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What can cause this to get worse or better?

The more you know and the more committed you are to your health and treatment, the better you are likely to do in the long run. MS is unpredictable. We each just need to do the best we can. The current disease-modifying drugs demonstrate an ability to reduce the number of exacerbations, the severity of exacerbations and the disease activity overall.  A few are also are thought to protect the nerves during and exacerbation.  These are the only options we can definitively point to and say they can make a positive difference in the course of the disease.