Multiple sclerosis (MS) is a neurological condition affecting the nerves in the brain and spinal cord. It causes damage to the myelin sheath, the protective coating around the nerve fibres in the central nervous system.
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Find out more about the symptoms, risk factors, and how it is diagnosed and treated.
Multiple sclerosis (MS) is a chronic (long-term) condition that causes damage to the central nervous system, including the nerves in the brain, the spinal cord and the optic nerves. In MS, the immune system attacks the myelin sheath (the protective coating around the nerve fibres). This nerve damage interrupts the flow of messages from the central nervous system, causing a reduction or loss of body function. MS causes a wide range of symptoms, such as fatigue, walking difficulties, problems with vision, and thinking and planning issues.
There are three main types of MS. They are named according to how they affect the body over time:
Relapsing-remitting MS (RRMS): Most people diagnosed with MS (85%) have relapsing-remitting multiple sclerosis (RRMS) and experience the first signs of the disease in their early 20s. A person with RRMS will have periods when existing or new symptoms flare up aggressively; such a period is known as a relapse, flare-up, or exacerbation. Relapses often happen without any warning, although they can be stress-related or occur after an illness. They typically last a few days or weeks, and the symptoms then improve slowly over a similar time. The period between attacks, when symptoms disappear, is called remission. However, the MS is still active during these periods, and damage to the nerves may continue. After diagnosis, a person with MS will typically have relapses from time to time, followed by weeks, months, or even years of remission.
Secondary progressive MS (SPMS): If left untreated, up to 80% of people with RRMS are at risk of developing SPMS, however with treatment this number is much lower. This happens slowly, usually over a period of 10–15 years. In this phase, the old pattern of relapses followed by periods of remission usually stops. Some people may still get relapses, but they probably will not make a full recovery afterwards and will suffer some symptoms throughout. In SPMS, the symptoms gradually worsen over time. SPMS generally develops from RRMS, although a small number of people are diagnosed with SPMS at the outset.
Primary progressive MS (PPMS): About 15-20% of people with MS experience PPMS. The symptoms gradually worsen over time rather than appearing as relapses. It is called ‘primary progressive’ because it progresses from the first (primary) symptoms of the disease. There are no remissions, but there can be long periods of time when the condition seems to stabilise, with no noticeable changes.
There are an estimated 2.1-2.2 million people with MS worldwide,, and the condition is about two to three times more common in women than in men.
According to the European Multiple Sclerosis Platform, across Europe, more than 700,000 people suffer from MS. This means that over one million people throughout the EU are affected by MS through their role as caregivers and family members.
Everyone experiences MS differently. There is a wide range of symptoms, and they can vary from person to person, affecting different parts of the body.
There is no way to predict how an individual’s MS will progress. People can have different symptoms at different times.
The International Advisory Committee on Clinical Trials of MS provides standard definitions for the four basic forms of MS as:
Clinically isolated syndrome (CIS) was not included in the initial clinical definitions of MS. However, it is now recognised as the first episode of neurological symptoms that someone may experience, generally lasting for at least 24 hours. CIS can be the first indication that a person has MS. However, some people may never go on to experience further symptoms.
An MRI scan will confirm whether there are any lesions (areas of damage) in the brain or spinal cord. If this is the case, the chances of having further episodes are higher, and a diagnosis of MS is more likely.
There is also a late (or advanced) stage of MS that most people will never reach. If MS reaches the advanced stage, a person may lose the ability to walk, and may experience other life-changing symptoms, such as being unable to speak or write. They may need dedicated care and support to meet their day-to-day needs.
At the late or advanced stage, multiple MS symptoms may be experienced simultaneously, and there is significant physical impairment. Late-stage MS symptoms include:
Many of the symptoms in late-stage MS are the same as those of other forms of MS. However, the difference with late-stage MS is that many of the symptoms are likely to be experienced simultaneously, and they can be difficult for doctors to treat.
It is not currently known why some people develop MS. It is likely that the condition is caused by a combination of genetic and environmental factors.
MS is an autoimmune condition, which means the body’s immune system mistakes parts of the body as a foreign substance and attacks its own tissues. In MS, the immune system attacks the myelin sheath, which protects and covers the nerve fibres in the brain and spinal cord. The myelin sheath becomes inflamed in small patches which disrupt the messages (signals) travelling along the nerves, leading to the neurological signs and symptoms of MS.
It is not yet understood what causes the immune system to attack the myelin sheath, but some of the factors that may play a role in the development of MS include:
MS is not contagious and cannot be inherited. Scientists have identified some factors that may eventually be found to play a role in causing MS:
MS is not usually fatal; it is rare to die from MS itself. However, some people may develop disabilities that make them more vulnerable to serious complications, which can be fatal.
The average life expectancy for someone with MS is approximately 5–10 years lower than for someone without the condition, but this gap in life expectancy has shrunk dramatically in recent years.
MS is not easy to diagnose. It is a complex disease with many different symptoms. If possible MS symptoms arise, the first port of call is to see a doctor.
Depending on your age, your route to diagnosis will be slightly different.
The early signs and symptoms of MS vary from individual to individual, and it can be difficult to pinpoint exactly when they started to develop. It may take several months to get an accurate diagnosis, because doctors will need to investigate all the possible causes of the symptoms, involving many different tests.
If a doctor thinks someone may have MS, they will refer to a neurologist – a specialist in disorders that affect the central nervous system – to be assessed.
There is no set test to diagnose MS. Instead, a doctor will carry out an initial assessment and may order some blood tests to rule out other causes of the symptoms. They will then make a referral to a neurologist for further assessments if required.
Tests used by neurologists to diagnose MS include:
There is no cure for MS. Instead, treatment and medication focus on controlling the symptoms, reducing the number of relapses and slowing the progression of the disease.
Treatment for MS depends on the individual and the symptoms or issues they are experiencing.
Currently, there is no proven way to prevent MS from developing or to cure the disease completely.
Experts believe a combination of genetic and environmental factors contributes to MS developing. Once these factors are better understood, it could open the door to finding prevention methods and effective treatment options in the future.
Although researchers have not yet been able to identify the cause of multiple sclerosis or work out how to prevent it, there has been significant progress which has helped to improve diagnosis, treatments, and support.
Decades of research into MS and the immune and nervous systems’ function have built a solid foundation for more scientific progress. Significant investment in MS research has resulted in:
New discoveries are continually changing MS treatment options and helping to reduce MS-related disabilities.