Understanding multiple sclerosis: from symptoms to treatment

Multiple sclerosis (MS) affects around 1 in 400 people in the UK. It causes the immune system to destroy the layer of insulation that wraps around nerves in the brain and spinal cord, which is called the myelin sheath. 

Multiple sclerosis can develop at any age, but it most commonly develops in adults aged between 20–40. It is a lifelong condition for which there is currently no cure. 

While it can reduce your life expectancy due to complications related to the disease, multiple sclerosis itself is not a fatal condition.

Here, we will explore the risk factors, symptoms and treatments for multiple sclerosis as well as how it is diagnosed and the outlook for living with multiple sclerosis.

Risk factors for multiple sclerosis

The exact cause of multiple sclerosis is currently unknown. However, there are several risk factors. 

Women are much more likely to develop multiple sclerosis, with around 7 in every 10 cases occurring in women.

People who live further away from the equator are also more likely to develop multiple sclerosis (the latitude effect). This may be because people living closer to the equator are exposed to more sunshine. 

Exposure to sunshine is needed for your body to make vitamin D. Some propose that low vitamin D levels are associated with an increased risk of developing multiple sclerosis; however, the reasons for this remain unclear.  

Additionally, your risk is higher if you have a family history of the disease. However, it is important to note that multiple sclerosis is not an inherited condition.

Infection with Epstein-Barr virus, which causes glandular fever, increases your risk of developing multiple sclerosis too.

Types of multiple sclerosis

Multiple sclerosis occurs when the immune system attacks and destroys the insulating layer that wraps around nerves. This is called demyelination. Episodes of demyelination result in the symptoms of multiple sclerosis. 

If you have a one-off episode of demyelination, this does not qualify as multiple sclerosis. This is because multiple sclerosis only occurs when there are multiple episodes of demyelination (according to McDonald’s criteria).

There are 3 main types of multiple sclerosis: 

1. Relapsing-remitting multiple sclerosis (RRMS) — this occurs when there are flare-ups that cause new or worsening symptoms (relapses), followed by periods of recovery where the symptoms improve (remissions)
2. Primary progressive multiple sclerosis (PPMS) — this occurs when there are no periods of remission and symptoms continue to worsen over time without a break
3. Secondary progressive multiple sclerosis (SPMS) — this occurs when RRMS gradually deteriorates leading to a progressive, continuous worsening of symptoms without any periods of remission 

Symptoms of multiple sclerosis

The demyelination of nerves that occurs during multiple sclerosis leads to neurological symptoms. Symptoms vary depending on which parts of the brain and spinal cord are affected. 

Symptoms can include: 

• A tight or squeezing feeling around the chest known as the MS hug
• Muscle spasms, weakness and stiffness
• Nerve or musculoskeletal pain
• Numbness and tingling
• Urinary symptoms eg having sudden urges to urinate, urinating more frequently and urinating at night 
• Visual disturbances caused by inflammation of the optic nerve (optic neuritis)

Individuals with multiple sclerosis also often experience fatigue and cognitive changes such as a reduced ability to:

• Concentrate for a long time
• Continue with an activity after being interrupted
• Make plans and solve problems
• Recall a specific word when having a conversation
• Remember things you need to do or things that have happened recently

Diagnosing multiple sclerosis

Multiple sclerosis is diagnosed using established diagnosing guidelines called McDonald’s criteria.

These criteria help your doctor identify multiple sclerosis by looking for signs of damage to your brain and spinal cord that have occurred over time (ie more than once) and over space (ie affecting different areas of the brain and spinal cord). 

Gathering evidence of this will include taking a detailed medical history and performing a physical examination. A physical examination will check various aspects of your health, including your: 

• Balance
• Coordination
• Limb strength
• Reflexes 
• Vision

 It may also include tests, such as: 

• Lumbar puncture — collection of cerebrospinal fluid from your spine with a needle for testing in a lab; lab testing will look for proteins that are signs of inflammation
• MRI scans of your brain and spinal cord

Visual evoked potentials — an electrical test to check your brain’s response to visual stimulus

Treating multiple sclerosis

Multiple sclerosis is treated with disease-modifying therapies (DMTs). These treatments target the underlying cause of the disease and prevent relapses rather than only targeting the symptoms. 

Different DMTs are prescribed depending on the type and stage of the disease. They include: 

• Injectables such as beta-interferon
• Infusions such as natalizumab and ocrelizumab — infusions deliver medication directly into the bloodstream but more slowly than an injectable 
• Oral medications such as teriflunomide

Other treatments for multiple sclerosis vary depending on the stage and severity of your condition, and not everyone will need the same treatments. 

If you have signs of a relapse, you will be treated with a high dose of steroids, either given orally or via infusions.

Specific symptoms of multiple sclerosis are treated with different medications. For example, if you have urinary symptoms, your doctor may prescribe medications or botulinum toxin injections, which relax the muscles in the bladder wall to stop them from contracting and causing symptoms. 

Movement and mobility problems can be treated with physiotherapy and regular muscle-strengthening exercises and can be supported with mobility aids. 

Preventative treatments

It can be helpful to take vitamin D supplements as lower levels of vitamin D are associated with an increased risk of relapses. 

As excessive heat can worsen multiple sclerosis symptoms (this is known as Uhthoff’s phenomenon), it is important to stay cool by wearing loose-fitting clothing, drinking water and taking cool showers. 

Complications of multiple sclerosis

Most of the complications associated with multiple sclerosis occur in severe or advanced cases. 

When mobility is significantly reduced, there is an increased risk of a serious chest infection, namely pneumonia.

When swallowing is affected, there is an increased risk of aspiration pneumonia. Aspiration pneumonia occurs when food, liquids, saliva, vomit or stomach acid are inhaled into the airways and lead to a chest infection. 

Bladder problems, such as incomplete emptying of the bladder after urination, increase the risk of urinary tract infections (UTIs). UTIs are also more likely when movement problems make proper personal hygiene difficult. 

Living with multiple sclerosis

Although multiple sclerosis cannot be cured, effective management with disease-modifying therapies, treatments for specific symptoms, physiotherapy and mobility aids can help you lead a full life. 

Living with multiple sclerosis can be challenging and consequently affect your mood, mental health and stress levels. It is important to seek appropriate help via your GP. This may include cognitive behavioural therapy, cognitive rehabilitation, medications and joining support groups. 

You can find advice and support for living with multiple sclerosis from the Multiple Sclerosis Trust, MS Society, MS UK and Shift.ms.