Multiple sclerosis (MS)

Published by Bupa's Health Information Team, June 2010.

This factsheet is for people who have multiple sclerosis, or who would like information about it.

Multiple sclerosis (MS) affects the nerves in the brain and spinal cord, causing problems with muscle control, vision and balance. It's thought that around 100,000 people in the UK have MS. It usually starts in early adulthood, and it affects about three times as many women as men.

About MS

MS is a condition that affects your nerves. Nerves are made up of many fibres. Thousands of nerve fibres transmit tiny electrical impulses (messages) between your brain and spinal cord to the rest of your body, for example to your muscles, skin or organs (such as your heart and lungs).

Your nerves are like tiny wires and are protected by a sheath made of a substance called myelin. This makes sure the messages are transmitted correctly from your brain and spinal cord to the rest of your body. Myelin is the white matter in your brain.

MS is thought to be an autoimmune disease. This means that your body's immune system, which usually just attacks harmful things like bacteria and viruses, attacks and damages your own healthy body tissue causing inflammation.

If you have MS, your immune system damages the myelin sheaths around the nerves in your brain and spinal cord. These become scarred and hardened (sclerosis means hardening). This scarring prevents the affected nerves from sending signals properly.

Symptoms of MS

The symptoms of MS are caused by the scarring and hardening of the central nervous system. They can vary widely from person to person and will depend on the area of the central nervous system that is affected. Some people have very few mild symptoms, especially in the early stages. However, others have symptoms that get worse over time.

Some of the most common symptoms include:

• eye problems, including pain and blurred or double vision
• fatigue
• muscle weakness, stiffness and spasms
• bladder and bowel problems, including incontinence
• loss of balance, co-ordination and dizziness
• pain from the nerve damage, or related to a loss of mobility
• numbness or tingling of your skin
• difficulty speaking and swallowing
• feeling emotional, anxious or depressed
• sexual difficulties

Types of MS

Unfortunately there is no cure for MS. If you're diagnosed with the condition, you will always have it. However, this doesn't mean that you will have symptoms all of the time. There are several different patterns of MS and each progress differently.

Benign MS

This type is characterised by very few relapses (times when your symptoms flare up) with long periods of good health in between. As a result, a doctor can't diagnose this straight away. The long-term outlook for people with benign MS is generally good, but it's possible that it will get worse later in life.

Relapsing-remitting MS

For about eight out of 10 people with MS, it begins as a relapsing and remitting condition. This means you have periods of remission (good health) followed by sudden relapses (flare ups). Remission can last for any length of time, while relapses can last for anything between a few days and a few months.

Secondary progressive MS

About half of all people who have relapsing-remitting MS go on to develop secondary progressive MS within 10 years. It's characterised by progressively worsening symptoms and fewer periods of remission.

Primary progressive MS

Approximately one in 10 people with MS have symptoms that get steadily more severe without any periods of remission.

Causes of MS

The exact reasons why you may develop MS aren't fully understood at present. Several factors are thought to be involved.

• MS isn't inherited but having a certain combination of genes may make you more susceptible. However, these genes are also found in the general population, and other factors are thought to be involved.
• Where you live in the world may affect your risk. MS is more common in countries further from the equator (such as the UK, USA and Canada), where sun exposure is lower. Your body produces vitamin D when your skin is exposed to sunlight, and it is thought that a lack of vitamin D could play a part in the development of MS in some people. More research needs to be done to say for certain.
• Environmental factors, such as a virus or bacteria may trigger MS.

Diagnosis of MS

Multiple sclerosis can be very difficult to diagnose. There is no single test that can confirm MS and many of the symptoms are also found in other conditions so these may need to be excluded first.

If your GP thinks you may have MS, he or she will refer you to see a neurologist (a doctor specialising in conditions that affect the nervous system). The neurologist will ask detailed questions about your symptoms and your general health. He or she may recommend some tests including:

• An MRI (magnetic resonance imaging) scan. This uses magnets and radiowaves to produce images that show up areas of scarring or inflammation in the myelin.
• Evoked potential testing. This measures the time it takes for messages to travel to your brain, usually from your eyes.
• A lumbar puncture (also known as a spinal tap) - a sample of the fluid that surrounds your brain and spinal cord (cerebrospinal fluid) is taken by inserting a needle at the base of your spine.

Unfortunately, these tests don't always give a definite result, so it can be very difficult to establish a firm diagnosis.

If your initial symptoms get better, your neurologist may wait and see if you have another relapse before making a definite diagnosis of MS.

Treatment of MS

The treatment you have for MS depends on the type of MS and your symptoms. If you have mild MS with no relapses then you won't need any treatment. You may need steroid therapy if you have a relapse. If you have several relapses, you will have medicines to reduce the frequency and severity of the relapses. The symptoms of MS will need specific treatments. For further information about the different types of treatment for the symptoms, please see Related topics.

Self-help

Therapies and management techniques can be used to help you control your symptoms. Some examples include:

• exercise to help with fatigue and muscle weakness
• cognitive behavioural therapy for depression
• pelvic floor exercises to reduce urinary incontinence
• speech therapy to help with communication
• physiotherapy to help with musculoskeletal pain

Talk to your GP for more information about different self-help treatments.

Medicines

There is no cure for MS, but there are medicines to help you manage the symptoms of the condition, such as depression, incontinence and pain.

These medicines don't prevent relapses or slow the progression of your MS, but they may help you to deal with the symptoms and carry on with your day-to-day life.

If you get new symptoms or your symptoms get worse, visit your GP or talk to your specialist MS nurse.

If you have a relapse, your doctor can offer you a course of steroids for a few days to improve your symptoms. Steroids reduce your inflammatory response and can speed up your recovery from the relapse.

Disease Modifying Drugs slow down the development of disability and reduce the frequency and severity of relapses in people with relapsing-remitting MS. They aren't a cure for MS and they don't seem to work for the progressive forms of MS. These medicines must be prescribed by a neurologist at a specialist MS centre.

Complementary therapy

Although there isn't enough scientific evidence to show that these are effective, many people find reflexology, massage and t'ai chi helpful. Speak to your doctor before trying any complementary therapy.

Living with MS

Good practical and emotional support is important. Your neurologist will usually refer you to specialist services that aim to help you carry on living independently and continue your daily activities. As well as your GP and neurologist, some of the health professionals who can help include:

• MS specialist nurses
• physiotherapists
• occupational therapists
• speech and language therapists
• clinical psychologists
• social workers

You may be entitled to support services at work and, under the Disability Discrimination Act, your employer may need to make reasonable adjustments to help you continue with your job.

Infections can trigger a relapse, so you should consider having seasonal 'flu immunisations to reduce the risk.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.