Multiple sclerosis (MS)

What causes multiple sclerosis?

No one knows exactly why a person develops multiple sclerosis (MS). It isn't caused by anything you have done, and it isn't clear whether it can be prevented.

It seems to come from a mix of genes passed down from your parents and outside factors that may trigger the condition.

Some of the factors thought to play a part are described below.

MS isn't passed directly from parent to child, but if someone in your family has it, your own chances of developing it are somewhat higher. A brother, sister or child of a person with MS has around a 2 to 3 percent chance of developing it themselves.

MS shows up more often in countries that lie farther from the equator. This has led experts to wonder whether getting less sunlight and having low vitamin D levels might be part of the cause. Whether taking vitamin D supplements can help prevent MS is still not clear.

People who smoke are roughly twice as likely to develop MS as people who don't.

Certain infections may also play a role, particularly one caused by the Epstein Barr virus, the virus behind glandular fever. This infection may set off a reaction in the immune system that leads to MS in some people.

As more research is done, we should get a clearer picture of why MS develops and whether there is a way to stop it from happening.

It can be hard to tell whether you have multiple sclerosis (MS), since some of its symptoms look like those of other conditions. Your doctor will usually need to rule out other possible causes first.

If your GP suspects MS, you should be referred to a neurologist (a specialist in nervous system conditions) for a full assessment.

Some tests that may help confirm MS include:

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

Types of multiple sclerosis

Once you're diagnosed with MS, your neurologist may be able to tell which type you have, either relapsing remitting MS or primary progressive MS.

This is largely based on:

• the pattern of your symptoms, such as whether you go through periods when they worsen (relapses) and then improve (remissions), or whether they steadily get worse (progress)
• what the MRI scan shows

It can take time to identify which type of MS you have, since the symptoms vary so much. Diagnosing progressive MS accurately may take a few years, as it usually worsens slowly.

Contact your specialist MS nurse or GP practice if you think you're having a relapse.

Treatment with disease modifying therapies

There's no cure for MS yet, but certain medicines can reduce how often relapses happen and how severe they are for some people. These are known as disease modifying therapies, or disease modifying drugs.

They work by cutting down the damage and scarring caused to the myelin sheath, the protective layer around your nerves, that happens during MS relapses.

These treatments also lower the chances of developing progressive symptoms of MS, and may help slow down worsening disability over time.

That said, disease modifying therapies aren't right for everyone with MS. Doctors generally only prescribe them to people who have:

• relapsing remitting MS
• secondary progressive MS, if they meet certain criteria, such as the number of relapses they've had
• primary progressive MS, if they meet certain criteria, such as new lesions showing up on an MRI scan

If you haven't been having relapses, you're less likely to benefit from these treatments, and you could still face side effects from taking them.

Treating a relapse of multiple sclerosis

Sometimes what looks like a relapse is actually a flare up caused by an infection, so your nurse or GP will first check for other possible causes before deciding on treatment.

Treatment for a genuine relapse often involves a five day course of steroid tablets that you can take at home.

Steroids help speed up your recovery from a relapse, but they won't prevent future relapses or stop MS from getting worse over time.

Because of this, steroids are only given for a short period, to keep the risk of side effects low. These possible side effects include infections, mood changes, stomach ulcers, osteoporosis (weakened bones), weight gain, and diabetes.

Coming to terms with a long-term condition like MS is not easy, and it can put a strain on you, your family and your friends. It helps to be honest about how you are feeling and to let the people close to you 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 to you.

If you are finding it hard to look after yourself day to day, your local authority may be able to offer some help. You can ask them 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 should not affect your ability to have children. Women with MS can go through a normal pregnancy, deliver a healthy baby and breastfeed without trouble.

That said, some of the medications used to treat MS are not suitable during pregnancy or breastfeeding, and some can affect fertility in both men and women. If you are thinking about starting a family, it is worth discussing this with your healthcare team beforehand.

Having a baby does not change the long-term course of MS. Relapses often become less frequent during pregnancy itself, though they can become more common again in the months after giving birth.

Money and financial support

If you have had to stop working, or have cut down to part-time work because of your MS, money can become tight. Support is often available, so it is worth checking what financial help you might be entitled to.

Driving

If you have MS, you are required to tell the Driver and Vehicle Licensing Agency (DVLA) about it, and you should also let your insurance company know.

In many cases you will still be able to drive, but you will be asked to fill in a form giving more detail about your condition, including the names of your doctors and specialists. The DVLA uses this information to decide if you are fit to drive.

When filling in this form, do not include personal details such as your name, your location or any other personal health conditions.