Multiple sclerosis (MS)

Multiple sclerosis (MS) is a condition that affects the brain and/or spinal cord. It can cause symptoms like problems with vision, arm or leg movement, sensation or balance.

It's a lifelong condition that can sometimes cause serious disability. In many cases, it’s possible to treat symptoms. Average life expectancy is slightly reduced for people with MS.

MS Society estimates that there are more than 130,000 people diagnosed with MS in the UK.

It's often diagnosed in people in their 20s and 30s, although it can develop at any age. It's about two to three times more common in women than men.

Symptoms of MS

Multiple sclerosis (MS) can cause a wide range of symptoms and can affect any part of the body. It affects everyone differently.

The symptoms are unpredictable. Some people's symptoms develop and worsen over time, while for others, they come and go.

Periods when symptoms get worse are known as relapses. Periods when symptoms improve or disappear are known as remissions.

Some of the most common symptoms include:

What happens when someone has MS

MS is an autoimmune condition. This means your immune system mistakes part of your body for a foreign substance and attacks it.

In the case of MS, it attacks the myelin sheath in the brain and/or spinal cord. This is the layer that surrounds your nerves, protecting them and helping electrical signals travel from the brain to the rest of the body.

The attacks cause the myelin sheath to become inflamed in small patches (plaques or lesions). This can be seen on a magnetic resonance imaging (MRI) scan.

These patches of inflammation can disrupt the messages travelling along the nerves. It can slow them down, jumble them, send them the wrong way, or stop them from getting through completely. This disruption leads to the symptoms and signs of MS.

When the inflammation goes away, it can leave behind scarring of the myelin sheath (sclerosis). These attacks, particularly if frequent and repeated, can lead to permanent damage.

What causes MS?

Exactly why someone develops multiple sclerosis (MS) isn't known. It's not caused by anything you've done and it's not clear if you can prevent it.

It's likely to be partly caused by genes you inherit from your parents and partly by outside factors that may trigger the condition.

Some of the factors that might cause MS include:

More research will help us understand why MS occurs and whether it can be prevented or not.

Diagnosing multiple sclerosis

It can be hard to tell if you have multiple sclerosis (MS) because some of the symptoms are like other conditions. You may need to rule out other possible causes of your symptoms first.

If your GP thinks you could have MS, you should see a neurologist (a specialist in conditions of the nervous system) for a specialist assessment.

Some of the tests you may need to confirm MS are:

• neurological examination
• magnetic resonance imaging (MRI) scan
• lumbar puncture
• blood test

Types of MS

Once you have a diagnosis of MS, your neurologist might be able to identify which type of MS you have - either relapsing remitting MS or primary progressive MS.

This will largely be based on:

• the pattern of your symptoms - like whether you experience periods when your symptoms get worse (relapses) then improve (remissions), or whether they get steadily worse (progress)
• the results of an MRI scan

It can take some time to find out which type of MS you have because the symptoms are so varied. It can take a few years to make an accurate diagnosis of progressive MS, as the condition usually worsens slowly.

Treating multiple sclerosis

Treatment with disease-modifying therapies

Although there isn't a cure for MS, there are medicines that can help to reduce the number and severity of relapses in some people. These are called disease-modifying therapies or disease modifying drugs.

These reduce the amount of damage and scarring to the myelin sheath (layer surrounding your nerves), associated with MS relapses.

These treatments reduce the chances of developing progressive symptoms of MS. They might also help to slow worsening disability in MS.

Disease-modifying therapies are not suitable for everyone with MS. They're only prescribed to those with either:

• relapsing remitting MS
• secondary progressive MS who meet certain criteria, like the number of relapses they've had
• primary progressive MS who meet certain criteria like new lesions found by an MRI scan

People without relapses are less likely to benefit from the treatments and could still experience side effects from them.

Treatment of a relapse of MS

Sometimes an infection can cause a flare up of symptoms rather than a relapse, so your nurse or GP will check for other possible causes.

Treatment for a relapse might involve a five-day course of steroid tablets taken at home.

Steroids can help speed up your recovery from a relapse. They don't prevent further relapses or stop MS getting worse over time.

Steroids are only given for a short period of time to avoid possible steroid side effects. The side effects could include infection, mood disturbance, stomach ulceration, osteoporosis (weak bones), weight gain and diabetes.

Not using steroids more than three times a year (if possible) will help to reduce the risk of side effects.

Treatment for MS symptoms

There are different treatments available for MS symptoms.

Support for living with multiple sclerosis

Coming to terms with a long-term condition like MS can put a strain on you, your family and your friends. Be honest about how you feel and let your family and friends know what they can do to help.

If you have any questions, your MS nurse or GP can help and will let you know what support is available.

If you find it difficult to look after yourself, your local authority may be able to provide you with some help. Ask for a care and support needs assessment. For more information, read about assessing your care and support needs.

Having a baby

Being diagnosed with MS shouldn't affect your ability to have children. Women with MS can have a normal pregnancy, deliver a healthy baby and breastfeed.

Some of the medications prescribed for MS aren't suitable for taking during pregnancy or breastfeeding and might affect fertility in males and females. If you're considering starting a family, discuss it with your healthcare team.

Having a baby doesn't affect the long-term course of MS. Relapses can be less common in pregnancy, but they can be more common in the months after giving birth.

Money and financial support

If you have to stop work or work part-time because of your MS, you may find it hard to cope financially. You might be able to get financial support.

Driving

If you have MS, you must tell the Driver and Vehicle Licensing Agency (DVLA) and inform your insurance company.

You might be able to continue driving, but you’ll be asked to complete a form providing more information about your condition. You'll be asked for details of your doctors and specialists. The DVLA will use this to decide whether you're fit to drive.