Multiple Sclerosis

Expert reviewers, Dr Oliver Lily, Consultant Neurologist, and Ade Adeniyi, Bupa Clinics GP
Next review due July 2023

Multiple sclerosis (MS) is an autoimmune condition. This means that your immune system attacks healthy tissue (cells). It’s a lifelong condition that affects the nerves in your brain and spinal cord (your central nervous system). It can affect muscle control, vision and balance, and cause other symptoms like pain and extreme tiredness (fatigue).

A woman is thinking

What is multiple sclerosis?

Multiple sclerosis (MS) affects your central nervous system – that is, your brain or spinal cord. Your nerves are protected by a sheath (covering) made of a substance called myelin. With MS, your immune system damages these myelin sheaths. Scar tissue (sclerosis) forms, which stops your nerves sending messages properly. This causes the symptoms of MS.

MS affects people differently. Some people only ever have mild symptoms. Others may have more serious symptoms that get worse more quickly.

MS is unpredictable. It’s very hard for doctors to say how it will affect you over time. But MS doesn’t usually affect your lifespan except in very serious cases.

Just over 130,000 people in the UK have MS. It usually starts when people are in their 20s and 30s, but it can affect people at any age. It affects about three times as many women as men.

Symptoms of multiple sclerosis

Multiple sclerosis (MS) symptoms depend on which part of your central nervous system is affected. They also vary from person to person. You may have only a few symptoms. At first, symptoms may be mild and making a diagnosis can be difficult. Symptoms may get worse over time.

Inflammation of the nerve to your eye is a common early symptom. This is called optic neuritis. You may lose some or all of your vision for a while. It can also cause eye pain, especially when moving your eye. MS can also cause double vision and oscillopsia (pronounced oss-ill-op-see-ah), meaning objects seem to be moving even though they’re not.

Other common symptoms include:

  • extreme tiredness (fatigue)
  • muscle weakness, stiffness and spasms, which can affect walking and using 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
  • slurred speech and difficulty swallowing
  • feeling emotional, anxious or depressed
  • sexual problems, including erection difficulties in men or vaginal dryness in women – for more information, see our FAQ: Will multiple sclerosis affect my sex life?

If you do have MS, you won’t get all these symptoms, and certainly not all at the same time. Sometimes, you may notice them on one side of your body, but not on the other side.

Having any of these symptoms doesn’t mean you have MS – they may be caused by something else. But see your GP if you have any symptoms. The earlier you’re diagnosed with MS, the easier it is for your doctor to prescribe treatments that stop it getting worse.

Types of multiple sclerosis

Multiple sclerosis (MS) has three main patterns. They are grouped according to symptoms and how quickly they progress.

Relapsing/remitting MS

This is the most common type, affecting about eight in every 10 people with MS. Symptoms come (relapse) and go (remission). You may develop new symptoms which disappear during remission. Over time, symptoms may no longer disappear completely between relapses, so you have some permanent effects from the MS.

Some people relapse only once or twice a year and others relapse more often. You may have fewer relapses as you get older and have had MS for longer.

Secondary progressive MS

About two thirds of all those with relapsing/remitting MS develop secondary progressive MS within 15 years of diagnosis. It means that symptoms gradually worsen over time with fewer (if any) remissions.

Primary progressive MS

About one in 10 people with MS has this type. You don’t ever have relapses and remissions. Symptoms gradually get worse from when you first develop MS.

Causes of multiple sclerosis

Multiple sclerosis (MS) is an autoimmune reaction, when your immune system attacks your own cells. But doctors don’t know exactly why some people develop the condition.

Having a certain combination of genes may make you more likely to develop MS. But the risk of developing MS if someone in your family has it is very small. It seems that you need to be exposed to certain environmental triggers too. Some researchers have suggested that MS may be triggered by a virus, but no specific virus has been found. The Epstein–Barr virus (glandular fever) has been linked to an increased risk of MS, although there isn’t proof that it directly causes it. Smoking doubles the risk of developing MS.

Some research suggests that having too little vitamin D may play a part in some people developing MS. But whether or not this is true and how it works isn’t yet clear.

Infection and stress may increase the risk of relapse in people with MS.

Diagnosis of multiple sclerosis

Multiple sclerosis (MS) 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. Your 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 affecting your nervous system. Your neurologist will ask detailed questions about your symptoms and general health. They will examine you, checking your nerve reflexes and movement. They may check for any problems with your eyes.

You may need to have one or more tests. Your neurologist will choose these according to your symptoms. They can include the following.

  • A magnetic resonance imaging (MRI) scan. This uses magnets and radio waves to produce images of the inside of your body. It may show scarring or swelling in the myelin around your nerves.
  • Evoked potential testing. This measures the time it takes for messages to travel to your brain, usually from your eyes.

