Multiple Sclerosis

Expert Reviewer, Dr Oliver Lily, Consultant Neurologist
Next review due, November 2020

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

About multiple sclerosis

Around 100,000 people in the UK have multiple sclerosis (MS). MS usually starts when people are in their 20s and 30s. It affects about three times as many women as men.

MS only affects your central nervous system – that is either the brain or the spinal cord. Your nerves are protected by a sheath (covering) made of a substance called myelin. If you have MS, your immune system damages some of these myelin sheaths. The sheaths then become swollen and your nerves can’t send messages properly around your body. This causes symptoms of MS. Why this happens to some people but not others still isn’t clear.

MS affects people differently. Some people only have a few mild symptoms that don’t affect their daily lives. Others may have more serious symptoms that get worse much more quickly.

Types of multiple sclerosis

Multiple sclerosis (MS) affects people differently. There are three main types of MS depending on your symptoms and how quickly they get worse.

Relapsing/remitting MS

If you have relapsing/remitting MS, your symptoms will come and go. This is the most common form of MS, affecting about eight in every 10 people with the condition. You may develop new symptoms (called a relapse) which then may or may not get better over time. Some people have a relapse once or twice a year and others have a relapse more often. Your symptoms may disappear completely during remission. You may have fewer MS relapses as you get older and have had MS for longer.

You may hear the term ‘benign MS’. This is sometimes used to describe a version of relapsing/remitting MS where, ten years or more after diagnosis, you have a low level of disability and it seem to be staying that way for a long time. It’s a controversial term though, and there’s evidence that people who were thought to have benign MS may still experience a return of more severe symptoms.

Secondary progressive MS

If you have secondary progressive MS, your symptoms will get gradually worse over time without any relapses. You’ll gradually notice fewer periods of good health (remissions). About half of all people who have relapsing/remitting MS develop secondary progressive MS within the first 15 years after they’ve been diagnosed.

Primary progressive MS

If you have primary progressive MS, you won’t have relapses and remissions. Your symptoms will gradually get worse over time. About one in 10 people with MS has primary progressive MS.

Symptoms of multiple sclerosis

Multiple sclerosis (MS) causes lots of different symptoms. The symptoms often depend on which part of your central nervous system is affected. They also vary from person to person. You may have only a few mild MS symptoms, especially in the early stages. Or you may have symptoms that get worse over time.

Inflammation of your optic nerve (inside your eye) can be one of the early symptoms of MS. This is called optic neuritis. It can cause you to lose some or all of your vision for a while. It can also cause eye pain, especially when you move your eye. Other eye problems caused by MS include double vision and oscillopsia, which is when objects seem to be moving even though they’re not.

Other common MS symptoms include:

  • extreme tiredness (fatigue)
  • muscle weakness, stiffness and spasms, which can affect walking and using your hands
  • bladder problems, such as needing the toilet more often and urgently and not emptying your bladder completely
  • incontinence, caused by bladder and/or bowel problems
  • loss of balance, coordination and dizziness
  • pain from nerve damage, such as facial pain (trigeminal neuralgia) or pain in your lower back
  • numbness or tingling on your skin
  • slurred speech and difficulty swallowing
  • feeling emotional, anxious or depressed
  • sexual problems, including trouble having erections in men or vaginal dryness in women – see our FAQ on Sex life for more information

If you have any of these symptoms, it’s important to make an appointment with your GP. At first the symptoms may be mild and making a diagnosis can be difficult. However, the earlier you’re diagnosed with MS, the easier it is for your doctor to prescribe treatments that stop your symptoms getting worse. It’s also important to remember that having any of these symptoms doesn’t mean you have MS, as they may be caused by something else.

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

Diagnosis of multiple sclerosis

Multiple sclerosis (MS) can be difficult to diagnose. There’s no single test for MS and many of the symptoms can be caused by other conditions instead. These may need to be ruled out first. Your GP will ask you about your symptoms and may arrange for you to have some blood tests.

If your GP thinks you may have MS, you’ll be referred to a neurologist (a doctor who specialises in conditions affecting your nervous system). Your neurologist will ask detailed questions about your symptoms and your general health. They will examine you, including checking your nerve reflexes and your ability to move different parts of your body. They may check for any problems with your eyes, such as changes to your sight.

You may also need to have one or more tests. Your neurologist will choose the tests you need according to your symptoms. These tests can include:

  • a magnetic resonance imaging (MRI) scan. This uses magnets and radio waves to produce images of the inside of your body. This is the most common test for MS. The scan may show up areas of scarring or inflammation (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
  • a lumbar puncture. This involves taking a sample of the fluid that surrounds your brain and spinal cord (cerebrospinal fluid). This only needs to be done when the neurologist thinks you may have primary progressive MS

Your neurologist will look at your test results with your symptoms to confirm whether or not you have MS. They will usually only make a definite diagnosis of MS after you’ve had a second relapse. So it can take a while to get a diagnosis. If you have had a single attack of inflammation, such as optic neuritis or inflammation in your spine, neurologists call this clinically isolated syndrome (CIS). People who experience CIS may go on to develop MS.

Treatment of multiple sclerosis

Multiple sclerosis can’t be cured and you’ll always have it. But you may not have symptoms all the time. If your symptoms flare up (called a relapse), there may be some things you can do to ease them. Your doctor may prescribe medicines and other treatments to relieve your symptoms, stop your MS progressing and help you keep moving. Your treatment will depend on which type of MS you have and your exact symptoms. You may be able to help some of your symptoms yourself, such as extreme tiredness, by making simple changes to your lifestyle.

