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.

Neuraxpharm provides medication alternatives for the treatment of symptoms related to multiple sclerosis and once your doctor has determined your specific needs, they can prescribe the product that best adapts to your needs and condition.

Find out more about the symptoms, risk factors, and how it is diagnosed and treated.

What is multiple sclerosis (MS)?

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.

What are the main types of MS?

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.

How many people have MS?

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.

Symptoms

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.

What are the symptoms of MS?

MS can cause many different symptoms and there is no typical pattern that applies to everyone. An early symptom for one person might never be experienced by someone else. However in general, some of the most common first symptoms are:
  • Fatigue (about 80% of people with MS experience excessive tiredness.)
  • Stumbling due to problems with balance or leg coordination
  • Numbness or pins and needles in the skin
  • Cognitive issues involving concentration, problem solving, and memory
  • Problems with eyesight, such as blurred vision, blind spots, twitching or pain during eye movements
Other MS symptoms are listed below but they are less commonly experienced in the early stages of the condition and tend to occur at a later stage.
  • Walking difficulties
  • Vertigo
  • Dizziness
  • Weakness in the muscles
  • Spasticity (stiffness in the muscles caused by prolonged muscle contractions)
  • Difficulties with speech
  • Problems swallowing (dysphagia)
  • Depression and anxiety
  • Problems with bladder control
  • Bowel issues
  • Problems with sleep
  • Sexual issues
  • Chronic pain
  • Tremor
  • Temperature sensitivity
  • Hearing problems
Depending on the type of MS a person has, the symptoms may come and go in phases and gradually worsen over time.

What are the stages of MS?

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:

  • Relapsing-remitting MS (RRMS)
  • Secondary progressive MS (SPMS)
  • Primary progressive MS (PPMS)
  • Progressive relapsing MS (PRMS)

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:

  • Breathing difficulties
  • Increased susceptibility to chest (respiratory) infections
  • Severe bladder and bowel problems
  • Difficulties swallowing
  • Risk of dangerous blood clots
  • Pressure sores due to lack of mobility
  • Increased confusion and disorientation
  • Increasing levels of pain
  • Spasticity and muscle spasms
  • Lack of coordination (ataxia)

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.

Causes, risk factors and life expectancy

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.

What causes multiple sclerosis?

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:

  • Genetics: The chance of developing MS is higher if a close family member (for example, a parent or sibling) has the disease.
  • Environment: Lack of sunlight and low levels of vitamin D are associated with a greater risk of MS.
  • Smoking: People who smoke have a higher risk of developing MS than non-smokers.
  • Weight: People who were obese in their teenage years have an increased risk of developing MS.
  • Gender: Women are two to three times more likely to develop MS than men

Is MS hereditary?

MS is not directly inherited. However, if a sibling has MS, there is a higher risk of developing the disease. The risk is estimated to be around 2–4% compared to a 0.2% risk in the general population.

Who gets MS?

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:

  • Gender: Females are more likely to develop MS, which suggests hormones may play a role.
  • Age: Most people are diagnosed with MS between the ages of 20 and 40, although the condition can occur in children and older adults.
  • Geography: MS is more common in parts of the world that are furthest from the equator.
  • Ethnic background: MS occurs in most ethnic groups; however, it is most common in Caucasians of Northern European ancestry.
  • Infections: Certain viral infections may trigger the immune system, which leads to MS in some people. Several viruses are being investigated to determine whether they contribute to the development of MS, including Epstein-Barr virus and the human herpes virus 6.

How long can you live with 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.

Diagnosis

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.

How is MS diagnosed?

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.

Test to diagnose MS

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:

  • Neurological examination: A physical assessment to check for any abnormalities, changes, or weakness in eye movements and vision, hand and leg strength, balance, coordination, sensation, speech, and reflexes.
  • Magnetic resonance imaging (MRI): A scan to create a detailed image of the inside of the brain and spinal cord. It is a highly accurate way to confirm whether there is any inflammation, damage, or scarring (lesions).
  • Evoked potentials test: There are several types of evoked potentials test, but the most common one assesses the time it takes for the brain to receive messages from the eyes. It is a painless test in which light patterns are shown on a screen and brainwaves are monitored.
  • Lumbar puncture: A procedure is done under local anaesthetic to extract some of the fluid surrounding the brain and spine by inserting a needle into the lower back. The fluid sample is then tested for immune cells and antibodies; if these are present, it is a sign of possible MS. Lumbar punctures are safe, but may feel uncomfortable, and some people get a headache afterwards which can last for a few days.

