Multiple Sclerosis

Multiple sclerosis (MS) is a lifelong condition that affects the nerves in your brain and spinal cord. It can affect your muscle control, sight, and balance. It can also cause other symptoms such as pain and extreme tiredness (fatigue).

About multiple sclerosis

Multiple sclerosis affects your central nervous system. It’s an autoimmune condition, which means your immune system attacks healthy tissues (cells) in your brain or spinal cord. Your nerves are protected by a covering (sheath) made of a substance called myelin. If you have MS, your immune system damages your myelin sheaths. This forms scar tissue (sclerosis), which stops your nerves sending messages properly. This causes multiple sclerosis symptoms.

Over 150,000 people in the UK have multiple sclerosis. MS usually starts when people are in their 20s to 40s. It can affect people at any age. But it’s rare to develop multiple sclerosis before the age of 10 or over the age of 60.

MS affects 2 to 3 times as many women as men.

Types of multiple sclerosis

There are three main types of MS.

Relapsing/remitting MS

This is the most common type. It’s also called relapsing MS. It affects about 8 in every 10 people with MS. Symptoms come (relapse) and go (remission).

Secondary progressive MS

Around 6 in every 10 people with relapsing/remitting MS go on to develop secondary progressive MS within around 15 years. Your symptoms gradually get worse over time with fewer (if any) remissions.

Primary progressive MS

Up to 2 in 10 people with MS have this type. You don’t have relapses and remissions. Your symptoms gradually get worse.

Causes of multiple sclerosis

Doctors don’t know exactly what causes multiple sclerosis. If you have a certain combination of genes, you may be more likely to develop MS. But it seems that you need to be exposed to certain environmental triggers too. The environmental causes of MS are still known, but may include:

• a virus, although no specific virus has been found – the Epstein–Barr virus (which causes glandular fever) has been linked to an increased risk of MS, but there’s no proof it causes MS
• smoking for many years, which can damage your immune system – smoking may also make MS worse
• having too little vitamin D, which is important for your immune system

Infections and stress may increase the risk of having a relapse if you have MS.

Symptoms of multiple sclerosis

Multiple sclerosis symptoms depend on which part of your central nervous system is affected. They also vary from person to person. Your symptoms may be mild at first, then get worse over time. It’s very hard for doctors to predict how multiple sclerosis will affect you.

Inflammation of the nerve to your eye is a common early symptom. This is called optic neuritis. It can be painful, especially when you move your eye. MS can also cause double vision and oscillopsia (pronounced oss-ill-op-see-ah). This means objects seem to be moving even though they’re not.

Other common MS symptoms include:

• muscle weakness, stiffness, spasms, and pain, affecting how you walk and use your hands
• needing to pee more often and urgently, and not emptying your bladder completely
• incontinence, caused by bladder or bowel problems
• loss of balance and coordination
• dizziness
• pain in your face from nerve damage (trigeminal neuralgia)
• numbness or tingling in your skin
• slurred speech and difficulty swallowing
• memory problems
• problems with sex
• extreme tiredness (fatigue)
• feeling emotional, anxious, or depressed

If you have multiple sclerosis, you won’t get all of these symptoms and not all of them at the same time. Sometimes, you may notice them on only one side of your body.

See a GP if you have any possible symptoms of MS. The earlier you get a multiple sclerosis diagnosis, the easier it is for your doctor to prescribe treatments that will help to stop it getting worse.

Diagnosis of multiple sclerosis

Multiple sclerosis can be difficult to diagnose. There’s no single test and many of the symptoms can be caused by other conditions, which may need to be ruled out first. A GP will ask about your symptoms and may arrange for you to have blood tests. If they think you may have MS, your GP will refer you to a neurologist, a doctor who specialises in conditions that affect your nervous system.

Your neurologist will:

• ask questions about your symptoms and general health
• examine you
• check your nerve reflexes and movement
• check for any problems with your eyes

You may also need to have some of the following tests before your neurologist can make a diagnosis of MS.

• A magnetic resonance imaging (MRI) scan). This uses magnets and radio waves to produce images of the inside of your body. An MRI scan is the best way to help diagnose MS that affects your spinal cord.
• A lumbar puncture. This involves taking a sample of the fluid that surrounds your brain and spinal cord (cerebrospinal fluid).
• Evoked potential testing. This measures the time it takes for messages to travel to your brain, usually from your eyes.

If you’ve had a single attack of inflammation, such as optic neuritis or inflammation in your spine, neurologists call this clinically isolated syndrome (CIS). People who have had CIS may go on to develop MS.

Self-help for multiple sclerosis

Staying as healthy as possible may help to improve your multiple sclerosis symptoms.

MS-related fatigue (tiredness) can get worse with heat, stress, and overdoing it. It may help to plan each day carefully and prioritise certain tasks. Several short rests during the day may be better than one long rest. If you’re struggling with tiredness, see a GP. You may need tests to check for an infection, low iron levels (anaemia), or a problem with your thyroid gland.

Regular exercise may help with fatigue and keep you mobile. Try aerobic activities (walking or swimming), as well as balancing and stretching exercise such as yoga. Your neurologist can refer you to a physiotherapist to discuss the best exercises for you and how to pace yourself.

There’s no evidence that a specific diet or certain foods can help MS symptoms. But eat a balanced, healthy diet to help to keep your weight stable. Being overweight can make you less mobile and make fatigue worse. If you’re prone to constipation, drink more fluids and eat more high-fibre foods, such as fruit and vegetables.

If bladder problems are causing incontinence, your neurologist may refer you to a specialist physiotherapist for pelvic floor exercises and bladder retraining.

If you smoke, try to give up because smoking can make MS symptoms worsen more quickly. Speak to a GP or local pharmacist to get some support to help you stop smoking.

Living with multiple sclerosis

Being diagnosed with a lifelong condition can be distressing and you may have lots of questions. Your neurologist will discuss how your condition will affect your daily life. You should have a follow-up appointment within six weeks of your multiple sclerosis diagnosis with a specialist nurse.

Your multiple sclerosis will usually be reviewed at least once a year. This is the chance to discuss changes in your condition or new treatments. Your doctor may refer you to other healthcare professionals, including:

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

It’s important to have practical support so you can deal with MS symptoms. Your neurologist will usually refer you to specialist rehabilitation services to help you stay independent. Local support groups, national charities, and organisations may also help.

Multiple sclerosis can affect your mood, memory, and concentration. It can also affect your relationships and sex life. If you have any worries, discuss your feelings with a GP. You may find it helpful to see a counsellor too.

Having MS may make it harder for you to work or you may need to change how you work. You may be entitled to support services at work. Employers are required by law to help if you have a progressive or long-term condition, such as MS. They may be able to make changes to your workplace, including flexible working hours so you can get some rest when you need to. They may also be able to provide special equipment.