In recent years, the Jewish-American actress Selma Blair (“Cruel Intentions,” “Legally Blonde,” “The Sweetest Thing”) has become one of the more hopeful public figures associated with multiple sclerosis. In 2022, she published her memoir Mean Baby: A Memoir of Growing Up, in which she detailed the stages of her diagnosis and the professional dilemmas that came with it.
Blair, now 54, began experiencing symptoms at a young age, years before she was diagnosed following a significant deterioration in her physical condition. In the early years she faced considerable mobility limitations and severe fatigue, but today she reports being in remission and significant improvement in functioning. “I never imagined I could make an impact just by showing up as I am, honestly, with what I am going through,” she said in one of her interviews. She has clearly played an important role in raising awareness of a disease that affects women far more than men.
Multiple sclerosis typically emerges during the peak years of building family and career life. In Israel there are currently around 10,000 patients, about 66% of them women, most in their 20s to 40s. Alongside significant advances in research and new treatments that often allow people to live relatively normal lives with the disease, it still does not receive sufficient public attention. Awareness month is an important opportunity to help correct that.
Multiple sclerosis is a chronic autoimmune disease of the central nervous system in which the immune system mistakenly attacks myelin, the protective layer surrounding nerve fibers in the brain and spinal cord. This damage disrupts communication between the brain and body and can cause a wide range of symptoms, including extreme fatigue, vision problems, muscle weakness, difficulty walking, tingling sensations and sometimes impairments in memory and concentration.
Professor Shay Menascu, a senior physician in the National Multiple Sclerosis Centre and responsible physician of the Pediatric Multiple Sclerosis section at Sheba Medical Center, explains: “Multiple sclerosis is essentially a group of diseases, not a single one. Until a decade ago the treatment was the same, but today we know how to identify subtypes and tailor treatment to each one. Patients’ symptoms depend on the area of the brain affected: the region responsible for vision, balance, movement, parts of the spinal cord and more. In about 85% of patients the disease appears in a relapsing-remitting form, meaning there is a relapse with reduced vision, instability or difficulty moving, and after treatment there is remission and most people return almost to their baseline condition. The question is always how to prevent the next relapse and if one has already occurred, how to extend the remission period.
“The second type of the disease, primary progressive multiple sclerosis, is characterized by continuous progression without clear remissions and is more common in men, especially over the age of 40.”
Gender: the “female” disease behaves differently
As noted, multiple sclerosis affects women at a rate two to three times higher than men. For years, scientific explanations focused on the role of hormones such as estrogen, changes related to pregnancy and menopause, as well as genetic factors that may influence the risk of developing the disease. Another key explanation is a stronger immune response in women, which increases susceptibility to autoimmune diseases.
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Selma Blair at the 2026 Vanity Fair Oscar Party on March 15, 2026
(Photo: Amy Sussman/Getty Images)
A study from the University of Colorado in the United States, published this year, further strengthened the understanding that there is a real biological difference between women and men when it comes to multiple sclerosis. Researchers examined proteins in cerebrospinal fluid and found that women show higher inflammatory and immune activity, alongside reduced mechanisms linked to repair and protection of nerve cells. These findings support the hypothesis that multiple sclerosis in women is not simply “the same disease at higher frequency,” but a condition that may follow a different biological course. One possible implication is that in the future we may see treatments and diagnostic tests specifically tailored for women.
Prof. Shay Menascu adds an encouraging perspective: “As with all autoimmune diseases, multiple sclerosis is more common in women. On the other hand, we know that in women, despite the higher prevalence, the aggressiveness of the disease is lower compared to men.”
Fertility: no barrier to pregnancy and childbirth
A 2025 study from French universities found that women with multiple sclerosis receive less aggressive treatment than men, even when disease status is similar. Researchers examined more than 22,000 patients in France and found that women were 8% less likely to receive disease-modifying therapy to slow progression, and 20% less likely to receive more advanced, aggressive treatments. According to the researchers, one of the main reasons is fertility and pregnancy considerations. Among women of reproductive age, there is sometimes hesitation—both from physicians and patients—to initiate or escalate treatment due to concerns about future pregnancy. The study found that around 18 months before childbirth there is a significant decline in medication use.
