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Multiple sclerosis (MS)

Multiple sclerosis (MS) is a condition that affects the nerves in your brain and spinal cord (central nervous system). It can cause problems with muscle control, vision and balance.

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

MS is a condition that affects your central nervous system. Nerves are made up of thousands of fibres that transmit tiny electrical impulses (messages) between your brain, spinal cord and the rest of your body. So, for example, messages are sent to your muscles, skin and organs (such as your heart and lungs). Your nerves are protected by a sheath made of a substance called myelin. This makes sure the messages are transmitted quickly.

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. This causes inflammation (swelling).

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. This scarring (sclerosis) prevents the affected nerves from sending messages properly. The signals can slow down, change or not get through at all.

MS affects people differently and can progress in a number of ways. Some people have a very mild form of the condition, whereas others have a more severe form.

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Details

  • Types Types of of multiple sclerosis

    Relapsing/remitting multiple sclerosis (MS)

    Your symptoms will come and go. This is the most common form of MS, affecting about eight in 10 people who have the condition. This means you have relapses (flare ups of symptoms), followed by remission (periods of good health). Remission can last for any length of time, while relapses can last for anything between a few days and a few weeks.

    Progressive MS

    • Secondary progressive MS – this starts after a period of flare ups and remission. You’ll gradually have more or worse symptoms that don’t improve, and fewer periods of good health. About half of all people who have relapsing/remitting MS go on to develop secondary progressive MS within 10 years.
    • Primary progressive MS – from the beginning, your symptoms will gradually develop and get worse over time. About one in 10 people with MS have primary progressive MS.
  • Symptoms Symptoms of multiple sclerosis

    The symptoms of multiple sclerosis (MS) can vary widely from person to person. They can also depend on the area of your central nervous system that is affected. You may have only a few mild symptoms, especially in the early stages. You may have symptoms that get worse over time. Some of the most common symptoms include:

    • tiredness (fatigue)
    • muscle weakness, stiffness and spasms leading to difficulty walking
    • eye problems, blurred or double vision and temporary loss of vision
    • bladder problems, particularly emptying your bladder completely or needing to urinate frequently and urgently, in some cases leading to incontinence
    • bowel problems
    • loss of balance, coordination and dizziness
    • pain from nerve damage, for example you may have facial pain (trigeminal neuralgia) or pain related to loss of mobility
    • numbness or tingling on your skin
    • burning or twisting sensation
    • heat sensitivity, feeling too hot or too cold
    • slurred speech and difficulty swallowing
    • feeling emotional, anxious or depressed
    • sexual difficulties, such as problems with erections or vaginal dryness – see our frequently asked questions for more information

    You won’t get all of these symptoms, and especially not at the same time. And having them doesn't necessarily mean you have MS – they may be caused by something else.

    It’s a good idea to contact your GP for advice if you have any of the symptoms listed here.

  • Diagnosis Diagnosis of multiple sclerosis

    Multiple sclerosis (MS) can be difficult to diagnose. There’s no single test that can confirm MS and many of the symptoms are also found in other conditions. These may need to be ruled out first.

    If your GP thinks you may have MS, you’ll be referred to see a neurologist. This is a doctor who specialises in conditions that affect the nervous system. Your neurologist will ask detailed questions about your symptoms and your general health. You may be advised to have one or more tests, listed below.

    • A neurological examination to test your nerve reflexes and your ability to move different parts of your body.
    • An examination to look for problems with your eyes, such as changes to your sight.
    • An MRI scan – this uses magnets and radio waves to produce images of the inside of your body. The scan may show up areas of scarring or inflammation (swelling) in the myelin. This is a common test used to diagnose MS.
    • Evoked potential testing to measure the time it takes for messages to travel to your brain, usually from your eyes.
    • A lumbar puncture (also known as a spinal tap). This involves taking a sample of the fluid that surrounds your brain and spinal cord (cerebrospinal fluid). Lumbar punctures are only usually carried out if your MRI scan doesn't show for certain whether you have MS or not.

    These tests will help your neurologist to confirm whether or not you have MS. A first episode is called a Clinically Isolated Syndrome. The neurologist will usually only make a definite diagnosis of MS after a second episode. Thus if your initial symptoms get better, your neurologist may wait to see if you have another relapse. It can be difficult and may take time to get a firm diagnosis.

  • Treatment Treatment of multiple sclerosis

    Although there isn't a cure for multiple sclerosis (MS) and you will always have it, you won’t necessarily have symptoms all of the time. Your treatment will depend on the type of MS you have and your symptoms. The aim of treatment is to relieve these symptoms, manage the progression of MS and improve your mobility.

