Multiple Sclerosis

Your health expert: Dr David Paling, Consultant Neurologist
Content editor review by Rachael Mayfield-Blake, December 2022
Next review due December 2025

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

About MS

MS is an autoimmune condition, which means your immune system attacks healthy tissue (cells). MS affects your central nervous system – it attacks healthy parts of your brain or spinal cord. Your nerves are protected by a covering (sheath) made of a substance called myelin. With MS, your immune system damages your 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 MS symptoms. Others may have more serious symptoms that get worse quickly. It’s very hard for doctors to say how MS will affect you over time.

It’s estimated that just over 130,000 people in the UK have MS. It usually starts when people are in their 20s to 40s, but it can affect people at any age. Although it’s rare to develop MS under the age of 10 or over the age of 60.

MS affects two to three times as many women as men.

Types of MS

MS has three main types (also called patterns). The types are defined according to symptoms and how quickly they progress.

Relapsing/remitting MS or relapse onset MS

This is the most common type. It affects about eight in every 10 people with MS. Symptoms come (relapse) and go (remission). You may develop new MS symptoms that almost disappear during remission. Over time, symptoms may no longer improve completely between relapses, so you have some permanent effects from MS. When symptoms don’t remit, it’s known as relapse onset MS.

Secondary progressive MS

Over half of people with relapsing/remitting MS go on to develop secondary progressive MS within around 15 years. It means that symptoms gradually worsen over time with fewer (if any) remissions.

Primary progressive MS

Up to two in 10 people with MS have this type. You don’t have relapses and remissions; your symptoms gradually get worse from when you first develop MS.

Causes of MS

Doctors don’t know exactly why some people get MS and what the cause is.

If you have a certain combination of genes, it may make you more likely to develop MS. But the risk of developing MS if someone in your family has it is small. It seems that you need to be exposed to certain environmental triggers too.

  • Some researchers have suggested that MS may be caused by a virus, but no specific virus has been found. The Epstein–Barr virus (which causes glandular fever) has been linked to increased risk of MS, but there is no proof that this virus causes MS.
  • The risk of developing MS from smoking increases with how much and for how long you’ve smoked. Smoking may also make MS worse.
  • 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.

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

Symptoms of MS

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. Symptoms may be mild at first, but they may get worse over time.

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

Other common MS symptoms include:

  • muscle weakness, stiffness, spasms and pain, which can affect 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, and dizziness
  • pain in your face from nerve damage (trigeminal neuralgia)
  • numbness or tingling in your skin
  • slurred speech and difficulty swallowing
  • problems with your memory
  • problems with sex, including difficulty getting an erection in men and vaginal dryness in women
  • extreme tiredness (fatigue)
  • feeling emotional, anxious or depressed

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

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

Diagnosis of MS

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. 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. They’ll examine you and check your nerve reflexes and movement. They may check for any problems with your eyes.

You may need to have some of the following tests to make an MS diagnosis.

  • 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.
  • Your neurologist will look at your test results alongside your symptoms to make a diagnosis.

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 MS

If you stay as healthy as possible, it may help to improve your MS symptoms.

MS-related fatigue (tiredness) can get worse with heat, stress and overdoing it, so try to avoid these 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 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 be able to 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.

Treatment of MS

There isn’t a cure for MS, but MS treatments can help to reduce the number of relapses and how long they last. MS treatments can also help to manage symptoms and stop your MS progressing. At the same time, they may help to keep you mobile. Your MS treatment will depend on which type of MS you have and what your symptoms are.

Medicines for MS

Medicines to ease symptoms

A doctor can prescribe medicines to ease MS symptoms such as bladder problems, extreme tiredness and depression. If you have severe muscle spasms from MS, your doctor may prescribe a medicine to relax your muscles. This is usually either baclofen or gabapentin but there are alternatives. If you have nerve pain, such as burning sensations, pins and needles or stabbing pains, a medicine called amitriptyline may help.

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 your 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 you take steroids for three to five days. These reduce inflammation (swelling) and can speed up recovery from a relapse.

Disease-modifying medicines

Disease-modifying medicines can help to make relapses less severe and happen less often. They may also slow down how quickly your MS gets worse. Disease-modifying medicines include interferon beta, peginterferon beta-1a, dimethyl fumarate and teriflunomide. The medicine you have will depend on the type of MS you have.

Cannabis-based medicinal products

An oral spray that contains cannabinoids (chemicals found in cannabis) may reduce pain and stiffness from muscle spasms. You may be able to get this from a 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 MS

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

  • mindfulness or cognitive behavioural therapy (CBT ) for low mood, extreme tiredness or anxiety
  • speech and language therapy
  • physiotherapy to help with weakness, stiffness, pain or shaking (tremor)
  • occupational therapy to make some practical changes to your home and work to make it easier to live with MS

Complementary therapies for MS

There isn't much proof to show that complementary therapies work for 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 MS

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 diagnosis with a specialist nurse, so you can ask more questions then.

Your MS will 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 (who may suggest exercises if you have pain caused by poor mobility or poor posture)
  • occupational therapists (who can help with everyday tasks, such as eating, walking, using a computer or getting up and down stairs)
  • speech and language therapists
  • clinical psychologists
  • social workers

It’s important to have the practical support you need so you can deal with MS symptoms. 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 your mood, memory and concentration, as well as your physical health. 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, and employers are required by law to help if you have a progressive or long-term condition, such as MS. Your employer may be able to make changes to your workplace, for example to allow flexible working hours so you can get some rest when you need to. They may also be able to provide special equipment.

MS symptoms, such as fatigue, pain and problems with mobility, can affect your sex life but there are treatments to help. Problems can include a dry vagina, and difficulty getting an erection. There are medicines to treat both conditions. You may also be able to access counselling to help talk through problems with your partner. Ask a GP for more information.

See our section on living with MS for more information.

Doctors don’t know what causes MS. But it’s thought that you may get it if you have a certain combination of genes, and you’re exposed to certain environmental triggers. These triggers include things like smoking and having too little vitamin D. Getting infected with the Epstein–Barr virus (glandular fever) has also been linked to an increased risk of MS.

See our section on causes of MS for more information.

MS can affect people at any age, but it usually starts when people are in their 20s, 30s or 40s. It’s rare to develop MS under the age of 10 or over the age of 60.

See our section ‘About MS’ for more information.

One of the first signs of MS is developing problems with your sight and other senses. You may have problems with your sight in one eye. And your arms and legs may feel weak, which can affect how you walk.

See our section on symptoms of MS for more information.

MS symptoms depend on which part of your brain and spinal cord (central nervous system) is affected and can vary from person to person. Symptoms include problems with sight and extreme tiredness (fatigue). You may also get numbness or tingling in your skin, slurred speech and difficulty swallowing.

See our section on symptoms of MS for more information.

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