What is multiple sclerosis (MS)?
MS is a chronic, autoimmune, inflammatory, demyelinating condition of the central nervous system.
Chronic
Once diagnosed, MS is a condition you have for life, although people with MS can go through long periods where they are stable or symptom free.
Autoimmune
The immune system is the white blood cells which recognise infections or other potentially dangerous cells or chemicals, and help fight it off. Autoimmune conditions are where the immune system has incorrectly identified some normal part of your body as foreign. It is not clear how this occurs, but there are some theories.
Demyelinating condition
Myelin is the insulation around the wire of the nerve cells. If this is damaged (demyelination) the electrical impulses are slowed down or stop completely, meaning the nerve cell doesn’t work. This results in weakness, numbness or other symptoms.
Central nervous system
The cell type that is the target of the autoimmune process is the oligodendrocyte. These are found in the ventral nervous system, which is the nerve to the back of the eye, the brain and the spinal cord.
All the other nerves are called the peripheral nervous system and the myelin there is made up of Schwann cells. These are not affected in MS.
What causes MS?
It is not known for sure what causes MS. It is probably triggered by a virus that appears similar to the outside of the oligodendrocytes, possibly Epstein-Barr virus (EBV), which is the one that causes glandular fever.
Treating EBV won’t get rid of MS since your body has already fought it off by the time the MS develops.
There are genes that increase the risk of developing MS, but the contribution they make is so small there is no point in screening for them.
For some reason, some people only have one attack, known as clinically isolated syndrome (CIS), whereas others will have multiple or progressive problems.
What are the different types of MS?
Relapse-remitting or relapse onset MS
This is the commonest form of MS. Some relapses don’t completely recover, so patients with relapsing-remitting MS may have persistent symptoms or episodes of conduction block, even when not in relapse.
Secondary progressive MS
Nerve pathways previously affected by MS can gradually start to break down many years later. Some patients with relapse onset MS will have gradual deterioration in nerve function in between relapses or even if the relapses have stopped. This is called secondary progressive MS.
Primary progressive MS
A small minority of patients seem to get gradual deterioration in neurological function without having any relapses to start off with. This is called primary progressive MS. People with primary progressive MS can, rarely, get relapses later on.
How is MS diagnosed?
It is almost impossible to have MS with a completely normal MRI scan. If the MRI scan is completely clear the doctors can usually say you don’t currently have MS.
If you have had a single attack, known as clinically isolated syndrome (CIS), you may not have or develop MS. Often, people have had inflammation elsewhere in the brain or spine which they haven’t noticed. This can be found on the MRI scan and indicate a higher risk of MS.
To show that inflammation is an ongoing problem, rather than a one off event, you need to have two scans done or one with dye (contrast). If the scan shows new areas of inflammation (lesions) then your doctor can diagnose MS based on the McDonald criteria.
How is MS treated?
Relapses are treated with short courses of steroids which reduces the inflammation and helps the relapse to recover faster.
Patients who have frequent relapses and some patients with some types of progressive MS may be encouraged to try immunomodulatory therapy. The criteria for who should be given this are quite complex. You can find out more about these medications at the MS Trust website:
MS nurses will be able to offer advice on symptoms such as pain, stiffness or spasms, bladder and bowel problems or sleep problems.
What symptoms do you get from MS?
MS affects the central nervous system and symptoms are related to the part of the brain, optic nerve or spine that has been affected.
Symptoms can be related to areas that have previously been damaged by inflammation. This is sometime referred to as a pseudo-relapse and can be caused by high temperature, another illness such as a urinary tract infection (UTI), or fatigue. The symptoms will get better and worse over a few hours.
New or worse symptoms that come on over a few hours to days and then stay there for a few weeks before starting to improve may be a relapse and need to be reported to the MS team.
How do you manage MS symptoms?
Stiffness and spasms
Stiffness and spasms are treated with baclofen 5mg OD up to maximum dose of 30mg TDS.
Urinary urgency
We usually seek assistance from the continence team at the patient’s local hospital for urinary urgency.
Pain
Trigeminal neuralgia (facial pain) is treated with:
- carbamazepine
- oxcarbazepine, or
- lamotrigine
Pain in the arms and legs can be treated with any neuropathic pain agent:
- Duloxetine
- Amitriptyline
- Gabapentin
Sleep disturbance
To prevent sleep disturbance, try to treat pain or spasms and give advice on:
- reducing nocturia (limit drinking two to four hours before bed, limit caffeine and alcohol, raise the head of the bed slightly)
- sleep hygiene
Fatigue
Fatigue is often the most disabling symptom of MS. It's a good idea to make sure there is nothing else that might be making it worse. GPs could check for deficiency in:
- iron
- vitamin D
- vitamin B12
- folic acid
- thyroid hormones
Is MS hereditary?
Not really. There are susceptibility genes, which means that if you have relatives with MS, you are at a higher risk than people who don’t. However this does not mean that you are at high risk of developing MS.
Even with a first degree relative (mother, father, brother, sister, son or daughter) with MS, your absolute risk of MS is only around 1%, so a family history of MS probably is not that significant. There are lots of other things that probably contribute to developing MS, so there is no point in screening for these genes.
What is a pseudo-relapse?
Pathways that have previously been demyelinated can switch off if the patient gets:
- too hot
- another illness, usually a urinary tract infection (UTI), or
- too tired
Pseudo-relapses usually only last a few hours before the patients start to recover and are a recurrence of symptoms that the patient has had before.
In contrast, inflammatory relapses come on over a few hours to days and last for several weeks before improving. They are more likely to be symptoms that the patient has not had before (although this is not always the case).
Pseudo-relapses don’t need to be treated, but you should check for and treat any UTIs.
Pregnancy and fertility with MS?
MS should not stand in the way of patient having a family. Pregnancy and delivery are the same for patients with MS as anyone else.
Relapses are less common during pregnancy, but there is a slight increase in relapses after delivery. Treatment for relapses using corticosteroids remains the same.
Some immunomodulatory treatment can continue through pregnancy, but others need to be stopped for a time (which can be months) prior to conception. The MS nursing team will be able to provide guidance, but it is always better if pregnancy is planned.
Can MS patients drive?
The majority of people with MS can drive, but they need to inform the Driver and Vehicle Licensing Agency (DVLA).
Patients with visual impairment or double vision may not be able to drive.
Patients with neurological impairment or who have lost confidence and need assistance to drive can self refer to RDAC, who are often helpful in getting patients back on the road.
I'm worried I have MS, what should I do?
MS can cause lots of different symptoms, so if you have neurological symptoms and look them up on the Internet or ask your GP about them, the possibility of MS may crop up. The majority of people in this situation don’t have MS.
Your GP can refer you to the Neurology department through the advice and refer (A&R) service and we can arrange a scan. If the scan is clear, it makes it extremely unlikely that your symptoms are caused by MS. It doesn’t guarantee you will never get MS, although the life time risk would be less than 1%. Your GP can seek further advice and guidance or clarification if they need to or if your symptoms change.
Patients with lots of different symptoms, but normal investigations sometimes have something called functional neurological disorder.
If you have severe neurological symptoms, such that you are struggling to see or walk, then you would need to attend Emergency Department.
I have MS, how do I get help?
If you have MS and are having new or troublesome symptoms, side effects from your medication or have some other question you can:
- talk to the team at your GP practice who may be able to give you advice, or
- contact your MS nurse on your behalf
Last reviewed: 06 September 2024
