What Is Multiple Sclerosis? Symptoms, Signs and Treatments
What is multiple sclerosis?
Multiple sclerosis – or MS, as it’s usually called – is a lifelong neurological condition that affects the brain and spinal cord. It gets its name from the scarring (sclerosis) that damages nerve fibres in multiple areas of the brain and spinal cord.
MS causes a wide range of possible symptoms that can vary from one person to the next and sometimes lead to serious disability, though some cases can be mild. You’re most likely to be diagnosed with MS in your 20s and 30s, though anyone of any age can be affected by it. And according to the NHS there are around 127,000 diagnosed cases of people living with MS in the UK, with two or three times more women affected than men (i).
What causes it?
We don’t know exactly why some people develop MS, which is classed as an autoimmune disease. This means the immune system mistakes part of the body for a threatening substance and attacks it.
In the case of MS, the part of the body attacked by the immune system – mainly immune system cells called T cells – is a substance called myelin that forms a protective sheath around the nerve fibres in the brain and spinal cord. The myelin sheath not only protects the nerve fibres but it allows the nerves to send messages called electrical impulses to the brain and spinal cord.
However, when the immune system attacks the myelin sheath, it causes tiny patches of inflammation, which prevents the nerve fibres from working properly and causes a variety of symptoms. Repeated attacks on the myelin sheath cause more episodes of inflammation, and eventually this leads to scarring – also called plaques – that can damage the nerve fibres permanently. If you have MS you’ll typically have many small areas of scarring in the brain and spinal cord.
Types of MS
There are three main types of MS, the most common of which is called relapsing-remitting MS. This affects almost nine out of 10 people with MS (ii).
Relapsing-remitting MS is as its name suggests, causing episodes of symptoms called relapses, and periods between attacks called periods of remission. A relapse can last anything from days to several months, with most lasting for two to six weeks. Once the symptoms ease or go away, you’re said to be in remission (periods of remission can last for years at a time). Most people have one or two relapses a year, though this can vary, and some people get them more or less frequently. When you do get a relapse it can be without warning, or it can happen when you’re ill or under a lot of stress. Other things that can trigger a relapse include exercise and hot weather. And during a relapse you may experience the same symptoms as before, or new ones.
Secondary progressive MS
According to the NHS around half of those with relapsing-remitting MS go on to develop secondary progressive type of MS within 15 to 20 years (i). This is when the symptoms become progressively worse, with some people having occasional relapses.
Primary progressive MS
Around one in 10 people with MS do not have the relapsing-remitting pattern, but their symptoms become progressively worse from the start. In other words, their symptoms are permanent because they don’t have periods of remittance – though they may have times when their symptoms seem to stabilise.
There is also a fourth type of MS called benign MS, which is diagnosed in fewer than one in 10 people. This is the least serious form of MS because it only causes a few relapses and the symptoms don’t go on to be permanent.
What are the symptoms of MS?
There are many symptoms caused by MS, though most people affected by it only experience a few of them. Some of the most common symptoms are as follows:
According to the NHS, the first symptom to be picked up on in around one in four MS cases is a problem with one of your eyes (i). Called optic neuritis, this is caused by inflammation of the optic nerve. Problems can include temporary loss of vision, eye pain, blurred or double vision and seeing flashes of light. And while only one eye is usually affected, both eyes can have symptoms in a few cases.
Many people with MS are affected by an overwhelming sense of exhaustion that can make daily activities a challenge. It can affect your balance and concentration and may become worse as the day goes on or when the weather’s hot, after you’ve been exercising or when you’re otherwise ill.
Damage to the nerves that supply muscles can cause a range of problems, including spasms (tight muscle contractions), stiffness (spasticity) and weakness. If you have muscle weakness and spasticity, it can also lead to mobility problems where walking and moving about may become difficult.
People with mobility problems may also be affected by musculoskeletal pain, thanks to the way problems with walking and moving put pressure on their lower back or hips. Pain can also be caused by damage to the nervous system (neuropathic pain). This can cause severe facial pain, painful muscle spasms as well as other sensations such as burning and pins and needles.
Numbness or tingling that starts in different areas such as the arms, legs or trunk and spreads throughout the body can also be a common symptom of a first MS relapse.
Many people with MS experience depression from time to time, though experts don’t really know whether this is a side effect of having to live with the symptoms of MS or a direct cause of the condition. Other mental health issues that can affect people with MS include anxiety – again, this could be caused by the stress of living with the condition – and in a few cases severe mood swings.
There are many other symptoms besides these, including:
Cognitive dysfunction (this includes problems with thinking, learning and planning, with some affected people having difficulties with things like short-term memory, attention span, visual information processing and problem solving)
Speech difficulties (some people with MS are affected by slurred speech, while others may have difficulties with chewing or swallowing)
Dizziness and vertigo
Balance and co-ordination difficulties
Tremors (shaking of the limbs)
Who’s at risk?
While experts aren’t clear why some people’s immune systems cause MS symptoms, it’s thought that the condition is a result of partly genetic and partly environmental factors.