Treatment and medication

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.

How is MS treated?

Treatment for MS depends on the individual and the symptoms or issues they are experiencing.

Therapy

Many people with MS use therapy, including complementary therapies, to manage their symptoms and boost their sense of wellbeing. Therapies can be used in addition to conventional treatments such as DMTs.

Therapies may include:

  • Physiotherapy:Stretching and strengthening exercises to meet specific needs and abilities. A physiotherapist may help improve stiffness and muscle spasms (spasticity), pain, mobility, balance, posture, fatigue, and bladder problems.
  • Cognitive behavioural therapy (CBT):To help combat fatigue or depression.
  • Occupational therapy:An assessment of the home to suggest adaptations and equipment that may help with daily activities.
  • Clinical psychology:For problems with thinking, learning and memory, or emotional difficulties. A clinical psychologist will assess the issues and suggest ways of coping.
  • Relationship counselling or a sex therapist: Advice for people experiencing sexual problems.
  • Speech and language therapist:Can help those with MS to find ways to overcome problems with speech and swallowing.
  • Complementary therapies: Some people find that complementary therapies such as reflexology, massage, yoga, relaxation, meditation, aromatherapy, and acupuncture can be helpful.

Intervention

It is essential for someone with MS to have regular reviews with their care team and have a comprehensive review of their care and support needs at least once a year. This ensures any new symptoms or problems are addressed, they have access to the physical, psychological, and emotional they need, and they are kept informed of any new treatment options.

Medication

A range of medications is available to slow the progression of MS and manage the symptoms.

Treatment options may include:

  • Steroids (anti-inflammatory medications) to treat relapses and speed up recovery time.
  • Specific medications to alleviate individual MS symptoms; for example, muscle relaxants for stiffness and spasms, painkillers for neuropathic pain or joint pain, phosphodiesterase (PDE) inhibitors for sexual problems, and laxatives for bowel issues.
  • Medications called disease-modifying therapies (DMTs) to reduce the number and seriousness of relapses also help to slow or reduce the progression of the disease.

Diet

There is no recommended set diet to help slow the progression of MS, but a healthy balanced diet is advisable. Research suggests that following a healthy diet can help people with MS to boost their physical and mental health. It can also help alleviate MS symptoms such as constipation and fatigue.

A healthy, balanced diet should include a wide variety of foods and may include:

  • Fresh fruit and vegetables
  • Lean proteins
  • Low-fat dairy or dairy alternatives (for example, soya)
  • Fish high in omega-3 fatty acids and vitamin D (for example, salmon, tuna, mackerel)
  • Whole grains
  • Healthy fats (for example, olive oil, coconut oil, avocado)
  • Beans, pulses, nuts, and seeds

Exercices

Regular exercise is important for overall health and fitness. Research shows that for people with mild to moderate disability from MS, exercise training is effective for improving both aerobic capacity and muscular strength. It may also improve mobility, fatigue, and health-related quality of life.

People who participate in regular aerobic exercise benefit from:

  • Better cardiovascular fitness
  • Improved strength
  • Better bladder and bowel function
  • Less fatigue and depression
  • A more positive attitude
  • Increased participation in social activities

Prevention

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.

Scientific studies

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 therapies specifically approved for treating and managing MS
  • Quicker diagnosis of MS, allowing access to more effective treatment to slow disease progression
  • Greater awareness of MS symptoms and more understanding of how to improve them
  • Breakthroughs in identifying the risk factors that can increase susceptibility to MS, which will help to find ways to prevent the disease

New discoveries are continually changing MS treatment options and helping to reduce MS-related disabilities.

Referenced sources

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  16.  Hadgkiss EJ, Jelinek GA, Weiland TJ, Pereira NG, Marck CH, van der Meer DM. The association of diet with quality of life, disability, and relapse rate in an international sample of people with multiple sclerosis. Nutr Neurosci. 2015;18(3):125-36. doi:10.1179/1476830514Y.0000000117.
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