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, and it can sometimes cause serious disability. In many cases it's possible to treat the symptoms. Average life expectancy is slightly reduced for people with MS.

The MS Society estimates that more than 130,000 people in the UK have been diagnosed with MS.

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

Multiple sclerosis (MS) can cause many different symptoms, and it can affect any part of the body. It affects everyone differently.

The symptoms are unpredictable. In some people they develop and get worse over time, while in 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:

MS can cause your muscles to:

• feel weak
• become stiff and resistant to movement (spasticity)
• contract tightly and painfully (spasm)

In around 1 in 4 cases of MS, the first symptom you notice is a problem with one of your eyes (optic neuritis). You may have:

• some temporary loss of vision in the affected eye, usually lasting for days to weeks
• colour blindness
• eye pain, which is usually worse when you move the eye
• flashes of light when you move the eye

You might also have double vision or involuntary eye movements, which can make it seem as though objects are jumping around.

You might have numbness or tingling in different parts of your body that doesn't go away and can last a few days to weeks.

MS can make walking and moving around difficult, particularly if you also have muscle weakness and spasticity. You may have:

• clumsiness
• difficulty with balance and co-ordination (ataxia)
• shaking of the limbs (tremor)
• dizziness and vertigo, which can make it feel as though everything around you is spinning

Some people with MS have pain, and it can take two forms.

This is pain caused by damage to the nervous system, and it can include:

• stabbing pains in the face
• stabbing sensations in the torso (body) and limbs
• feeling like you're burning
• pins and needles
• feeling like you're being hugged or squeezed

Muscle spasms can sometimes be painful.

This can be back, neck and joint pain, particularly if you have problems walking or moving around.

Bladder problems are common in MS. They may include:

• having to pee more often
• having a sudden, urgent need to pee, which can lead to unintentionally passing urine (urge incontinence)
• difficulty emptying the bladder completely
• having to get up during the night to pee
• recurrent urinary tract infections

These problems can also have causes other than MS.

Many people with MS also have problems with their bowels.

Constipation is the most common one. You may find it hard to pass stools (poo), and pass them much less often than normal.

Bowel incontinence is less common, but it's often linked to constipation. If a poo becomes stuck, it can irritate the wall of the bowel. The bowel then produces more fluid and mucus, and this can leak out of your bottom.

Some of these problems aren't specific to MS and can be the result of medicines.

MS can have an effect on sexual function.

For women, problems include difficulty reaching orgasm. They might also have less vaginal lubrication and sensation.

Men with MS might find it hard to get or keep an erection (erectile dysfunction). They may also find it takes a lot longer to ejaculate during sex or masturbation. Some lose the ability to ejaculate altogether.

Both men and women with MS may find they're less interested in sex than they were before. This could be directly related to MS, or to a mood disorder like depression, or it could be the result of living with the condition.

Some people with MS have difficulty chewing or swallowing (dysphagia) at some point. They might also slur their speech or be hard to understand (dysarthria).

Feeling fatigued is a common and troublesome symptom of MS.

It can bring an overwhelming sense of exhaustion, so that even simple tasks are a struggle.

Fatigue tends to get worse:

• towards the end of each day
• in hot weather
• after exercising
• during illness

Many people with MS go through periods of depression. It's unclear whether this is directly caused by MS, or is due to the stress of living with a long-term condition, or both.

Anxiety can also be a problem for people with MS, possibly because of how unpredictable the condition is.

In rare cases, people with MS can have rapid and severe mood swings.

Some people with MS have problems with thinking, learning and planning. This is known as cognitive dysfunction and can include:

• problems learning and remembering new things, although long-term memory is usually unaffected
• slowness in processing lots of information or multi-tasking
• a shortened attention span
• getting stuck on words
• problems with understanding and processing visual information, such as reading a map
• difficulty with planning and problem solving (people often report that they know what they want to do, but can't grasp how to do it)
• problems with reasoning, such as mathematical laws or solving puzzles

Many of these problems aren't specific to MS. They can be caused by other conditions, including depression and anxiety, or by medicines.

• you think you have symptoms of MS

The symptoms can be similar to several other conditions, so they're not necessarily caused by MS.

Multiple sclerosis (MS) is an autoimmune condition. That means your immune system mistakes a part of your own body for a foreign substance and attacks it.

In MS, the attack is on the myelin sheath in the brain and/or spinal cord. This is the layer that surrounds your nerves. It protects them and helps electrical signals travel from the brain to the rest of the body.

The attacks make the myelin sheath inflamed in small patches (called plaques or lesions), and these can be seen on a magnetic resonance imaging (MRI) scan.

Inflammation in these patches 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 at all. This disruption is what leads to the symptoms and signs of MS.

When the inflammation goes away, it can leave scarring on the myelin sheath (sclerosis). If the attacks are frequent and repeated, they can lead to permanent damage.

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:

MS isn't directly inherited, but if you're related to someone with the condition, you're more likely to develop it. The chance of a sibling or child of someone with MS also developing it is around 2-3%.

MS is more common in countries far from the equator. This could mean that a lack of sunlight and low vitamin D levels may play a role. It's not clear whether vitamin D supplements can help prevent MS.

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

Infections, particularly those caused by the Epstein-Barr virus (responsible for glandular fever), might trigger the immune system and lead to MS in some people.

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

Multiple sclerosis (MS) can be hard to pin down, because some of its symptoms look like those of other conditions. Your doctor may need to rule out other possible causes first.

