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

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
• Blurred 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).

CreationMaks / Shutterstock

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. There is evidence that for multiple sclerosis, it makes sense to take vitamin D supplements at a dosage of 600-800 IU (international normalized units) per day. But about whether a particular patient needs it or not, and if so, in what dosages, it is necessary to consult a doctor.

Africa Studio / Shutterstock

Is it dangerous for women with MS to get pregnant?

Previously, women with MS were advised to avoid pregnancy because it was believed that the disease would be more severe in this case. In the United States, for example, this practice lasted until 1950. But since then, scientists have conducted many studies and concluded that pregnancy, on the contrary, can even reduce the number of relapses of the disease, especially in the second and third trimester. After delivery, the chance of recurrence increases, but the risk of disability does not appear to increase.

MS is more common in women of childbearing age than in other groups of people. And with MS, pregnancy can be more difficult than usual. For example, women who have difficulty walking may even require special walking aids. The bladder and bowel problems that most pregnant women experience may be more pronounced in women with MS. Therefore, it is important to discuss all the details with the doctor at the stage of pregnancy planning.

“Multiple sclerosis can develop at almost any age”

May 27th is International Multiple Sclerosis Day. AiF.ru talked about the features of an incurable disease with the president of the All-Russian Public Organization of Disabled People with Multiple Sclerosis (OOOI-BRS) Yan Vlasov.

According to the World Health Organization (WHO), among neurological diseases, multiple sclerosis (MS) is the most common cause of disability in young people. Interestingly, even 20 years ago, doctors were sure that MS only develops in adults. However, now the disease is diagnosed in children. AiF.ru talked about this and other features of multiple sclerosis with Yan Vlasov, Doctor of Medical Sciences, Professor of the Department of Neurology and Neurosurgery of the Samara State Medical University.

Evgenia Semyonova, AiF.ru: What is multiple sclerosis?

Jan Vlasov: Multiple sclerosis is an autoimmune disease that affects the central nervous system.

— Tell me why the disease is more common in women?

— Unfortunately, the beautiful half of humanity is more prone to autoimmune diseases. In the case of multiple sclerosis, the ratio of men to women with this diagnosis is two to three. The reasons for this circumstance are not fully understood. Perhaps this is due to a much larger number of hormonal and immune changes in the body of women: phases of the cycle, pregnancy, childbirth. Maybe the answer lies in the peculiarities of genetics, or viruses that in one way or another change the immunity of any person attack women more often.

– The disease affects both young and old. What is the reason for this age difference?

– Multiple sclerosis can develop at almost any age, cases of detection of reliable multiple sclerosis are described both in the first years of life and after the age of 60 years. However, the peak incidence falls on working age – from 20 to 40 years. Neuroimmunologists are trying to find an answer to the question why this particular age category is at risk. Perhaps, at this age, the immune system is under the most severe stress and it is more difficult for it to resist meeting with various bacteria and viruses.

– The risk of developing the disease is associated with geography and race. Tell us about the risks of the Russians?

– The Russian Federation belongs to the countries of medium risk for the incidence of multiple sclerosis, that is, up to 50 cases per 100,000 population. Although several large epidemiological studies in the regions revealed higher numbers – an average of 40 to 60 cases. In recent years, there has been an upward trend in patients with this diagnosis. The risk of getting sick is higher among representatives of the Caucasian race and among smokers. According to some studies, the risk of getting sick is slightly higher in people living near large industrial enterprises.

– The exact cause of multiple sclerosis is currently unknown. Talk about theories.

– There are many theories: genetic, viral, hormonal, vascular, environmental factors, lifestyle, the presence of pets are considered. The leading theory among researchers at the moment is the viral theory, implemented against the background of a genetic predisposition.

– Describe the symptoms of the disease.

— The symptoms of multiple sclerosis are extremely varied and unique to each patient. The disease is sometimes called the “great pretender”, it can manifest itself in visual, various sensory disturbances, movement disorders, muscle weakness, sometimes even epileptic seizures. Each symptom is caused by damage to the pathways in the brain or spinal cord – the so-called “plaque”, depending on the location, it causes certain disorders. There are a large number of asymptomatic foci that do not cause any disturbances.

– Multiple sclerosis is difficult to diagnose. Why?

– There are several reasons. Firstly, it is a variety of neurological symptoms, which are individual for each patient. Second, some diseases are clinically indistinguishable from multiple sclerosis, and some are indistinguishable by additional tests, such as MRI. Thirdly, so far there is no diagnostic method that would confirm or rule out multiple sclerosis with absolute certainty, even the relatively recently used determination of specific antibodies in the cerebrospinal fluid has false positive and false negative results.

— How is the diagnosis carried out?

— Diagnosis begins with a consultation with a neurologist. If necessary, the patient is referred to the centers or offices of multiple sclerosis, which exist in almost all regions of the Russian Federation. Mandatory additional methods for diagnosis are MRI of the brain with contrast, often repeated, the study of evoked potentials, the collection of cerebrospinal fluid for the determination of monoclonal antibodies. This analysis is available in almost all regions. It is also mandatory to study for diseases that can “mimic” multiple sclerosis, such as bleeding disorders, viral and parasitic diseases.

— Can people with multiple sclerosis be cured?

— Currently, there is no method or medicine that can cure multiple sclerosis. On the other hand, the life expectancy of patients with this diagnosis practically does not differ from the general population. The goal of treatment is to slow the progress of the disease, correct the symptoms that plague patients, and improve quality of life. The treatment of multiple sclerosis is to relieve exacerbations as quickly as possible and long-term use of drugs that change the course of multiple sclerosis (MRMS).

— I heard that multiple sclerosis can only be treated with injections? Has it changed?

— Among the drugs that change the course of multiple sclerosis registered to date, there are first and second line drugs. Until recently, first-line drugs were presented exclusively in injectable forms. But in 2014, the first first-line tablet drug, Abaggio, was registered in Russia. The second-line drugs are fingolimod, sold under the name Gilenya, and natalizumab, Tysabri. Fingolimod is a capsule that is taken daily. Natalizumab is given as a monthly intravenous infusion.

It should be noted that second-line drugs are not suitable for all patients with multiple sclerosis, as they require very careful monitoring, therapy and have a number of side effects. Before starting treatment with natalizumab, blood is necessarily taken for the presence of a certain virus (JCV), and if sufficiently high levels of antibodies are determined in the body, the administration of the drug can be simply dangerous for the patient.

— A bit about myths. It is said that people with this diagnosis will never be able to give birth, breastfeed and will be tied to a wheelchair for life. Is it really all that dark?

— There are many misconceptions associated with multiple sclerosis, rooted both in the mass consciousness and in the minds of doctors. For most of us, sclerosis is a decline in memory caused by old age. Multiple sclerosis is a disease of the young, and people with this disease can continue to engage in intellectual work for years and decades. Since the beginning of the 20th century, when a small study was done on women, doctors around the world have said that pregnancy increases the risk of exacerbating multiple sclerosis, and women have been advised to abstain from pregnancy. At the beginning of the 21st century, a large international study showed that pregnancy does not increase the overall risk of exacerbation: during the pregnancy itself, it even falls. Therefore, patients with a confirmed diagnosis are increasingly becoming mothers, and we are very happy for them. There is a very wide spectrum of activity in multiple sclerosis: it can be a steadily progressive disease, or it can be an MRI (radiologically isolated multiple sclerosis) finding that does not manifest clinically for decades. The task of doctors is to try to stop the progression of the disease, help to cope with the symptoms that have appeared, and improve the quality of life.