Multiple sclerosis – NHS

Multiple sclerosis (MS) is a condition that can affect the brain and spinal cord, causing a wide range of potential symptoms, including problems with vision, arm or leg movement, sensation or balance.

It’s a lifelong condition that can sometimes cause serious disability, although it can occasionally be mild.

In many cases, it’s possible to treat symptoms. Average life expectancy is slightly reduced for people with MS.

It’s most commonly diagnosed in people in their 20s, 30s and 40s although it can develop at any age. It’s about 2 to 3 times more common in women than men.

MS is one of the most common causes of disability in younger adults.

Symptoms of multiple sclerosis

The symptoms of MS vary widely from person to person and can affect any part of the body.

The main symptoms include:

• fatigue
• difficulty walking
• vision problems, such as blurred vision
• problems controlling the bladder
• numbness or tingling in different parts of the body
• muscle stiffness and spasms
• problems with balance and co-ordination
• problems with thinking, learning and planning

Depending on the type of MS you have, your symptoms may come and go in phases or get steadily worse over time (progress).

Getting medical advice

See a GP if you’re worried you might have signs of MS.

The symptoms often have many other causes, so they’re not necessarily a sign of MS.

Let the GP know about the specific pattern of symptoms you’re experiencing.

If they think you could have MS, you’ll be referred to a specialist in conditions of the nervous system (a neurologist), who may suggest tests such as an MRI scan to check for features of MS.

Find out more about diagnosing MS

Types of multiple sclerosis

MS starts in 1 of 2 general ways: with individual relapses (attacks or exacerbations) or with gradual progression.

Relapsing remitting MS

Between 8 and 9 of every 10 people with MS are diagnosed with the relapsing remitting type.

Someone with relapsing remitting MS will have episodes of new or worsening symptoms, known as relapses.

These typically worsen over a few days, last for days to weeks to months, then slowly improve over a similar time period.

Relapses often occur without warning, but are sometimes associated with a period of illness or stress.

The symptoms of a relapse may disappear altogether, with or without treatment, although some symptoms often persist, with repeated attacks happening over several years.

Periods between attacks are known as periods of remission. These can last for years at a time.

After many years (usually decades), many, but not all, people with relapsing remitting MS go on to develop secondary progressive MS.

In this type of MS, symptoms gradually worsen over time without obvious attacks. Some people continue to have infrequent relapses during this stage.

About two-thirds of people with relapsing remitting MS will develop secondary progressive MS.

Primary progressive MS

Between 1 and 2 in every 10 people with the condition start their MS with a gradual worsening of symptoms.

In primary progressive MS, symptoms gradually worsen and accumulate over several years, and there are no periods of remission, though people often have periods where their condition appears to stabilise.

What causes multiple sclerosis?

MS is an autoimmune condition. This is when something goes wrong with the immune system and it mistakenly attacks a healthy part of the body – in this case, the brain or spinal cord of the nervous system.

In MS, the immune system attacks the layer that surrounds and protects the nerves called the myelin sheath.

This damages and scars the sheath, and potentially the underlying nerves, meaning that messages travelling along the nerves become slowed or disrupted.

Exactly what causes the immune system to act in this way is unclear, but most experts think a combination of genetic and environmental factors is involved.

Treatments for multiple sclerosis

There’s currently no cure for MS, but a number of treatments can help control the condition and ease symptoms.

The treatment you need will depend on the specific symptoms and difficulties you have.

It may include:

• treating relapses with short courses of steroid medicine to speed up recovery
• specific treatments for individual MS symptoms
• treatment to reduce the number of relapses using medicines called disease-modifying therapies

Disease-modifying therapies may also help to slow or reduce the overall worsening of disability in people with a type of MS called relapsing remitting MS, and in some people with types called primary and secondary progressive MS, who have relapses.

Unfortunately, there’s currently no treatment that can slow the progress of inactive progressive MS, with no relapses or MRI activity.

Many therapies aiming to treat progressive MS are currently being researched.

Living with multiple sclerosis

If you have been diagnosed with MS, it’s important to take care of your general health.

Read more advice about living with MS

Outlook

MS can be a challenging condition to live with, but new treatments over the past 20 years have considerably improved the quality of life of people with the condition.

MS itself is rarely fatal, but complications may arise from severe MS, such as chest or bladder infections, or swallowing difficulties.

The average life expectancy for people with MS is around 5 to 10 years lower than average, and this gap appears to be getting smaller all the time.

Charities and support groups for multiple sclerosis

There are 2 main MS charities in the UK:

• MS Society
• MS Trust

These organisations offer useful advice, publications, news items about ongoing research, blogs and chatrooms.