If your doctor 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

Once you have a diagnosis of multiple sclerosis (MS), your neurologist might be able to tell 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 have periods when your symptoms get worse (relapses) and 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. And because the condition usually worsens slowly, it can take a few years to make an accurate diagnosis of progressive MS.

• you think you're having a relapse

There's no cure for multiple sclerosis (MS), but some medicines can help reduce the number and severity of relapses in some people. These are called disease-modifying therapies, or disease modifying drugs.

They work by reducing the damage and scarring to the myelin sheath (the layer that surrounds your nerves), which is linked with MS relapses.

These treatments lower the chances of developing progressive symptoms of MS. They might also help slow down worsening disability.

Disease-modifying therapies aren't suitable for everyone with MS. Doctors only prescribe them to people 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

If you don't have relapses, you're less likely to benefit from these treatments, and you could still get side effects from them.

Sometimes an infection, rather than multiple sclerosis (MS), is behind a flare up of symptoms. So your nurse or doctor will check for other possible causes before treating it as a relapse.

Treatment for a relapse might involve a five-day course of steroid tablets, which you take at home.

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

Steroids are only given for a short period, to avoid the side effects they can cause. These could include infection, mood disturbance, stomach ulceration, osteoporosis (weak bones), weight gain and diabetes.

There are different treatments for the symptoms of multiple sclerosis (MS).

Your doctor should give you advice on ways to manage fatigue. This might include exercise, keeping healthy sleep patterns and energy-saving techniques. The doctor might also suggest avoiding medicines that can worsen fatigue.

Specialist fatigue management courses or therapy, such as cognitive behavioural therapy (CBT), might also help.

Visual problems caused by MS will often improve on their own, usually within a few weeks. If your symptoms are particularly severe, your doctor might prescribe steroids.

If you have involuntary eye movements, a medicine like gabapentin can sometimes help. Some people with double vision need help from ophthalmologists (eye specialists).

Physiotherapy can help improve muscle spasms and stiffness. Techniques such as stretching exercises can help if your movement is restricted.

If your muscle spasms are more severe, you may be prescribed a medicine that can relax your muscles. This will usually be either baclofen, gabapentin or tizanidine. These medicines all have side effects, and you might experience dizziness, weakness, nausea and diarrhoea. Talk with your specialist MS nurse about which of them would be best for you.

Mobility problems are often the result of muscle spasms and spasticity. Muscle weakness, problems with balance or dizziness can also cause them.

If you have problems with mobility, your doctor might suggest:

• an exercise programme supervised by a physiotherapist
• special exercises called vestibular rehabilitation, if you have problems with balance
• medicine for dizziness or tremors
• mobility aids, such as a walking stick or a wheelchair
• home adaptations such as stair lifts or railings

An occupational therapist can carry out an assessment of your home and suggest adaptations.

Living with MS can put stress and strain on the muscles and joints in your body. A physiotherapist might be able to help with this pain by suggesting exercises or better seating positions. If your pain is more severe, you may be prescribed painkillers. Or you might be given a transcutaneous electrical nerve stimulation (TENS) machine, which stimulates your nerves.

Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also show up as extreme skin sensitivity or a burning feeling. This type of pain can be treated with neuropathic painkillers.

Your MS doctors and nurses can assess any problems you have with thinking, learning and memory, and suggest ways to manage them.

People with MS who have depression or anxiety can be treated with antidepressants or therapy, such as CBT.

If you have emotional outbursts, such as laughing or crying for no clear reason, a specialist should assess you. They may suggest treatment with an antidepressant.

Medicine might help if you have an overactive bladder or need to pee often during the night.

If you find it difficult to empty your bladder, advice from a continence nurse or physiotherapist can help. Hand-held external stimulators can help some people to start peeing or to empty the bladder.

Sometimes a catheter can empty the bladder when needed. You might be taught how to do intermittent self catheterisation (ISC). In rare cases, people with MS may need a long-term catheter to keep the bladder emptying safely.

You might be referred to a continence adviser or urologist for specialist treatment and advice. You can read more about treating urinary incontinence.

Mild to moderate constipation can possibly be treated by changing your diet or taking laxatives. More severe constipation may need suppositories, which are inserted into your bottom, or an enema. In an enema, liquid medicine is rinsed through your bottom and large bowel, which softens and flushes out your stools.

Anti diarrhoea medicine or pelvic floor exercises might help bowel incontinence.

If you have less interest in sex or difficulty reaching orgasm, relationship counselling or seeing a sex therapist might help.

If you have MS and find it hard to get or keep an erection (erectile dysfunction), you may be prescribed medicine to increase the blood flow to the penis.

A speech and language therapist can help you find ways to overcome problems with speech and swallowing. For example, they can advise you about foods that are easy to swallow. They might also recommend exercises to strengthen the muscles used in speech and swallowing.

Some people with MS find that complementary therapies help them feel better. These treatments claim to ease symptoms, although the scientific evidence is often not clear about how well they work.

Many people think complementary treatments have no harmful effects, but people can run into problems with them. It's not a good idea to use them instead of medicines prescribed by your doctor. If you're thinking about an alternative treatment, it's important to let your doctor know.

Clinical trials have helped to improve the treatments available for MS. Speak to your care team if you're interested in taking part in a clinical trial.

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

If you have any questions, your MS nurse or doctor can help and will tell you what support is available.

Being diagnosed with multiple sclerosis (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 medicines prescribed for MS aren't suitable during pregnancy or breastfeeding, and some might affect fertility in both males and females. If you're thinking about starting a family, talk it over with your doctor and the rest of your care team first.

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