If your neurologist thinks you may have primary progressive MS, they may suggest a lumbar puncture. This involves taking a sample of the fluid surrounding your brain and spinal cord (cerebrospinal fluid).

Your neurologist will look at your test results alongside your symptoms to confirm whether or not you have MS. They can usually make a definite diagnosis only after a second relapse. So it can take a while to get diagnosed.

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.

Treatment of multiple sclerosis

Unfortunately, there isn’t a cure for multiple sclerosis (MS), so you’ll always have it. But treatment for MS can help reduce the number of relapses and how long they last for and help manage the symptoms.

Your doctor can prescribe medicines and other treatments to relieve symptoms when you do have them. There are also medicines and therapies that can help to stop your MS progressing and keep you moving. Treatment will depend on which type of MS you have and your exact symptoms.

You may be able to help some symptoms, such as extreme tiredness, by making changes to your lifestyle.

Self-help for multiple sclerosis

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

MS-related fatigue (tiredness) can get worse with heat, stress and overdoing it, so try to avoid these triggers as much as possible. 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 unusually tired, see your GP. You may need tests to check for 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 eating a balanced, healthy diet should 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 be able to refer you to a specialist physiotherapist for pelvic floor exercises and bladder retraining. Your symptoms may get better if you have less caffeine (from tea, coffee and cola drinks) and drink around two litres of fluid each day.

If you smoke, speak to your GP or local pharmacist about giving up. Smoking can make MS symptoms get worse more quickly.

Medicines for multiple sclerosis

Medicines to ease symptoms

Your doctor may be able to prescribe medicines to ease multiple sclerosis (MS) symptoms, such as bladder problems, extreme tiredness and depression. These medicines may help to keep symptoms under control and make it easier for you to manage day-to-day life. But they won’t prevent relapses or slow the progression of your MS.

If you get new symptoms or symptoms suddenly get worse, you may be having a relapse, so tell your specialist MS nurse. You’ll be offered treatments as soon as possible, usually within 14 days of your symptoms starting. This will help you get better more quickly, and you may not need to go into hospital. If you have a relapse, your doctor may suggest steroids for a few days. These reduce inflammation (swelling) and can speed up recovery from a relapse.

Disease-modifying medicines

If you have relapsing-remitting MS with two or more serious relapses in the past two years, your doctor may prescribe disease-modifying medicines. These may mean relapses are less severe and happen less often. They may also slow down how quickly your MS gets worse. You may have medicines such as dimethyl fumarate or teriflunomide. These medicines don’t work so well in secondary progressive MS and won’t work for primary progressive MS.

If you have early primary progressive MS, your doctor may suggest a treatment called ocrelizumab. You have this through a drip into a vein (an infusion) for two initial doses, then every six months.

Ocrelizumab can also treat relapsing MS.

Biological treatments

More severe MS may be treated with biological treatments, such as natalizumab or alemtuzumab, which work by influencing your body’s immune system. You have these through an infusion.

Cannabis-based medicinal products

An oral spray containing cannabinoids (chemicals found in cannabis) may reduce pain and stiffness from muscle spasms. Under certain conditions (if other treatments don’t help, for example) you may be able to get this from your doctor for a four-week trial to see if it helps you.

Always read the patient information leaflet that comes with your medicines. If you have any questions, ask your specialist MS nurse or neurologist for advice.

Other treatments for multiple sclerosis

Depending on your multiple sclerosis (MS) symptoms, you may be offered other treatments. These include:

Complementary therapies for multiple sclerosis

There isn't much proof to show that complementary therapies work for multiple sclerosis (MS). But they can help with general wellbeing. Some people with MS say acupuncture, reflexology, meditation, aromatherapy and massage help their symptoms.

If you want to try complementary therapies, speak to your neurologist or specialist MS nurse first.

Living with multiple sclerosis

Being diagnosed with a lifelong condition can be distressing and you’re likely to have lots of questions. Your neurologist will discuss how your condition affects your daily life. You should have a follow-up appointment within six weeks of your diagnosis so you can ask more questions.

Your multiple sclerosis (MS) will be reviewed at least yearly. This is the chance to discuss changes in your condition or new treatments. Your need for support and advice may change over time, depending on how MS is affecting you. Your doctor may refer you to other healthcare professionals, including:

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

Occupational therapists can help with everyday tasks, such as eating, walking, using a computer or getting up and down stairs. A physiotherapist may suggest exercises if you have pain caused by poor mobility or poor posture.

It’s important to make sure you have the practical support you need. Your neurologist will usually refer you to specialist rehabilitation services that can help you carry on with daily life independently. Local support groups, national charities and organisations may also help.

MS can affect mood, memory and concentration, as well as your physical health. It can also affect your relationships and sex life. It’s important to try and avoid stress, as it can trigger a relapse. If you have any worries, discuss your feelings with your 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. Your employer may be able to make changes to your workplace, for example to allow wheelchair access. They may also be able to provide special equipment.

