLA) region, particularly the HLA-DRB1*15:01 allele. This gene variant is strongly linked to an increased risk of MS in various populations.

Other genes that have been implicated in MS susceptibility include those involved in immune regulation, such as:

IL2RA: Interleukin-2 receptor alpha chain, which plays a role in T cell function.
IL7R: Interleukin-7 receptor, important for the development and survival of lymphocytes.
CD58: A cell adhesion molecule involved in T cell activation.

These genes, along with others, contribute to the complex genetic architecture of MS. However, it’s important to note that these genes only account for a portion of the overall risk, and many individuals with these gene variants do not develop MS.

2.3 How Do Genes and Environment Interact in MS?

The interaction between genes and environmental factors is believed to be critical in the development of MS. Individuals with a genetic predisposition may be more susceptible to environmental triggers that can initiate the autoimmune process leading to MS. These triggers may include viral infections, vitamin D deficiency, smoking, and obesity.

For example, someone with the HLA-DRB1*15:01 allele may have a higher risk of developing MS if they also have low vitamin D levels and a history of Epstein-Barr virus infection. This combination of genetic susceptibility and environmental factors can increase the likelihood of the immune system attacking the myelin sheath.

2.4 Can Genetic Testing Predict MS Risk?

Currently, genetic testing is not used to predict the risk of developing MS. While researchers have identified genes associated with MS, these genes do not guarantee that someone will develop the disease. Genetic testing may identify a predisposition, but it cannot determine whether someone will ultimately develop MS.

Instead, diagnosis of MS relies on a combination of clinical evaluation, neurological examination, MRI scans, and spinal fluid analysis. These tests help to identify the characteristic signs of MS, such as lesions in the brain and spinal cord, and to rule out other conditions that may mimic MS symptoms.

3. What Is the Connection Between Viral Infections and MS?

Viral infections have long been suspected to play a role in the development of multiple sclerosis. Several viruses have been linked to an increased risk of MS, although the exact mechanisms by which they contribute to the disease are still being investigated.

3.1 Which Viruses Are Associated with MS?

The most consistently associated virus with MS is the Epstein-Barr virus (EBV). EBV is a common virus that causes mononucleosis (mono) and infects most people at some point in their lives. Studies have shown that individuals who have had EBV infection have a significantly higher risk of developing MS.

Other viruses that have been investigated for their potential role in MS include:

Human Herpesvirus 6 (HHV-6): A common virus that can cause roseola in children.
Varicella-Zoster Virus (VZV): The virus that causes chickenpox and shingles.
Human T-lymphotropic Virus Type 1 (HTLV-1): A retrovirus that can cause leukemia and neurological disorders.

While these viruses have been linked to MS in some studies, the evidence is not as strong as the association with EBV.

3.2 How Might Viruses Trigger MS?

Several mechanisms have been proposed to explain how viral infections might trigger the autoimmune processes that lead to MS:

Molecular Mimicry: Viruses may contain proteins that are similar in structure to myelin proteins. When the immune system responds to the viral proteins, it may mistakenly attack the myelin sheath due to this similarity.
Bystander Activation: Viral infections can cause inflammation and immune activation in the brain and spinal cord. This inflammation may inadvertently activate immune cells that attack myelin.
Persistent Infection: Some viruses, such as EBV, can persist in the body for life. This persistent infection may lead to chronic immune activation and an ongoing risk of autoimmune attacks.
Epitope Spreading: Damage to the myelin sheath caused by a viral infection may expose myelin proteins to the immune system. This exposure can trigger an immune response against these proteins, leading to a chronic autoimmune attack.

3.3 Can Preventing Viral Infections Reduce MS Risk?

Given the association between viral infections and MS, researchers are exploring whether preventing or treating these infections could reduce the risk of developing MS.

EBV Vaccine: Efforts are underway to develop a vaccine against EBV. If successful, this vaccine could potentially reduce the risk of MS in individuals who are vaccinated before EBV infection.
Antiviral Therapies: Some researchers are investigating whether antiviral therapies can help to prevent or treat MS in individuals with evidence of viral infection.
Lifestyle Measures: Maintaining a healthy immune system through proper nutrition, exercise, and stress management may help to reduce the risk of viral infections and their potential impact on MS risk.