Self-help for multiple sclerosis

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

MS-related fatigue (tiredness) can be triggered, or worsened, by heat, stress and overdoing it, so try to avoid these triggers as much as possible. It may help if you plan each day carefully to prioritise certain tasks so you don’t use up all your energy in one go. You may find you need short rests during the day, rather than a long rest. If you’re unusually tired, see your GP. You may need to have some tests to check for problems, such as an infection, low iron levels (anaemia) or a problem with your thyroid gland.

Regular exercise may help with fatigue and keep you mobile. Try some aerobic activities (such as walking or swimming), as well as balancing and stretching exercise, such as yoga. You may benefit from using an exercise bike or treadmill at your local gym. Your neurologist can refer you to a physiotherapist to discuss the right exercises for you and your symptoms and how to pace yourself.

There’s no clear medical 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 any fatigue worse. If you’re prone to constipation, drink more fluids and eat more high-fibre foods (such as fruit and vegetables). If you have trouble eating or getting enough essential nutrients in your diet, your neurologist can refer you to a dietitian.

If you have bladder problems 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 may make your MS symptoms get worse more quickly.

Medicines for multiple sclerosis

Your doctor may be able to prescribe medicines to ease specific multiple sclerosis (MS) symptoms, such as bladder problems, extreme tiredness and depression. These medicines may help to keep your symptoms under control and make it easier for you to get on with 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, you may be given a course of corticosteroids for a few days. Corticosteroids reduce inflammation (swelling) and can speed up your recovery from a relapse.

You may be prescribed disease-modifying medicines if you have relapsing-remitting MS and you've had two or more serious relapses within the past two years. These medicines may ease the symptoms of relapse and mean you have a relapse less often. They may also slow down how quickly your MS gets worse.

There are different disease-modifying medicines that your doctor may recommend. These could include medicines called diamethyl fumarate (Tecfidera) or teriflunomide (Aubagio). These medicines don’t work so well in secondary progressive MS and won’t work for primary progressive MS, so your doctor may recommend others. More severe MS may be treated with biological treatments, which work by influencing your body’s immune system. These biological treatments are given to you through an intravenous drip (infusion) and can include natalizumab or alemtuzumab.

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:

  • mindfulness or cognitive behavioural therapy (CBT) if your mood is affected, you have extreme tiredness or you’re feeling anxious or depressed
  • speech and language therapy if you’re having trouble communicating
  • physiotherapy to help with weakness, stiffness or pain in your muscles and joints

Complementary therapies for multiple sclerosis

There isn't much proof to show that complementary therapies work well for multiple sclerosis (MS). But some people with MS do find acupuncture, reflexology and massage can help their symptoms.

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

Causes of multiple sclerosis

Doctors don’t know why some people develop multiple sclerosis (MS) and others don’t. MS seems to be caused by an autoimmune reaction, when your immune system attacks your own cells. Your family history and certain environmental factors may make your immune system more likely to react in this way.

Having a certain combination of genes may make you more likely to develop MS. But most people with MS don’t have any close family relatives with the condition. It seems that you need to be exposed to certain environmental triggers too. MS may be triggered by a virus early on in life, 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 MS. 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. However, there’s no proof that this actually causes MS, and the link between vitamin D and MS is disputed by other experts.

Living with multiple sclerosis

Being diagnosed with a lifelong condition can be distressing and you’re likely to have a lot of questions. Your neurologist will discuss your multiple sclerosis (MS) symptoms and treatments and how your condition could affect your daily life. You may be offered a follow-up appointment around six weeks after your diagnosis in case there’s anything else you want to know.

You’ll be offered a review of your MS at least once a year. This will give you the chance to discuss any changes in your condition and new treatments that may be suitable for you. Your need for support and advice may change over time, depending on your symptoms and how MS affects you. Your doctor may refer you to other healthcare professionals. These include:

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

If your MS is affecting your everyday tasks, your neurologist can refer you to an occupational therapist. They may recommend some products that help with eating, walking, using a computer or getting up and down the stairs. A physiotherapist may suggest some exercises if your pain is 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 living independently and continue your daily activities. You can also get in touch with local support groups and national charities and organisations.

MS can affect your mood, memory and concentration, as well as your physical health. It can also affect your relationships and sex life. It’s important to relax, as too much stress 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, such as wheelchair access, and provide special equipment.

Frequently asked questions

  • MS is an unpredictable condition. It’s very hard for doctors to predict how it will affect you and how it changes over time. But MS usually only affects how long people live in very serious cases.

    How MS affects you will depend on which type of MS you have. Some people have mild symptoms that don’t affect their daily lives. Others have more serious symptoms that get worse much more quickly.

    Having the right treatment may reduce your chances of having a relapse and stop your MS from getting worse. It can also help you manage your symptoms and any problems keeping mobile.

    Your specialist MS nurse or doctor can help to answer any questions you may have.

  • Being pregnant won’t make your MS worse. You may even be less likely to get new MS symptoms (have a relapse). All pregnancies are different, so discuss any concerns or symptoms you have with your midwife or GP.

    You shouldn’t take some MS medicines in pregnancy, so they may need to be stopped or gradually reduced before you start trying for a baby. You should only do this under your specialist MS nurse or neurologist’s supervision. 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 breastfeeding and looking after your baby after the birth. You may be more likely to have a relapse in the three to six months after your baby is born. But your MS will then return back to the way it was before your pregnancy.

  • MS symptoms, such as fatigue, pain and problems with mobility, can affect your sex life. Muscle spasms may make it harder for you to have sex. If you have anxiety or depression, you may not be in the mood to have sex. 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 when having sex, which can affect their enjoyment. If you’re a woman with MS, your vagina may become drier, which can make you feel uncomfortable. If you’re a man with MS, you may also 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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  • Reviewed by Graham Pembrey, Lead Health Editor, Bupa Health Content Team, November 2017
    Expert Reviewer, Dr Oliver Lily, Consultant Neurologist
    Next review due, November 2020

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