According to Prof. Shay Menascu: “There are studies in both directions, but today most neurologists support early and effective treatment adjustment for both women and men. The treatments for multiple sclerosis are suitable for both sexes equally, but with women we naturally have many discussions around pregnancy and fertility. The reason is not concern about harm to eggs (or sperm in men), but concern that some medications may affect the fetus. We now know that with proper monitoring and treatment adjustment, women with multiple sclerosis can go through pregnancy very well. But we also know that after childbirth there is an increased risk of relapse, especially if the woman is not treated, so medical follow-up during this period is very important.”
Symptoms: muscle weakness and walking difficulties
Chronic fatigue is one of the most common and significant symptoms of multiple sclerosis, and at times it affects quality of life more than neurological symptoms such as muscle weakness or walking difficulties. It is a deep, disproportionate fatigue that does not necessarily improve with rest, and it can affect concentration, daily functioning and long-term ability to work.
Studies show that women often report more severe fatigue and greater functional impairment compared to men, even when neurological disease severity is similar. One hypothesis is that the gap is linked to a combination of biological factors (such as hormonal influences and immune activity) and more demanding daily responsibilities, such as balancing work, childcare and household management. Among men, in contrast, fatigue is reported less often or is described more in terms of reduced physical strength, which may also influence how it is identified and treated.
Prof. Shay Menascu notes: “This symptom is very common in men as well, and fatigue is part of the brain damage itself. I think women are simply better at describing it and therefore receive more appropriate treatment. Many men just say ‘I work hard,’ so the issue receives less attention. In any case, treatment today is very advanced in this area as well, and sometimes we give targeted medication for fatigue based on structured assessment questionnaires.”
The innovation: diagnosing “pre–multiple sclerosis”
In the past, the treatment approach to multiple sclerosis was largely reactive. Physicians tended to wait for clear relapses or clinical worsening before initiating significant treatment. This meant patients often went through a cycle of relapse, recovery and waiting before any intervention was introduced. The approach was based on the assumption that the disease was mainly active during relapses and less so during clinically quiet periods.
Today, that approach has changed substantially and has become more proactive and long-term. Instead of waiting for relapses, patients are followed continuously from the earliest stages, including during remission, in order to prevent cumulative damage that can occur even without obvious symptoms. Treatment now includes regular monitoring, imaging tests and tailored therapy aimed at suppressing silent inflammatory activity and preventing disease progression, even when the patient feels completely stable.
Prof. Shay Menascu: “We used to wait for a second relapse before starting treatment. Today, in many cases we begin treatment after the first relapse or even based on MRI-detected deterioration. We now understand that multiple sclerosis can progress even when the patient does not feel it clinically. The scientific discourse is already talking about pre–multiple sclerosis, similar to prediabetes. Brain atrophy begins very early, so it is important to prevent damage as early as possible.”
The future: living with the disease, treating it at home
Alongside the challenges of a chronic illness, advances in scientific research offer hope for easier management of multiple sclerosis in the future. “I have a very optimistic message in this regard,” stresses Prof. Shay Menascu. “The drug treatments introduced in the past decade show up to 70% slowing of disease progression, which allows for a normal lifestyle. The way medications are taken also helps: today there are options for monthly injections at home, pills taken several times a month, and infusions given once every six months. As mentioned, medical follow-up must be continuous and closely monitored, but patients no longer need to come frequently to medical centers and can manage much of their treatment at home.
“In summary, I can say that we now have better and more accessible treatments. Upcoming studies suggest that in the not-too-distant future, drugs will be developed that can better halt the disease and reduce the frequency of treatment.”
Christina Applegate
Christina Applegate, the American actress known for “Married… with Children” and “Dead to Me,” publicly revealed her multiple sclerosis diagnosis in 2021. She has experienced relatively rapid functional decline, with an active disease course involving significant balance problems, chronic pain and severe fatigue. Today, at 55, she faces substantial daily limitations, uses mobility aids and experiences fluctuations in her condition, including periods of worsening that require intensive medical treatment and sometimes hospitalization. “This is a horrible disease. I am angry at it, I don’t like it,” she said in interviews aimed at raising awareness of multiple sclerosis.
Jamie-Lynn Sigler
Jamie-Lynn Sigler, the American-Jewish actress known for “The Sopranos,” revealed her condition publicly in 2016, though she was diagnosed in her early 20s. Today, at 45, her disease is relatively stable and she manages it in episodes, mainly during periods of stress or flare-ups, without continuous progression. Her disease course is classified as relapsing-remitting, with worsening mainly expressed through leg weakness and walking difficulties, alongside long periods of remission that have allowed her to continue working over the years. “The disease is part of me, but it is not who I am,” she often says.