Multiple Sclerosis (MS)

What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is a lifelong condition affecting your brain and spinal cord, where your immune system mistakenly attacks the protective coating (myelin) around your nerve fibres. This disrupts the messages travelling between your brain and the rest of your body, and while there's no cure, treatment can help manage your symptoms and slow the condition down.

Symptoms of multiple sclerosis

MS symptoms vary enormously from person to person and can affect almost any part of your body. Common symptoms include:

• feeling extremely tired (fatigue)
• problems with your eyes or vision, such as blurred or double vision, or pain when you move your eyes
• numbness or tingling in different parts of your body
• feeling off balance, dizzy or clumsy
• muscle weakness, stiffness, cramps or spasms
• needing to pee more often, or difficulty controlling when you pee
• problems with memory or concentration
• mood changes, and sexual difficulties.

Symptoms often come in the form of flare-ups, called relapses, followed by periods where they ease off or disappear, known as remission. How much MS affects you day to day varies hugely between people, and can even change from one day to the next. Many people also find their symptoms temporarily worsen with a fever, in hot weather, or after a common infection.

Causes and risk factors

MS happens when your immune system mistakenly attacks myelin, the protective layer around your nerve fibres, though it's not fully understood why this happens. Genetics seem to play a part: hundreds of different genes and gene variants are thought to combine to make someone more vulnerable to MS, though the condition itself isn't directly inherited from a parent.

You're more likely to develop MS if you're aged between 20 and 50, if you're a woman, or if you have a close relative, such as a parent or sibling, with the condition. Smoking roughly doubles your risk, and having had the Epstein-Barr virus, which causes glandular fever, is also strongly linked to MS, although the vast majority of people who've had this common virus never go on to develop it.

People who spend more time in the sun, or who have higher vitamin D levels, seem less likely to develop MS, and tend to have a milder course of the disease if they do.

Types of multiple sclerosis

There are three main types of MS, and your neurologist may need to monitor you for some time to work out which one you have.

Relapsing remitting MS is the most common type. You have flare-ups (relapses) where symptoms get worse, followed by periods where they ease off or disappear (remission). Over time, this type often develops into secondary progressive MS, where symptoms are there most of the time and slowly get worse, sometimes still with occasional relapses.

Primary progressive MS is less common. Symptoms slowly get worse from the start, without the clear relapses and remissions seen in the other types.

How is multiple sclerosis diagnosed?

There's no single test for MS. If your GP suspects you might have it, they'll refer you to a neurologist, a specialist in conditions affecting the brain and nerves, who will ask about your symptoms and carry out a detailed examination.

You'll likely have tests to check your movement, coordination, vision, balance and reflexes, along with blood tests and an MRI scan to look for damage to the nerves in your brain or spinal cord. You may also need a lumbar puncture, where a small sample of fluid is taken from your lower back with a needle, or tests using small sensors on your skin to measure how quickly messages travel from your eyes or ears to your brain.

Because MS symptoms can look like several other conditions, getting a confirmed diagnosis can take time and several appointments.

How is multiple sclerosis treated?

There's no cure for MS, but treatments can slow its progression and ease your symptoms. You'll likely be supported by a team that includes a neurologist, a specialist MS nurse, a physiotherapist and an occupational therapist, and your treatment plan may change over time.

During a relapse, steroid medicine can help reduce inflammation and speed up your recovery, though it doesn't change the condition's long-term course. Separately, a group of medicines called disease-modifying therapies, taken as injections, infusions or tablets, can reduce how often you have relapses and how severe they are, and slow the disease down over time.

Beyond this, treatment focuses on managing your individual symptoms. Muscle stiffness and spasms can be helped by physiotherapy, stretching, water-based exercise or medicines, while mobility aids such as a stick, a frame, a walker or a wheelchair, along with home adaptations, can support you with everyday tasks if walking becomes difficult.

Fatigue often responds well to pacing your activity and staying moderately active while avoiding overheating, and an occupational therapist can help you manage your energy day to day. Vision problems may be helped by glasses or eye exercises, bladder and bowel symptoms by medicines or dietary changes, and mood or memory difficulties by talking therapies such as CBT, or, where needed, medication.

Some people find complementary approaches such as acupuncture, yoga or tai chi helpful alongside their usual treatment, though it's important to tell your doctor about anything you're taking or trying, since herbal supplements in particular can interact with your other medicines.

When should I see a doctor?

See your GP if you think you might have symptoms of MS. They're common to several conditions, so having them doesn't necessarily mean you have MS, but it's important to get them checked.

Call 999 or go to A&E if you suddenly develop weakness or numbness in one arm, sudden loss or blurring of vision, or sudden problems with balance and coordination, since these can be signs of a stroke and need urgent attention.

If you already have MS, contact your care team about any new or worsening symptoms, including feeling unusually sensitive to heat, increasing unsteadiness, new numbness or tingling, or sudden vision changes.