    Self-help

    There are things you can do for yourself to help improve the symptoms of MS. Some examples include:

    • exercise to help with fatigue and muscle weakness
    • pelvic floor exercises to reduce urinary incontinence

    Talk to your GP or specialist nurse for information about what will be helpful for you.

    Medicines

    Certain symptoms, such as depression, incontinence and pain, can be relieved with medicines. These medicines don’t prevent relapses or slow the progression of your MS. But they may help you to manage your symptoms and make it easier to get on with day-to-day life.

    If you get new symptoms or your symptoms get worse, tell your GP or specialist MS nurse.

    If you have a relapse, you may be given a course of steroids for a few days to improve your symptoms. Steroids reduce inflammation (swelling) and can speed up your recovery from a relapse.

    You may be prescribed disease modifying drugs if you have relapsing-remitting MS and you've had two or more serious relapses within the past two years. They can reduce the frequency and severity of relapses in people with relapsing/remitting MS and may slow down its progression. For example, you may be advised to take a medicine called interferon beta or glatiramer (copaxone). However, they aren't a cure for MS and they don’t seem to work for the primary progressive form of MS.

    Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your GP or pharmacist for advice.

    Other treatments

    Depending on what symptoms you have, you may be referred for different types of treatment. For example, you may be offered:

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

    Complementary therapy

    Although there isn't much proof to show that complementary therapies work well, some people with MS do find they work for them. They include complementary mind-body therapies, such as progressive resistance training (PRT), yoga, reflexology, massage and tai chi. Have a chat with your MS nurse before trying anything new.

  • Private GP appointments

    With our GP services, we aim to give you an appointment the next day or sooner if it’s urgent. Find out more today.

  • Causes Causes of multiple sclerosis

    The exact reasons why you may develop multiple sclerosis (MS) aren't well understood at the moment. Several factors are thought to be involved, including the following.

    • Having a certain combination of genes may make some people more susceptible to MS. These genes are also found in the general population so having them doesn't definitely mean you will develop MS. MS isn’t inherited and most people who develop the condition don’t have anyone else in their family with it. However, you do have a slightly higher risk of developing MS if you have a relative with the condition.
    • A lack of vitamin D could play a part in the development of MS in some people. Your body produces vitamin D when your skin is exposed to sunlight. More scientific research needs to be done to say for certain, but 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 less.
    • Environmental factors, such as a virus or bacteria, may also trigger MS. But so far no single virus has been identified that causes MS.
  • Living with multiple sclerosis Living with multiple sclerosis

    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, other health professionals who can help include:

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

    You may be entitled to support services at work. Under the Equality Act, your employer can make reasonable adjustments to help you continue with your job.

    Infections can trigger a relapse, so you will probably be advised to have a flu jab to reduce this risk.

  • FAQs FAQs

    Will multiple sclerosis (MS) shorten my life?

    Answer

    MS may affect how long you live.

    Explanation

    If you have MS, your overall life expectancy may be slightly lower than that of the general population if you have severe symptoms. However, usually MS doesn't directly cause death – it’s generally related to a complication of MS, such as an infection.

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

    Can I still have children if I have multiple sclerosis?

    Answer

    Yes. MS doesn’t directly affect your fertility and there is no reason why you can’t still have children.

    Explanation

    MS doesn't directly affect your fertility so your chances of conceiving are as good as somebody who doesn't have MS.

    If you have MS and you’re planning to get pregnant, talk to your specialist nurse. Some medications aren't recommended in early pregnancy and may need to be stopped or gradually reduced before you start trying for a baby. You should only do this under your specialist nurse or doctor’s supervision, as stopping your medicine suddenly may be harmful. If you find out that you’re pregnant unexpectedly and you’re taking disease modifying drugs (DMDs), talk to your specialist nurse as soon as possible.

    During pregnancy, most women feel well and have no new MS symptoms. Some symptoms of pregnancy and MS are similar, such as fatigue, so it may appear that some of your symptoms become worse. All women’s pregnancies are different, so discuss any concerns or symptoms you have with your midwife or GP.

    Overall, the number of relapses women have during pregnancy and the year that follows remains constant. Pregnancy doesn't seem to have a long-term effect on disease progression. If you do have a relapse, research shows that it’s more likely to happen during the three months after you have given birth.

    Will multiple sclerosis affect my sex life?

    Answer

    MS can affect the practical and emotional aspects of sex, for both men and women.

    Explanation

    Not everybody that has MS will be affected by issues with their sex life.