Frequently asked questions

  • Being pregnant won’t make MS worse. In fact, relapse is less likely during pregnancy. All pregnancies are different, so discuss any concerns or symptoms you have with your midwife or GP.

    There are some MS medicines you can’t take in pregnancy, so they need to be stopped before you start trying for a baby. Talk to your neurologist as soon as you know you want to become pregnant, but don’t stop your medicines before then. If you find out that you’re pregnant unexpectedly and you’re taking disease-modifying medicines, talk to your specialist nurse as soon as possible.

    You may want to discuss how you and your partner will manage after the birth. Fatigue can be a problem and you may be more likely to have a relapse in the three months after having your baby. It’s possible that breastfeeding may reduce the risk of relapse, but we don’t yet know this for sure.

  • MS symptoms, such as fatigue, pain and problems with mobility, can affect your sex life. Muscle spasms may make it harder to have sex. Anxiety or depression may mean you’re not in the mood.

    It’s important to get the right treatments to help these symptoms as much as possible. Both men and women with MS may find they have reduced sensation, which can affect their enjoyment of sex. Women with MS may develop a dry vagina, which can be uncomfortable. Men with MS may have ejaculation or erectile problems. Your GP may be able to prescribe medicines and other treatments to help with these sexual problems.

    If you and your partner are having sexual problems, your GP can refer you to relationship or psychosexual counselling.

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Related information

    • Multiple sclerosis. NICE Clinical Knowledge Summary., last updated October 2019
    • Multiple sclerosis in adults: management. National Institute for Health and Care Excellence (NICE)., last updated November 2019
    • Multiple sclerosis. BMJ Best Practice., last updated August 2019
    • Multiple sclerosis. Medscape., last updated October 2019
    • Multiple Sclerosis (MS). MSD Manuals., last updated December 2019
    • Neurology. Multiple sclerosis. Oxford Handbook of General Practice. 4th ed. Oxford Medicine Online., published online April 2014
    • Tallantyre EC, Major PC, Atherton MJ, et al. How common is truly benign MS in a UK population? J Neurol Neurosur Ps 2019; 90(5):522–28. doi:10.1136/jnnp-2018-318802
    • Multiple sclerosis. Patient., last updated September 2015
    • Neurology. Multiple sclerosis. Oxford Handbook of Clinical Medicine. 10th ed. Oxford Medicine Online., published online September 2017
    • Sexual problems affecting women. MS Society., accessed February 2020
    • Multiple sclerosis. NICE British National Formulary., accessed March 2020
    • Therapy-related issues: central nervous system: Multiple sclerosis. Oxford Handbook of Clinical Pharmacy. 3rd ed. Oxford Medicine Online., published online April 2017
    • Nutrition in neurological conditions: Multiple sclerosis. Oxford Handbook of Nutrition and Dietetics. 2nd ed. Oxford Medicine Online., published online January 2012
    • Overactive Bladder. Patient., last updated August 2015
    • Symptom Management. National MS Society., accessed March 2020
    • Ocrelizumab for treating primary progressive multiple sclerosis. National Institute for Health and Clinical Excellence (NICE)., published June 2019
    • American Academy of Neurology. Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis. Neurology 2014; 82(12):1083–92. doi:10.1212/WNL.0000000000000250
    • Esmonde L, Long AF. Complementary therapy use by persons with multiple sclerosis: Benefits and research priorities. Complement Ther Clin 2008; 14:176–84. doi:10.1016/j.ctcp.2008.03.001
    • Cannabis-based medicinal products. National Institute for Health and Clinical Excellence (NICE)., published November 2019
    • van Gorp DAM, van der Hiele K, Heerings MAP, et al. Cognitive functioning as a predictor of employment status in relapsing-remitting multiple sclerosis: a 2-year longitudinal study. Neurol Sci 2019; 40(12):2555–64. doi:10.1007/s10072-019-03999-w
    • Reasonable adjustments for disabled workers. UK Government., accessed March 2020
    • Dobson R, Dassan P, Roberts M, et al. UK consensus on pregnancy in multiple sclerosis: Association of British Neurologists’ guidelines. Pract Neurol 2019; 19(2):106–114
    • Complementary and alternative medicine. MS Trust., last updated May 2018
    • Claflin SB, van der Mei IAF, Taylor BV. Complementary and alternative treatments of multiple sclerosis: a review of the evidence from 2001 to 2016. J Neurol Neurosur Ps 2018; 89:34–41.
  • Reviewed by Liz Wool, Freelance Health Editor, and Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, July 2020
    Expert reviewers, Dr Oliver Lily, Consultant Neurologist, and Ade Adeniyi, Bupa Clinics GP
    Next review due July 2023