3.4 What Research Is Being Done on Viruses and MS?

Ongoing research is focused on further elucidating the role of viruses in MS and developing strategies to prevent or treat virus-related MS. This research includes:

Epidemiological Studies: Examining the prevalence of viral infections in individuals with MS and comparing them to control groups.
Immunological Studies: Investigating the immune responses to viruses in individuals with MS and identifying potential targets for therapy.
Clinical Trials: Testing antiviral therapies and vaccines in individuals at risk of or with MS.

4. How Does Vitamin D Deficiency Contribute to MS?

Vitamin D deficiency has been identified as a significant environmental risk factor for multiple sclerosis. Numerous studies have demonstrated a strong association between low vitamin D levels and an increased risk of developing MS, as well as more severe disease progression.

4.1 What Is the Role of Vitamin D in the Body?

Vitamin D is a fat-soluble vitamin that plays a crucial role in various bodily functions, including:

Calcium Absorption: Vitamin D helps the body absorb calcium from the diet, which is essential for bone health and preventing osteoporosis.
Immune Function: Vitamin D modulates the immune system, helping to regulate immune responses and prevent autoimmune reactions.
Nerve Function: Vitamin D supports the health and function of nerve cells, which is important for transmitting signals throughout the body.
Cell Growth: Vitamin D influences cell growth and differentiation, helping to prevent abnormal cell proliferation.

4.2 How Does Vitamin D Affect MS Risk and Severity?

Several mechanisms have been proposed to explain how vitamin D deficiency may contribute to MS:

Immune Dysregulation: Vitamin D deficiency can lead to immune dysregulation, increasing the risk of autoimmune attacks on the myelin sheath.
Reduced T Cell Regulation: Vitamin D helps to regulate T cells, which are important for controlling immune responses. Low vitamin D levels can impair T cell function, leading to increased inflammation and myelin damage.
Increased Inflammation: Vitamin D has anti-inflammatory properties. Deficiency can result in increased inflammation in the brain and spinal cord, exacerbating MS symptoms and progression.
Nerve Damage: Vitamin D protects nerve cells from damage. Low levels can increase the vulnerability of nerve cells to injury, leading to more severe neurological symptoms.

Studies have shown that individuals with higher vitamin D levels have a lower risk of developing MS and tend to have milder disease with fewer relapses and slower progression.

4.3 What Are the Optimal Vitamin D Levels for MS Prevention?

The optimal vitamin D levels for MS prevention and management are a subject of ongoing research. However, most experts recommend maintaining a serum vitamin D level of at least 30 ng/mL (75 nmol/L). Some experts suggest that higher levels, such as 40-60 ng/mL (100-150 nmol/L), may be more beneficial.

It is important to consult with a healthcare provider to determine the appropriate vitamin D level for your individual needs and to monitor your levels regularly.

4.4 How Can You Increase Vitamin D Levels?

There are several ways to increase vitamin D levels:

Sun Exposure: The body produces vitamin D when exposed to sunlight. Spending 15-20 minutes in the sun each day can help to boost vitamin D levels. However, it’s important to protect your skin from sunburn by using sunscreen and limiting exposure during peak hours.
Diet: Certain foods are rich in vitamin D, such as fatty fish (salmon, tuna, mackerel), egg yolks, and fortified foods (milk, cereal, orange juice).
Supplements: Vitamin D supplements are available in two forms: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Vitamin D3 is generally considered more effective at raising vitamin D levels in the body.

It is crucial to talk to your doctor before starting vitamin D supplements, as excessive intake can lead to toxicity.

5. How Do Lifestyle Factors Like Smoking and Obesity Affect MS?

Lifestyle factors, such as smoking and obesity, have been shown to significantly impact the risk and progression of multiple sclerosis. These factors can influence the immune system, inflammation, and overall health, thereby affecting the course of MS.

5.1 What Is the Impact of Smoking on MS?

Smoking is a well-established risk factor for MS. Studies have consistently shown that smokers have a higher risk of developing MS and experience more severe disease progression.

Increased Risk of MS: Smokers are approximately 1.5 to 2 times more likely to develop MS compared to non-smokers.
Faster Disease Progression: Smoking is associated with a faster rate of disease progression in people with MS, leading to disability and reduced quality of life.
More Relapses: Smokers with MS tend to have more frequent and severe relapses compared to non-smokers.
Worse Cognitive Symptoms: Smoking is linked to worse cognitive function in people with MS, including problems with memory, attention, and information processing.
Increased Brain Atrophy: Smoking can accelerate brain atrophy (shrinkage) in people with MS, contributing to neurological decline.

