Leonie Martin has relapsing remitting multiple sclerosis (MS). She resigned from her job in management seven years ago after a series of relapses and cognitive problems left her unable to carry out her role. Here, she explains how she learnt to manage her symptoms.

“When I was diagnosed with MS I tried to ignore it. I had a busy, hectic lifestyle and a well-paid job in office management at a local school.  

“I thought I’d be able to manage my MS and that my lifestyle wouldn’t have any affect on my symptoms, but soon problems started to occur. I would be in the middle of an important presentation when my mind would suddenly go blank. I found concentrating extremely difficult; if I was interrupted while in the middle of something I would need to start from the beginning again.

“I lost the ability to delegate work to my staff, mainly because I couldn’t keep track of what I’d asked, and I began taking unfinished work home so I could concentrate on it in the evening. I could no longer multi-task and gradually lost all sense of perspective – I would regularly break down in floods of tears at my desk, which was unsettling for my colleagues.

“I knew the problems were connected to my MS as I’d been doing the job very capably for years – and I think it was because of this that my employer and colleagues struggled to understand. I became anxious, paranoid and depressed and two years after my diagnosis, decided to leave work. At the time I was having three relapses a year and my neurologist prescribed me weekly beta interferon injections.

“Following a full neuropsychological assessment by a specialist, I became involved in a cognitive behavioural therapy (CBT) pilot study. The course helped me understand more about managing my symptoms and showed me how to focus more on what I could do rather than what I couldn’t. I learnt to pace myself more and be kinder to myself – refraining from getting angry when I forgot to do something. 

“I found that by splitting my day into three sections – morning, afternoon and evening – I could manage my fatigue, and therefore my cognitive problems and mood swings. Now, I know that I can’t do something in all three sections so if I’m out to dinner with friends on an evening, I’ll sleep in the afternoon. I also try to exercise more but have to ensure I build in a rest period afterwards.

“I’ve learnt more about the types of fatigue and now understand that applying a lot of concentration to something for a period of time can be as exhausting as standing all afternoon. I need to get the right balance and think about my daily choices.

“I’m now self employed as a freelance writer – it’s flexible and has reduced my stress levels and relapses, I haven’t had a major flare-up in three years, but understandably it’s had a major impact on the family in terms of finances.

“Cognitive behavioural therapy worked for me – but it’s not a magic wand. You need to be open minded about it and want to learn how to get the best out of your own set of circumstances. You also have to be prepared to commit time and energy both during the sessions and at home in between.

“I wish I had known about CBT earlier – I learnt to deal with my symptoms the hard way but I’m happy that I’ve now found the right balance.”

Sara was 22 when she was diagnosed with relapsing remitting multiple sclerosis (MS).

“It all started when I was in my final year of university, aged 22. I was travelling home from a job interview when somebody stole my purse. It was very upsetting.

“Then I woke the next day and couldn’t see properly. My vision was blurry in my left eye, and I couldn’t see colours clearly. I also had pain behind my eye. I went to the doctor, thinking it would be something like conjunctivitis, but my GP was so concerned that she sent me to hospital that night.

“After a series of tests I was diagnosed with optic neuritis, which is the swelling of the optic nerve. I didn’t realise it at the time, but this is sometimes one of the first signs of multiple sclerosis.

“I then saw a neurologist and had a magnetic resonance imaging (MRI) scan and some really uncomfortable eye tests. I was diagnosed with relapsing remitting MS and felt very scared.

“By this time, it was six months after my initial eye problems and I was struggling to walk. I was weak, shaky and felt a lot of tingling in my body. My parents noticed I was dragging my left leg. But I think these symptoms were linked to stress – it was just after September 11th, and I remember feeling
absolutely devastated.

“I was very fortunate. My neurologist thought I was very well suited for beta interferon injections. Beta interferon is a disease-modifying medicine that reduces the number and severity of MS relapses.

“Three months later, I was approved for this treatment and started my weekly injections. The side effects were absolutely dreadful. I had flu-like symptoms, which began 24 to 48 hours after the injection.

“I’m still on the injections now, aged 30. Fortunately, the side effects have now become less severe, although I do still suffer from them. Because the disease and treatment side effects can make you feel lousy, I’m prone to depression so I also take antidepressants.

“But by looking at me, you’d never know I have the disease. I work full-time for the NHS, and am doing a Masters degree. I find that it really helps to keep a positive mental attitude.

“I still suffer from fatigue and eye problems, and I now wear glasses. Some days, when my leg isn’t working well, I just take it easy. My work colleagues have been very supportive.

“When I go for my hospital check-ups twice a year, I see people in wheelchairs who are clearly in much worse condition than I am. I consider myself very lucky.”

Narinder Kaur-Logue has an aggressive form of relapsing remitting multiple sclerosis. She experiences severely debilitating fatigue on a daily basis and has regular relapses. Earlier this year she began having a monthly infusion of the disease-modifying drug (DMD) Tysabri.

“When I was first offered Tysabri I didn’t want it. I’d heard about people who had died on the trial and didn’t want to put my life at risk. When my doctor explained how isolated those cases were, and that the treatment had finished trials and had been approved for treating aggressive forms of MS, I decided I would give it a go.”

Narinder had previously taken Copaxone and Avonex – DMDs that are self-injected. 