They can be very useful if you, or someone you know, has just been diagnosed with MS.

There’s also the shift.ms website, an online community for younger people affected by MS.

Information:

Social care and support guide

The social care and support guide explains your options and where you can get support if you:

• need help with day-to-day living because of illness or disability
• care for someone regularly because they’re ill, elderly or disabled, including family members

Page last reviewed: 22 March 2022
Next review due: 22 March 2025

Multiple sclerosis – Causes – NHS

Multiple sclerosis is caused by your immune system mistakenly attacking the brain and nerves. It’s not clear why this happens but it may be a combination of genetic and environmental factors.

What happens in multiple sclerosis

MS is an autoimmune condition, which 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 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), which can be seen on an 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 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 eventually lead to permanent damage to the underlying nerves.

Causes of multiple sclerosis

It’s not clear what causes the immune system to attack the myelin sheath.

It seems likely that it’s partly caused by genes you inherit from your parents and partly by outside factors that may trigger the condition.

Some of the factors that have been suggested as possible causes of MS include:

• your genes – MS isn’t directly inherited, but people who are related to someone with the condition are more likely to develop it; the chance of a sibling or child of someone with MS also developing it is estimated to be around 2 to 3 in 100
• lack of sunlight and vitamin D – MS is more common in countries far from the equator, which could mean that a lack of sunlight and low vitamin D levels may play a role in the condition, although it’s not clear whether vitamin D supplements can help prevent MS
• smoking – people who smoke are about twice as likely to develop MS compared with those who don’t smoke
• teenage obesity – people who were obese during their teenage years have an increased risk of developing MS
• viral infections – it’s been suggested that infections, particularly those caused by the Epstein-Barr virus (responsible for glandular fever), might trigger the immune system, leading to MS in some people
• being female – women are 2 to 3 times more likely to develop MS than men; the reason for this is unclear

Further research is needed to understand more about why MS occurs and whether anything can be done to prevent it.

Further information

• MS Society: Causes of MS

Page last reviewed: 22 March 2022
Next review due: 22 March 2025

Primary progressive type of multiple sclerosis | ICRC

The first question is how many patients suffer from this type of course? Not so much: 10-15% of the total number of MS patients.

At what age does it usually start? While the relapsing-remitting type most often begins at age 30, PPMS usually affects people around the age of 40. In addition, men and women suffer from primary progressive multiple sclerosis equally, in contrast to relapsing-remitting, where women are more likely to get sick.

Is there a genetic predisposition? Let’s just say no. There is no clear, proven genetic predisposition. In patients with PPMS, as well as in all other patients with MS, there is a genetically determined risk factor — the presence of the HLA-DR2 haplotype (HLA-DRB1*1501 on chromosome 6). Scientists have tested a large number of different haplotypes (I remind you that a haplotype is a combination of genes that is transmitted unchanged from parents to children), but did not confirm the relationship between any combination of genes and the occurrence of PPMS, and could not find genetic factors that determine the rate of increase in the disease. Let me also remind you that a genetic risk factor and a genetic disease are two different things: a genetic risk factor is a combination of normal genes (haplotype) proven in a large number of patients, the presence of which increases the risk of developing MS. Therefore, the presence of a certain haplotype is necessary, but not sufficient for the development of MS – a combination of many other risk factors is also needed. A genetic disease is the presence of an incorrect, abnormal, damaged, or, scientifically speaking, mutated gene, which is responsible for the development of a genetic disease. Therefore, the presence of a mutation is necessary and sufficient for the development of a genetic disease. We tried to simplify the answer to the constant question of patients: “is multiple sclerosis inherited? Is it a genetic disease?

The main features of primary progressive multiple sclerosis are the absence of exacerbations and the steady increase in symptoms. However, this increase can be quite slow, because about a quarter of patients after 25 years of the disease continue to move independently, without support. Also, a quarter of patients need support (unilateral support) already 7 years after the onset of the disease. This data is for patients who did not receive any treatment.

However, if no specific features of PPMS were found at the level of risk factors compared to relapsing-remitting MS, then studies of pathological changes in the substance of the central nervous system and the picture on magnetic resonance imaging corresponding to these pathological changes made it possible to confirm a significant difference between PPMS and relapsing-remitting multiple sclerosis, so to speak, to substantiate the long-known features of the clinical picture of the disease (see Fig. ).