    If you have MS, symptoms such as fatigue, bladder and bowel problems, mobility issues and pain may reduce your desire for sex.

    If you’re a woman, you may also find the sensation and regularity of orgasm is different and penetration may be uncomfortable. Your vagina may become drier and vaginal muscle tone can decrease. If you’re a man with MS, you may have less sensation in your penis, fewer and less intense orgasms. You may also have ejaculation or erectile problems.

    If you need any advice, talk to your GP. You may find counselling helps as it gives you a chance to talk through any worries that you have. If the sensations you experience have changed, getting used to your body and what feels good may help. Water-soluble lubricants can help reduce dryness. Men can try medicines such as sildenafil or prostaglandins for erectile difficulties.

    Always read the patient information leaflet that comes with your medicine and if you have any questions, speak to your pharmacist or GP.

    Establishing and maintaining your relationship is important. If you’re concerned that MS is affecting your sex life, talk to your MS nurse or GP.

    My lumbar puncture showed oligoclonal bands – what does this mean?

    Answer

    If your lumbar puncture shows you have oligoclonal bands, it’s likely that you have MS.

    Explanation

    You may be offered a lumbar puncture to help diagnose MS. This involves taking a sample of the fluid that surrounds your brain and spinal cord (cerebrospinal fluid). The fluid is then checked for certain types of antibodies. Usually these are produced by your immune system to help your body fight infection but in MS they attack your nerves. Your neurologist will use a process known as electrophoresis to test this. This makes antibodies that are the same size group together to form bands. If there is more than one band showing up, these are called oligoclonal bands.

    Oligoclonal bands are found in more than nine out of 10 people who have MS. But you can still get a firm MS diagnosis without this kind of testing.

  • Resources Resources

    Further information

    Sources

    • Neurology. Oxford handbook of general practice (online). Oxford Medicine Online. www.oxfordmedicine.com, published April 2014
    • Multiple sclerosis. Medscape. www.emedicine.medscape.com, published October 2014
    • Mackenzie IS, Morant SV, Bloomfield GA, et al. Incidence and prevalence of multiple sclerosis in the UK 1990–2010: a descriptive study in the general practical research database. J Neurol Neurosurg Psychiatry 2014; 85(1):76−84. doi:10.1136/jnnp-2013-305450
    • Multiple sclerosis. Brain and Spine Foundation. www.brainandspine.org.uk, published July 2013
    • Multiple sclerosis. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed October 2014
    • Management of multiple sclerosis in primary and secondary care. National Institute for Health and Care Excellence (NICE), 2014. www.nice.org.uk
    • Multiple sclerosis. BMJ Best Practice. www.bestpractice.bmj.com, published November 2013
    • Multiple sclerosis. The Merck Manuals. www.merckmanuals.com, published March 2014
    • Map of Medicine. Multiple sclerosis. International View. London: Map of Medicine; 2014 (Issue 4)
    • McClurg D, Lowe-Strong A, Ashe RG. The benefits of pelvic floor muscle training in people with multiple sclerosis and lower urinary tract dysfunction. Journal of the Association of Chartered Physiotherapists in Women’s Health 2008; 103:21–28. www.pogp.csp.org.uk
    • Kjølhede T, Vissing K, Dalgas U. Multiple sclerosis and progressive resistance training: a systematic review. Mult Scler 2012; 18(9):1215−28. doi: 10.1177/1352458512437418
    • Work and MS. Multiple Sclerosis Society. www.mssociety.org.uk, published April 2014
    • Buraga I, Popovici RE. Multiple sclerosis and pregnancy: current considerations. The Scientific World Journal 2014; 2014 doi: 10.1155/2014/513160
    • Sex, intimacy and relationships. Multiple Sclerosis Society. www.mssociety.org.uk, published April 2012
    • Erectile dysfunction. PatientPlus. www.patient.co.uk/patientplus.asp, published April 2013
    • Oligoclonal bands in multiple sclerosis. University of Birmingham. www.birmingham.ac.uk, accessed November 2014
    • Dobson R, Ramagopalan S, Davis A, et al. Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes. J Neurol Neurosurg Psychiatry 2013; 84(8):909−14. doi: 10.1136/jnnp-2012-304695
    • Chiras, D. Human Biology. 7th ed. Sudbury, US: Jones and Bartlett; 2013:190
    • Walking difficulties. MS Trust. www.mstrust.org.uk, published 13 May 2014
    • Lumbar puncture. MS Trust. www.mstrust.org.uk, published 16 October 2013
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