The mechanisms by which smoking affects MS are not fully understood, but they may involve:

Immune Dysregulation: Smoking can disrupt the balance of the immune system, promoting inflammation and autoimmunity.
Increased Oxidative Stress: Smoking generates free radicals, which can damage cells and tissues, including myelin.
Impaired Myelin Repair: Smoking may interfere with the body’s ability to repair myelin damage, leading to more severe neurological deficits.

5.2 How Does Obesity Influence MS?

Obesity has also been identified as a significant risk factor for MS. Both childhood and adult obesity have been linked to an increased risk of developing MS and worse disease outcomes.

Increased Risk of MS: Obese individuals are more likely to develop MS compared to those with a healthy weight.
Earlier Onset of MS: Obesity is associated with an earlier age of onset of MS, meaning that symptoms may appear at a younger age.
Greater Disease Severity: Obese individuals with MS tend to have more severe disease, with greater disability and faster progression.
Increased Inflammation: Obesity is characterized by chronic low-grade inflammation, which can exacerbate MS symptoms and contribute to myelin damage.
Hormonal Changes: Obesity can lead to hormonal imbalances that may influence the immune system and increase the risk of autoimmunity.

5.3 What Are the Recommendations for Managing Lifestyle Factors in MS?

Given the significant impact of smoking and obesity on MS, it is crucial to address these lifestyle factors as part of MS management.

Smoking Cessation: Quitting smoking is one of the most important steps that people with MS can take to improve their health and reduce the risk of disease progression. Healthcare providers can offer support and resources to help with smoking cessation.
Weight Management: Maintaining a healthy weight through diet and exercise can help to reduce inflammation, improve immune function, and slow the progression of MS. A balanced diet rich in fruits, vegetables, and whole grains, combined with regular physical activity, is recommended.

6. Are There Geographic and Ethnic Variations in MS Prevalence?

Yes, there are significant geographic and ethnic variations in the prevalence of multiple sclerosis. These variations suggest that environmental and genetic factors play a role in the development of MS.

6.1 How Does Geography Affect MS Prevalence?

MS is more common in regions farther from the equator. This phenomenon has been observed in both the Northern and Southern Hemispheres. Areas with higher prevalence include:

Northern Hemisphere: Canada, the northern United States, Europe, and Russia.
Southern Hemisphere: New Zealand and southeastern Australia.

The reasons for this geographic variation are not fully understood, but several factors may contribute:

Vitamin D Levels: Regions farther from the equator tend to have lower levels of sunlight, which can lead to vitamin D deficiency. As discussed earlier, vitamin D deficiency is a significant risk factor for MS.
Environmental Factors: Other environmental factors, such as exposure to certain viruses or toxins, may also vary by geographic location and influence MS risk.
Genetic Factors: Certain genetic traits may be more common in populations living in specific geographic regions, contributing to variations in MS prevalence.

6.2 How Does Ethnicity Influence MS Risk?

Ethnicity also plays a role in MS risk. White people, especially those of Northern European descent, have the highest risk of developing MS. People of Asian, African, and Native American ancestry have the lowest risk.

The reasons for these ethnic variations are likely related to differences in genetic susceptibility and environmental exposures:

Genetic Predisposition: Certain genes that increase the risk of MS, such as HLA-DRB1*15:01, may be more common in specific ethnic groups.
Environmental Exposures: Different ethnic groups may have varying exposures to environmental factors, such as viruses, diet, and lifestyle habits, which can influence MS risk.

6.3 What Research Is Being Done on Geographic and Ethnic Variations in MS?

Researchers are actively investigating the reasons for geographic and ethnic variations in MS prevalence. This research includes:

Epidemiological Studies: Examining the incidence and prevalence of MS in different geographic regions and ethnic groups.
Genetic Studies: Identifying genes that are associated with MS risk in different populations.
Environmental Studies: Investigating the role of environmental factors, such as vitamin D levels, viral exposures, and toxins, in MS development.

Understanding the factors that contribute to geographic and ethnic variations in MS prevalence can help to identify individuals at higher risk and develop strategies for prevention and treatment.