In the brain of patients with PPMS, there are significantly fewer foci of demyelination (plaques) compared to patients with other types of MS. Indeed, the appearance of a new plaque indicates an active process of inflammation, affecting primarily myelin (the sheath of the nerve fiber – the process of the neuron, the axon). This is characteristic of relapsing-remitting MS, while in PPMS the damage is non-localized, “less focal”, more widespread, diffuse, active plaques rarely (or not at all). Damage to axons (outgrowths of nerve cells) and a non-focal process of demyelination spreads both in the cerebral cortex and in the white matter, as well as in the spinal cord. In addition, the blood-brain barrier suffers: it becomes permeable in all parts of the brain in patients with PPMS, while in remitting permeability occurs mainly in the foci. If we look at the immunological markers of inflammation, then in PPMS their concentration is significantly lower than in patients with remitting MS. Which indicates a less inflammatory nature of changes in the central nervous system.

MRI findings in patients with PPMS confirm the above features. First, active, contrast-mediated demyelination foci are rarely detected (which is typical in relapsing-remitting MS). The brain appears not to be significantly damaged, with few lesions, but the use of certain imaging modes (DWI) reveals marked changes in the gray matter of a seemingly normal-looking brain. Moreover, the degree of changes in the DWI regimen corresponds to the severity of movement disorders, which will appear in a person only two years after the examination.

Secondly, in patients with PPMS, signs of atrophy (reduction in volume) of the gray and white matter of the brain and spinal cord are noted much earlier, almost from the first year of the disease.

Thirdly, with another type of MR study – MR spectroscopy, changes are determined that are characteristic of an increase in the number of astrocytes. Astrocytes are cells of the brain and spinal cord that have a supporting, nourishing effect on neurons (axons dressed in myelin sheath depart from neurons). So, with the decay of neurons, astrocytes begin to increase quantitatively, which is denoted by the term astrocytosis.

Fourth, PPMS is again characterized by diffuse, widespread damage to the spinal cord. Not focal, as in relapsing-remitting MS or as in neurooptic myelitis, but diffuse. Moreover, the degree of spinal cord atrophy has a strong correlation between the severity of disorders (the number of points on the EDSS scale, the degree of disability) in a person. And if atrophy of the brain to one degree or another takes place in a relapsing type of course, then such a pronounced atrophy of the spinal cord is characteristic exclusively for PPMS.

Thus, in the primary progressive type of the course of multiple sclerosis, in contrast to the relapsing type, damage to the central nervous system is diffuse, widespread, the main damage affects primarily axons – processes of nerve cells (the process of neurodegeneration), and not their sheaths – myelin (the process of demyelination), which leads to atrophy of the brain and spinal cord and the constant accumulation of disorders (symptoms) of the nervous system – the accumulation of disability.

What are the symptoms of PPMS?

Before describing the manifestations, symptoms, it should be noted that there are no exacerbations in the primary progressive type of multiple sclerosis. From the very beginning, the symptoms do not improve, do not go away, the disturbances gradually increase. There may be slight fluctuations in their severity, but there is no talk of any remission.

The main manifestation of PPMS is the lower spastic paraparesis. Let’s break this term down. “Lower” means the lower limbs, i.e. changes occur mainly in the legs. “Paresis” – weakness of the limb, “pair” – either upper or lower limbs at the same time, so “lower paraparesis” means weakness of the lower limbs. “Spastic” – in addition to weakness, an increase in tone occurs in the legs. The muscles become tense, and the movements in the legs become limited, not only because of weakness, but also because of the need to overcome the high muscle tone that interferes with the implementation of voluntary movements. However, spasticity is not only an increase in muscle tone. Painful muscle spasms, which are sometimes more pronounced than the actual increase in tone, are also referred to as spasticity. A separate symptom of PPMS is an increase in weakness during movement: the further the patient goes, the more tired he is. Those. weakness begins to increase in the process of movement. Such fatigue has its own mechanism of development and is associated not only with the presence of lower paraparesis. Frequent manifestations of PPMS include urinary disorders: usually a strong urge to urinate, as well as urges at night.

Thus, the main manifestations of PPMS are weakness of the lower extremities and their spasticity (increased tone and pain spasms), increasing fatigue during movement (walking) and frequent urination (urgency). These symptoms are present in 80% of patients.

In 15% of patients, a violation of coordination, the so-called atactic syndrome, is detected. When it occurs, the patient experiences difficulty in performing targeted movements due to their mismatch. Movements become redundant, inaccurate, a person misses the object that he wants to take. In addition, stability disorders may occur, when it is difficult for the patient to maintain balance in a standing position, he begins to swing to the sides, sometimes there is a kind of trembling of the legs and torso.