That said, strictly speaking MS isn’t an inherited condition. But if you have a family member with MS your risk of developing it yourself is very slightly higher than that of the general population (according to the NHS, if a parent or sibling has MS your chance of developing it is around two to three per cent higher than someone who doesn’t have MS In their family) (iii).
Other things that may affect your risk of developing MS include the following:
If you’re a woman, you’re two to three times more likely to develop MS than a man, though experts still don’t know why.
Lack of sunlight
MS is more common in countries far from the equator, which has led some to believe that vitamin D – or, rather, a lack of vitamin D – may be a factor in the development of the condition, since a lack of sunlight can lead to low vitamin d levels.
According to the NHS, those whose weight was classed as obese while they were teenagers have a higher-than-average risk of developing MS.
There’s a theory that infections, particularly those caused by the Epstein-Barr virus, may trigger problems with the immune system that lead to the development of MS. One of these infections is infectious mononucleosis, or glandular fever.
According to the NHS, people who smoke are about twice as likely to develop MS than non-smokers (iii).
How is MS treated?
There is currently no cure for MS, so medical treatments aim to ease relapse symptoms as well as reduce the number of relapses and, in some cases, slow the progression of the disease. Some of the main treatments include the following:
Known as immunomodulatory agents, these medicines aren’t suitable for everyone with MS (they are most commonly used to treat those with relapsing-remitting MS and secondary progressive MS featuring relapses). Most are given by injection, with a few available in tablet form. They include:
These medicines are designed to interfere with the immune system with the aim of reducing relapses and slowing the progression of symptoms – though there is some uncertainty as to how effective they are. All these medicines can also have a range of side effects.
Medicines called corticosteroids can be used to treat relapses, including visual symptoms, and may help speed up recovery – though they don’t affect the ongoing progression of MS.
These help relax muscles, so they’re useful for muscle spasms. Physiotherapy is also an option for muscle spasms and spasticity.
Different types of painkillers can be used for different causes of MS pain, including painkillers for neuropathic pain (nerve pain) and painkillers for muscle and joint pain (using a TENS machine may also be useful for musculoskeletal pain).
These may be prescribed to people with MS who are experiencing depression. Talking therapies such as counselling and cognitive behavioural therapy can also be offered.
Other therapies can also be useful for certain MS symptoms, including:
MS and your lifestyle
The average life expectancy for someone with MS is slightly less than that of someone who doesn’t have MS. However according to the NHS staying fit and maintaining good physical and mental health can help people with MS live longer and have a better quality of life (iv).
Here are some of the ways your lifestyle can help:
According to the Multiple Sclerosis Trust, while there’s no specific diet proven to help everyone with MS, many of those living with the condition have found switching to a healthy diet beneficial. If you want to learn about a healthy balanced diet, a good place to start is the Eatwell Guide, which recommends which food groups form the basis of a healthy diet, including how many portions of each type of food you should be eating every day.
The MS Society also suggests that some people find special diets make a difference to how they feel, but they don’t work for anyone – and there isn’t any evidence to date to suggest special diets are effective. These special diets include the Swank diet, the Overcoming MS programme, the Paleo diet and the Best Bet diet. Details of all these diets can be found on the MS Society’s website.
Regular exercise is important for everyone’s health and fitness, and according to the NHS research has shown specific benefits of exercise for people with MS. These benefits include more energy, improved strength, better mobility and improved bowel and bladder function (v).
The MS Society recommends finding an activity that you enjoy and that feels right for you, such as:
Strengthening exercise (weight training)
Stretching (yoga, Pilates etc)
Most importantly, if you’re new to exercise and you have MS, start very slowly and don’t try to progress too quickly. Learn what your limits are, and don’t push yourself beyond them. Try to keep cool while you exercise too, as many people with MS are affected by heat. This may mean taking regular breaks, sipping ice drinks, taking a cool bath before exercising or using a fan while you exercise.
Giving up smoking
Smoking is a risk factor for many conditions, including MS, and may increase the speed at which the condition progresses. If you’re a smoker, ask your GP about the help that’s available for people who want to quit. You can also buy products that can help with nicotine withdrawal symptoms, including patches, gum and lozenges.
Maintaining good health
Always try to take up the offer of a free flu jab each year if you’re eligible for one (people who have significant MS-related disability qualify).
Adapting your home
If your MS is affecting your balance and co-ordination, you may want to consider some home adaptations – such as stair lifts and rails – to help you get on with daily living more easily. Ask your GP if you can be assessed by an occupational therapist, who can suggest adaptations and other equipment that could make life easier.
Natural support for multiple sclerosis
Currently there aren’t any well-documented natural treatments for MS. However, there are a few nutritional supplements that may offer some support, including the following:
High-strength fish oils
The omega-3 fatty acids found in fish oils are widely suggested as being beneficial for MS symptoms, though there’s a lack of evidence to confirm this idea. That said, some studies have found people with MS have lower levels of omega-3 fatty acids than those who don’t have MS (vi). One study has also found fish oils moderately beneficial in relapsing-remitting MS when combined with a low-fat diet, though the study itself only included 31 participants (vii).