7. What Are the Early Warning Signs of MS?

Recognizing the early warning signs of multiple sclerosis can lead to earlier diagnosis and treatment, which can help manage the disease more effectively.

7.1 What Are the Common Early Symptoms of MS?

The early symptoms of MS can vary widely depending on the individual and the location of the affected nerve fibers in the brain and spinal cord. Some of the most common early symptoms include:

Vision Problems:
- Optic Neuritis: Inflammation of the optic nerve, causing blurred vision, double vision, or vision loss in one eye. Pain may occur when moving the eye.
- Double Vision (Diplopia): Seeing two images of a single object.
Sensory Disturbances:
- Numbness and Tingling: Sensations of numbness, tingling, or pins and needles in the arms, legs, face, or fingers.
- Pain: Nerve pain, muscle pain, or other types of pain.
Motor Impairment:
- Muscle Weakness: Weakness in the arms or legs, making it difficult to perform daily tasks.
- Balance Problems: Difficulty with balance and coordination, leading to falls.
- Spasticity: Muscle stiffness and spasms.
Fatigue:
- Overwhelming Tiredness: Persistent and debilitating fatigue that is not relieved by rest.
Other Symptoms:
- Dizziness: Feeling lightheaded or unsteady.
- Bowel and Bladder Problems: Incontinence, frequent urination, or constipation.
- Cognitive Difficulties: Problems with memory, concentration, and information processing.

7.2 How Do MS Symptoms Develop?

MS symptoms typically develop gradually over days or weeks. They may come and go, with periods of exacerbation (relapses) followed by periods of remission (recovery). The pattern of symptoms can vary widely from person to person.

7.3 When Should You See a Doctor?

If you experience any of the symptoms described above, especially if they are persistent or unexplained, it is important to see a doctor for evaluation. Early diagnosis and treatment can help to slow the progression of MS and manage symptoms more effectively.

7.4 How Is MS Diagnosed?

Diagnosing MS can be challenging because there is no single test that can definitively confirm the diagnosis. Instead, doctors rely on a combination of clinical evaluation, neurological examination, MRI scans, and spinal fluid analysis.

Clinical Evaluation: The doctor will ask about your medical history and symptoms.
Neurological Examination: The doctor will assess your nerve function by checking your vision, strength, coordination, sensation, and reflexes.
MRI Scans: MRI scans of the brain and spinal cord can reveal lesions (areas of damage) that are characteristic of MS.
Spinal Fluid Analysis: Analyzing the fluid from the spinal cord can help to identify abnormalities that are consistent with MS.

8. What Are the Different Types of MS and Their Causes?

Multiple sclerosis is a complex disease with several different forms, each characterized by distinct patterns of symptom development and progression. Understanding these different types is crucial for effective diagnosis and management.

8.1 What Are the Main Types of MS?

The four main types of MS are:

Relapsing-Remitting MS (RRMS): This is the most common form of MS, accounting for about 85% of cases at the time of diagnosis. RRMS is characterized by clearly defined relapses (attacks) of new or worsening symptoms, followed by periods of remission during which symptoms improve partially or completely.
Secondary Progressive MS (SPMS): SPMS typically develops after RRMS. In SPMS, the disease progresses steadily over time, with or without relapses. The transition from RRMS to SPMS can occur gradually, and it is not always easy to determine when the transition has occurred.
Primary Progressive MS (PPMS): PPMS is characterized by a gradual accumulation of neurological deficits from the onset of the disease, without distinct relapses or remissions. PPMS accounts for about 10-15% of cases at the time of diagnosis.
Progressive-Relapsing MS (PRMS): PRMS is a rare form of MS that is characterized by a steady progression of the disease from the onset, with occasional acute relapses.

8.2 What Causes the Different Types of MS?

The underlying causes of the different types of MS are not fully understood, but they are likely related to variations in the immune system, inflammation, and myelin damage.

Relapsing-Remitting MS (RRMS): RRMS is believed to be caused by intermittent attacks of immune system activity that damage the myelin sheath. During remissions, the immune system calms down, and the body may be able to repair some of the damage.
Secondary Progressive MS (SPMS): SPMS may develop as a result of cumulative damage to the myelin sheath over time, leading to a gradual decline in neurological function. The transition from RRMS to SPMS may be influenced by factors such as age, genetics, and environmental exposures.
Primary Progressive MS (PPMS): PPMS is thought to be caused by a more gradual and continuous process of myelin damage and nerve degeneration. The immune system may play a less prominent role in PPMS compared to RRMS.
Progressive-Relapsing MS (PRMS): PRMS is likely caused by a combination of steady disease progression and intermittent relapses.