How is PPMS diagnosed?

The diagnosis of PPMS should be based, as with any other type of course, on a body of data. The main, obligatory sign of a progressive and primary type of course is the presence of an increase in neurological disorders for a year or more. Any two of the following must be added to this main feature:

• the presence of nine or more lesions on MRI of the brain or the presence of 4 or more lesions on MRI of the brain and changes in visual evoked potentials
• presence of two or more lesions in the spinal cord
• oligoclonal type of IgG synthesis in cerebrospinal fluid (CSF)

We obtain cerebrospinal fluid during a lumbar puncture. Currently, this is a mandatory procedure for suspected multiple sclerosis, and especially for the primary progressive type of its course.

In addition, before setting up PPMS, we need to conduct a wide examination to rule out a number of diseases that are clinically similar to this type of MS course. These include a tumor of the spinal cord, hereditary diseases, metabolic disorders, inflammation of the central nervous system (sarcoidosis, vasculitis), neuroinfections, vascular lesions of the central nervous system, degenerative diseases. Therefore, tune in to the fact that they will take a lot of blood tests from you, and even puncture.

What is the prognosis for a patient with PPMS?

The prognosis is based on the rate of progression: the sooner the patient reaches an EDSS disability level of 3, the sooner he will reach a level of disability of 6 points (walking with a stick), and the sooner a degree of disability of 6 points occurs, the sooner the patient will be in a wheelchair . The majority of patients reach the level of 6 points 10-20 years after the onset of the disease. However, these are data without treatment. If we apply a therapy that has proven its effectiveness in clinical trials in patients with a primary progressive type of multiple sclerosis, then all these prognostic periods increase by a third. More on this in the section on anti-B cell therapy and more specifically in the article on ocrelizumab, an approved drug for the treatment of PPMS.

Does it only happen to the elderly? Is it true that there is no cure? Important questions about multiple sclerosis – Meduza

Repina Valeriya / Shutterstock

Every year on the last Wednesday of May, World Multiple Sclerosis Day is celebrated. To draw attention to this disease, a musical flash mob was held in Moscow in mid-May. Together with the organizers of the action – the Moscow Society of Multiple Sclerosis and the Roche company – we answer important questions about this disease: what is multiple sclerosis, how is it diagnosed and is it possible to fully recover.

What kind of illness is this? Is it somehow related to age and forgetfulness?

Multiple sclerosis (MS) is not related to senile dementia and can start at any age. Briefly, its mechanism can be described as follows. The disease affects the central nervous system, which is based on nerve cells, neurons. They exchange electrical signals with each other and with other parts of the body using long processes. Thanks to this exchange, we can think, speak, move and digest food. Each nerve process is “wrapped” in myelin – a sheath of proteins and lipids. Myelin works like an insulator at the wire – it protects the nerve processes and facilitates the exchange of information between nerve cells and the body. In multiple sclerosis, the myelin begins to break down, causing damage to the “insulation” of the nerves. Because of this, the speed at which the body and brain exchange signals decreases – and in some cases the signals are blocked altogether.

Most cases of MS occur in young people between the ages of 20 and 30—that is, it occurs at an active age, when they usually get higher education, create families and build a career. And in 5% of cases, patients are children at all.

When multiple sclerosis is just beginning to develop, there may be no symptoms. But when myelin is destroyed a lot, a person begins to see and speak worse. Problems arise with thinking, learning and planning – they gradually weaken, and in the end the disease can cause disability.

Choksawatdikorn / Shutterstock

Why do people get MS?

Doctors and scientists still do not know exactly why multiple sclerosis occurs. It is believed that the disease develops due to errors in the immune system: instead of attacking harmful microbes, the immune system destroys the cells responsible for the synthesis of myelin. Because of this, multiple sclerosis is called an autoimmune disease.

Studying risk factors, doctors concluded that the place of birth seems to play an important role (it is believed that the risk of developing multiple sclerosis increases from south to north) and genetic characteristics of a person. In addition, smoking and obesity in children and adolescents may increase the risk of MS.

How do you know if someone has multiple sclerosis?

There is no single test that can unequivocally show that a person has started MS. To make a diagnosis, a doctor will have to take a person’s medical history, examine them, order a neurological examination and magnetic resonance imaging (MRI) of the brain, and conduct behavioral tests.

Multiple sclerosis has symptoms, and of course, you should pay attention to them. But the same problems can occur with other diseases (or even due to overwork). In any case, if you notice something similar, you should consult a doctor.