Alpha lipoic acid
Is a substance believed to act as an antioxidant – may affect the behaviour of some immune system cells and prevent them from entering the central nervous system (viii). The MS Society charity is now conducting trials involving people with progressive MS to find out whether alpha lipoic acid can protect nerves from damage. However, this research is still at an early stage, and it may be several years before the outcome is published.
Alpha lipoic acid is available in supplement form.
Since MS is more common in parts of the world that are further from the equator (and therefore less sunny) than others, and that people who eat more fish have a lower risk of MS than those who don’t eat fish (ix), a theory has developed that vitamin D – which is found in oily fish and made in the body when skin is exposed to sunlight – may have a protective effect against MS. Studies so far, have yet to confirm this conclusively, but according to the MS Society research into whether vitamin D could help manage MS is still very much ongoing (x).
Meanwhile, the UK government currently recommends that everyone in this country should consider taking vitamin D supplements during the autumn and winter months, and that some who don’t get much sun during the summer should consider taking them all year round.
If you have MS you may also be tested for vitamin B12 deficiency, since some experts have found the condition can occasionally be associated with it (xi). Elsewhere, researchers have investigated the use of another B vitamin – biotin – as a natural treatment for MS, though results have so far been inconclusive with studies finding conflicting results.
Vitamins A, C and E
These are all vitamins that have antioxidant capabilities, which means they’re thought to help decrease damage to cells of the body caused by unstable molecules called free radicals (also called oxidants). According to the US-based National MS Society, there is some preliminary evidence that free radical damage may be involved in MS – though so far there aren’t any studies to suggest taking antioxidant supplements may be clinically beneficial in people living with MS (xiii).
You can get a variety of antioxidants by eating lots of fruit and vegetables, particularly those that are brightly coloured. Vitamins A, C and E are also found in good-quality multivitamin supplements. However, vitamin A supplements should be avoided by women who are pregnant, as large amounts of vitamin A can harm unborn babies.
Available online: https://www.nhs.uk/conditions/multiple-sclerosis
Available online: https://patient.info/brain-nerves/multiple-sclerosis-leaflet
Available online: https://www.nhs.uk/conditions/multiple-sclerosis/causes
Available online: https://www.nhs.uk/conditions/multiple-sclerosis/living-with
Available online: https://www.nhs.uk/conditions/multiple-sclerosis/living-with
Nightingale. S., Woo. E., Smith. A.D., et al. Red blood cell and adipose tissue fatty acids in mild inactive multiple sclerosis. Acta Neurol Scand.. 1990. 82:43-50. Available online: https://www.ncbi.nlm.nih.gov/pubmed/2239137
Cunnane. S.C., Ho. S.Y., Dore-Duffy. P., et al. Essential fatty acid and lipid profiles in plasma and erythrocytes in patients with multiple sclerosis. Am J Clin Nutr.. 1989. 50:801-806. Available online: https://www.ncbi.nlm.nih.gov/pubmed/2801584
Weinstock-Guttman. B., Baier. M., Park. Y., et al. Low fat dietary intervention with omega-3 fatty acid supplementation in multiple sclerosis patients. Prostaglandins Leukot Essent Fatty Acids. 2005. 73:397-404. Available online: https://www.ncbi.nlm.nih.gov/pubmed/16099630
Information for healthcare professionals – Advice for GPs regarding supplement prescription in anorexia nervosa. Available online: https://www.ncbi.nlm.nih.gov/pubmed/16099630
Goldberg. P. Multiple sclerosis: vitamin D and calcium as environmental determinants of prevalence (a viewpoint). Part I: Sunlight, dietary factors and epidemiology. Int J Environ Studies. 1974. ;6:19-27. Available online: https://www.ncbi.nlm.nih.gov/pubmed/9316607
Hayes. C.E., Cantorna. M.T., DeLuca. H.F. Vitamin D and multiple sclerosis. Proc Soc Exp Biol Med. 1997. ;216:21-27. Available online: https://www.ncbi.nlm.nih.gov/pubmed/9316607
Vieth. R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999. ;69:842-856. Available online: https://www.ncbi.nlm.nih.gov/pubmed/10232622
Schwartz. G.G. Multiple sclerosis and prostate cancer: what do their similar geographies suggest? Neuroepidemiology. 1992. ;11:244-254. Available online: https://www.ncbi.nlm.nih.gov/pubmed/1291888
Baig. S.M., Qureshi. G.A., Minami. M. The interrelation between the deficiency of vitamin B12 and neurotoxicity of homocysteine with nitrite in some of neurologic disorders. Biogenic Amines. 1998. ;14:1-14. Available online: https://www.researchgate.net/publication/287416748_The_interrelation_between_the_deficiency_of_vitamin_B12_and_neurotoxicity_of_homocysteine_with_nitrite_in_some_of_neurologic_disorders
Reynolds. E.H. Multiple sclerosis and vitamin B12 metabolism. J Neuroimmunol. 1992. ;40:225-230. Available online: https://www.ncbi.nlm.nih.gov/pubmed/1430153
Birnbaum. G., Stulc. J., Snyder. T. High Dose Biotin as Treatment for Progressive Multiple Sclerosis.
Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.