8.3 How Do the Types of MS Affect Treatment?

The type of MS can influence the choice of treatment. Disease-modifying therapies (DMTs) are used to reduce the frequency and severity of relapses in RRMS and to slow the progression of disability in SPMS. Some DMTs are also approved for use in PPMS.

Other treatments, such as corticosteroids, may be used to manage acute relapses. Symptomatic therapies can help to manage specific symptoms, such as fatigue, pain, and spasticity.

9. How Is MS Treated and Managed?

While there is currently no cure for multiple sclerosis, there are numerous treatments available to manage symptoms, slow disease progression, and improve quality of life.

9.1 What Are the Goals of MS Treatment?

The primary goals of MS treatment are to:

Reduce the frequency and severity of relapses.
Slow the progression of disability.
Manage symptoms.
Improve quality of life.

9.2 What Are the Different Types of MS Treatments?

The main types of MS treatments include:

Disease-Modifying Therapies (DMTs): DMTs are medications that can reduce the frequency and severity of relapses and slow the progression of disability in MS. There are several different types of DMTs available, including injectable medications, oral medications, and infusions.
Corticosteroids: Corticosteroids are medications that can reduce inflammation and suppress the immune system. They are often used to treat acute relapses of MS.
Symptomatic Therapies: Symptomatic therapies are medications and other treatments that can help to manage specific symptoms of MS, such as fatigue, pain, spasticity, and bladder problems.
Rehabilitation Therapies: Rehabilitation therapies, such as physical therapy, occupational therapy, and speech therapy, can help to improve function and quality of life in people with MS.
Lifestyle Modifications: Lifestyle modifications, such as regular exercise, a healthy diet, and stress management, can also play a role in MS management.

9.3 How Are DMTs Chosen?

The choice of DMT depends on several factors, including the type of MS, the severity of the disease, the individual’s preferences, and the potential risks and benefits of the medication. It is important to discuss the options with a neurologist to determine the best treatment plan.

9.4 What Are the Potential Side Effects of MS Treatments?

MS treatments can have side effects, ranging from mild to severe. It is important to discuss the potential side effects of any treatment with a doctor before starting it.

9.5 What Is the Role of Lifestyle Modifications in MS Management?

Lifestyle modifications can play an important role in MS management. Regular exercise can help to improve strength, balance, and coordination. A healthy diet can help to reduce inflammation and support overall health. Stress management techniques can help to reduce stress and improve mood.

10. What Research Is Being Done to Find a Cure for MS?

Researchers around the world are actively working to find a cure for multiple sclerosis. This research includes:

10.1 What Are the Current Areas of MS Research?

Some of the main areas of MS research include:

Understanding the Causes of MS: Researchers are working to identify the genes, environmental factors, and immune mechanisms that contribute to the development of MS.
Developing New Treatments: Researchers are developing new medications and therapies to slow the progression of MS, reduce symptoms, and improve quality of life.
Repairing Myelin Damage: Researchers are investigating ways to repair damaged myelin and promote nerve regeneration.
Preventing MS: Researchers are exploring strategies to prevent MS in individuals at high risk of developing the disease.

10.2 What Are Some Promising New Treatments for MS?

Some promising new treatments for MS include:

Stem Cell Therapy: Stem cell therapy involves transplanting stem cells into the body to repair damaged tissue and promote nerve regeneration.
Remyelination Therapies: Remyelination therapies aim to stimulate the body’s natural ability to repair myelin damage.
Targeted Immune Therapies: Targeted immune therapies are designed to selectively suppress the immune cells that attack myelin, while preserving the function of other immune cells.

10.3 How Can You Participate in MS Research?

Individuals with MS can participate in research by enrolling in clinical trials, donating tissue samples, and providing information about their medical history and symptoms. Participating in research can help to advance the understanding of MS and contribute to the development of new treatments.

Understanding What Causes Ms is a complex and ongoing area of research. While the exact cause remains unknown, a combination of genetic, environmental, and lifestyle factors are believed to play a significant role. By being aware of these factors and taking steps to manage them, you can empower yourself to live a healthier and more fulfilling life with MS.

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