The symptoms of MS depend on where in the brain the myelin destruction has begun, and therefore may differ from person to person. Most often, MS affects the nerve fibers responsible for vision and movement.

Movement problems in MS :

• numbness or weakness in an arm or leg, or both arm and leg, and on one side of the body electric shock “, which runs along the spine from head to toe (Lermitte’s symptom)
• hand shaking, uncoordinated, unsteady gait

Rdonar / Shutterstock

Visual problems in MS :

• partial or complete loss of vision, most often in one eye. Moving your eyes can be painful
• Double vision
• Blurry vision

In addition, slurred speech and dizziness can occur with MS. Some patients complain of fatigue, tingling or pain in different parts of the body, sexual dysfunction, bowel or bladder problems.

Understanding that a person is developing MS can also be difficult because the disease manifests differently at different stages. Doctors have to focus not so much on the results of tests and studies, but on the human condition. And often the doctor needs time to make an accurate diagnosis. In 85-90% of cases, MS begins as relapsing-remitting (RRS), which is when symptom exacerbations (relapses) are followed by periods of improvement (remissions). And only after 10–20 years can the next stage begin – secondary progressive MS (SPMS). In this case, the symptoms during the attacks gradually become more severe. Or there may be no periods of improvement at all – the patient just gets worse and worse.

But in about 10% of patients, the disease immediately manifests itself in a more severe form, then it is called primary progressive MS (PPMS). It is believed that in Russia there are 5–6% of such patients. PPMS occurs later in life (around age 40) but can progress almost twice as fast as relapsing-remitting multiple sclerosis. And with this type of illness, a person’s condition is steadily deteriorating from the very beginning, there are no periods of improvement. A common symptom of PPMS is difficulty walking, which gradually gets worse. It is easy to confuse these symptoms with difficulties with movement, which people in their 40s and 50s often have for other reasons. Therefore, it may also take some time to make an accurate diagnosis.

Thiti Wongluang / Shutterstock

They say there is no cure for multiple sclerosis. This is true?

Indeed, there is currently no cure for multiple sclerosis. But there are drugs that help slow down the progression of the disease and control the symptoms. They must be prescribed by a doctor.

If the disease proceeds with exacerbations and develops relatively slowly, the doctor focuses on alleviating the patient’s condition. For example, to cope with a relapse, steroid drugs are used to reduce inflammation, relieve swelling, and generally improve the quality of life. Also, with relapsing-remitting multiple sclerosis, the patient may be prescribed drugs that affect the probable cause of the disease – immune cells. Relapsing-remitting MS can proceed in very different ways – from an extremely mild variant to an aggressive one. Therefore, sometimes immune-suppressing drugs are not needed in principle – if the disease develops slowly, they will do more harm than good. In other cases, the doctor may prescribe such drugs. For example, interferons, drugs that can regulate immunity and make immune cells a little less aggressive.

If a person develops primary progressive multiple sclerosis, then treatment is immediately aimed at reducing the risk of developing disability. To do this, the patient requires anti-B-cell therapy, which affects certain immune cells – it affects mature B-lymphocytes and thus suppresses the immune system. This treatment is expensive (like any therapy designed to slow the progression of MS) ​​and is not included in the 12 High Cost Nosologies program (so it may not be easy to get it for free).

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Need MS Rehab?

Rehabilitation is an essential component of comprehensive care for people with MS. Its goal is to improve and maintain a variety of functions: the ability to speak, walk, work. Moreover, rehabilitation is useful for people with both PPMS and RMS.

The benefits of exercise for people with MS were first proven in 1996. It turned out that patients who engaged in aerobic exercise improved their cardiovascular system and muscle strength, they suffered less from fatigue and depression, and more often participated in social activities. According to Canadian recommendations, twice a week it is useful to do aerobic exercises for half an hour and a couple of times to do strength exercises for the main muscle groups. You can also do this at home. But today it is believed that complex rehabilitation works best, which is organized by a medical team of a physical therapist, a rehabilitation therapist and a neuropsychologist, and, if necessary, a speech therapist. Compared to patients who were not offered rehabilitation, participants in rehabilitation programs improved their ability to self-care, well-being, and quality of life. Therefore, it makes sense to carefully choose a rehabilitation center.

Can a special diet slow down the development of MS?

There is no such diet. However, a balanced healthy diet is very important because it helps prevent cardiovascular disease and manage other problems such as constipation. Experts recommend that people with MS eat a diet that is low in fat and salt but high in fiber.

Vitamins and dietary supplements will not help with MS. And even more than that: it seems that they do more harm than good. The only exception is vitamin D.