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Your Basic Guide to Multiple Sclerosis

Medically Reviewed by Dr Samantha Miller, MBChB

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Multiple sclerosis (MS) is a chronic inflammatory condition. It affects the protective layer of nerves, called the myelin sheath, in your central nervous system — which comprises your brain and spinal cord. MS disrupts the ways that your nerves typically send messages from your brain to the rest of your body.

There's no specific cause of MS. However, you're more likely to develop it if you have a family history of MS, if you were born female or if you smoke. There's also an association between low vitamin D levels and an increased risk of MS that's possibly related to reduced exposure to sunlight.

Various wellness habits and strategies can help you manage MS symptoms and lead a more comfortable life. If you or someone you know has recently been diagnosed with MS or you're interested in understanding this health condition, learn more about its symptoms, diagnosis and treatment.

Types of Multiple Sclerosis

There are three types of MS, all of which vary slightly in symptoms and severity. Relapsing-remitting is the most common; about 85% of patients with MS have this form of the disease when they're diagnosed. It's characterized by defined periods of symptoms, known as relapses, that are interspersed with variable periods of no or fewer symptoms. These periods of symptom lessening are called remissions. The frequency at which relapses occur can vary, and relapses can last anywhere from days to months. Each relapse can affect a different area of your nervous system, so symptoms can differ each time an attack occurs.

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Another type of MS, called primary progressive, affects about 10% of patients with MS. This form of the condition is characterized by a worsening of primary symptoms with no periods of remission. Secondary progressive MS differs from the first two types in that it's what relapsing-remitting MS often turns into. Almost all patients diagnosed with the relapsing-remitting type of MS will go on to develop the secondary progressive disease within 25 years. This form is characterized by worsening symptoms with no periods of remission in between.

Symptoms of Multiple Sclerosis

Symptoms of MS are highly variable and can differ in severity, onset and duration. MS is typically diagnosed between the ages of 20 and 40, with common early symptoms including fatigue (tiredness), sensory disturbance (such as numbness and tingling), muscle problems (such as stiffness or weakness), balance and coordination issues, and difficulty thinking or concentrating. Initial symptoms can last anywhere from two days to years depending on the type of MS that affects you.

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Other symptoms can appear that depend on nerves that have been affected. These include bladder problems (such as urinary frequency), sexual problems (such as erectile dysfunction) and pain. Visual disturbance is a common symptom that arises due to a condition called optic neuritis. This affects the nerves going to your eye and can lead to blurred vision, vision loss, loss of color vision and pain when you move your eye.

A significant proportion of people with MS also have mental health conditions, such as depression, anxiety and mood disorders.

Testing for and Diagnosis of Multiple Sclerosis

Testing for MS involves different investigation modalities. There's no one definitive test for MS, and a diagnosis often first involves ruling out other conditions that display similar symptoms.

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Your doctor will likely learn about your health history and give you a physical exam initially as first steps in the diagnosis process. Diagnosing relapsing-remitting MS involves having a history of at least two attacks with different symptoms and a period of wellness in between.

Your physical examination may involve testing your muscle power, tone, reflexes, coordination and vision. You may need to undergo blood tests to rule out other causes of symptoms; for example, some infections can cause symptoms similar to those of MS.

It's common to have a magnetic resonance scan (MRI) performed. This imaging test shows areas of your brain where myelin may have been destroyed due to MS. You might also undergo a procedure called a lumbar puncture. This involves taking a sample of the fluid from around your spinal cord. It can determine the presence of specific proteins that are commonly found in people who have MS.

Treatment for Multiple Sclerosis

There is no cure for MS. However, there are several treatments that can alleviate some of the symptoms, prevent or treat attacks, and slow the progression of the disease. In an acute relapse, corticosteroids may be used to lessen the inflammatory response. If you have relapsing-remitting MS, you might use immunomodulatory drugs long term to reduce the severity and frequency of your relapses.

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Other treatments are available to target specific symptoms of MS, including urinary problems, muscle tension, tremors and balance problems. Newer drugs called monoclonal antibodies have become available in recent years, and they may help. These are usually given as an intravenous infusion, and they can slow the progression of the disease.

Anyone who's diagnosed with MS is encouraged to maintain a healthy, active lifestyle. Regular exercise is recommended, as is a healthy diet. Patients are advised to stop smoking and reduce their alcohol intake. It's also important to better manage any comorbid conditions, such as depression, diabetes or cardiovascular disease.

Prognoses for people who are diagnosed with MS vary. Some patients have infrequent relapses that respond well to treatment, and some patients progress very rapidly from the onset of their first symptoms. The average life expectancy for those diagnosed with MS is typically up to 10 years lower than the average life expectancy.

Medical content reviewed by Dr Samantha Miller, MBChB

Resource Links:

https://bestpractice.bmj.com/topics/en-gb/140

https://cks.nice.org.uk/topics/multiple-sclerosis/

https://www.nhs.uk/conditions/multiple-sclerosis/

https://medlineplus.gov/multiplesclerosis.html

https://www.who.int/mental_health/neurology/neurodiso/en/

https://www.mssociety.org.uk/

https://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-MS

https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/expert-answers/vitamin-d-and-ms/FAQ-20058258