“I had lots of side affects with Avonex and I hated the daily injections with Copaxone. I felt like I was stabbing myself and sometimes had to ask my husband to do it for me. The monthly infusions for Tysabri are painless and straightforward and I no longer have the stress of bad injection site bruises.”

Narinder’s MS symptoms include fatigue, mobility and vision problems. “I’m unable to work because of my fatigue,” she explains. “I tend to get errands and exercise done in the morning and then come midday my body starts to shut down, fatigue sets in and I can’t do anything other than rest; it’s like flicking a switch”.

Tysabri has been known to cause the life-threatening virus progressive multifocal leukoencephalopathy (PML), but risk of developing this is small. Potential side effects of the treatment can include infections, headaches, dizziness, vomiting, nausea, liver damage and infusion reactions. Narinder started receiving the infusions in January and hasn’t experienced any side effects so far (eight months later).

She said: “I can notice a difference in myself and it seems to be keeping some symptoms at bay. My balance has improved; I don’t wobble as much when I stand after sitting and I now have the confidence to wash my hair without someone in the house. I have more energy too. I danced at a party recently – something I haven’t done in a long time.”

“I’m lucky that I’ve been able to access Tysabri – I know of others that have had to campaign for months. Tysabri won’t work for everyone; it only treats aggressive forms of relapsing remitting MS and some people may develop side effects or not like the idea of the two-hour hospital infusions once a month, but it’s working well for me at the moment.”

Jo was diagnosed with multiple sclerosis following the birth of her son. She explains how it affects her body, her ability to move around and her family life, and where to find support.

The exact reason why someone develops multiple sclerosis (MS) is not known. What is known so far suggests it is caused by a combination of environmental and genetic factors.

Autoimmune condition

MS is an autoimmune condition. This means your immune system mistakes the myelin for a foreign substance and attacks it. The myelin becomes inflamed in small patches (called plaques or lesions), which can be seen on an MRI scan.

This can disrupt the messages travelling along nerve fibres. It can slow them down, jumble them, send them down a different nerve fibre, or stop them from getting through completely.

When the inflammation goes away, it can leave behind scarring of the myelin sheath (known as sclerosis). These attacks can eventually start to destroy the myelin sheath (demyelination), which can damage the underlying nerve fibre.

Why do people develop multiple sclerosis?

It is not understood what causes the immune system to attack myelin, although there are several theories. Most experts agree that MS is probably caused by a combination of genetic and environmental factors. This means it’s partly caused by genes you inherit from your parents and partly caused by outside factors that may trigger the condition.

Genetic factors

MS is not defined as a genetic condition because there is no single gene that causes it. It’s not directly inherited, although research has shown people who are related to someone with MS are more likely to develop it.

Researchers have found that if one twin develops MS then the second twin has around a one in four chance of also developing MS.

The chance of a brother, sister or child of a person with MS also developing MS themselves is less than one in 30.

It’s possible that different combinations of genes make developing MS more likely, and research into this is continuing. However, genetic theories cannot explain the wide variation in occurrences of MS throughout the world.

Sunlight and vitamin D

Research into MS around the world has shown that it’s more likely to occur in countries far from the equator. For example, MS is relatively common in the UK, North America and Scandinavia, but rare in Malaysia or Ecuador.

It’s possible that people living further from the equator are exposed to less sunlight and, therefore, have less vitamin D in their bodies. Some studies have found a link between lower levels of vitamin D and incidence of MS.

Some researchers have suggested that vitamin D supplements may reduce the risk of MS. However, this has not been proven.

Smoking

Smoking is another factor that appears to increase someone’s risk of developing MS. It is not yet clear exactly why this is, although one theory is that the chemicals in the cigarette smoke affect the immune system.

Viral infection

Another theory is that a virus may be involved in the development of MS. The Epstein-Barr virus (EBV) has been the subject of most of the current studies.

MS is thought to be an autoimmune condition, where the body’s own immune system attacks healthy tissue. One possible explanation is that a virus might cause a strong response from the immune system, which leads it to target healthy parts as well as the virus.

More research is needed to further understand how EBV may increase the risk of developing MS.

 

If you have unexplained symptoms that are similar to those of multiple sclerosis (MS), see your GP. If your GP suspects MS, they will ask you for a detailed medical history, including past signs and symptoms as well as the current state of your health.

Your GP can refer you to a neurologist (a specialist in conditions of the central nervous system).

If your GP suspects MS, you should see a neurologist within six weeks.

Read more about waiting times in the NHS.

Diagnostic tests

Diagnosing MS is complicated because no single laboratory test can positively diagnose it.

Several conditions have symptoms similar to those of MS, so your neurologist may rule them out first.

It may also not be possible to confirm a diagnosis if you have had only one ‘attack’ of MS-like symptoms. A diagnosis can usually only be made with confidence once there is evidence of at least two separate attacks.

To confirm MS, your neurologist may carry out a number of tests.

Neurological examination

Your neurologist will look for changes or weakness in your eye movements, leg or hand co-ordination, balance, speech and reflexes. This will show whether your nerve pathways are damaged.

Magnetic resonance imaging (MRI) scan

An MRI scan creates a detailed image of your brain and spinal cord.

MRI scans can show whether there is any damage or scarring of the myelin in your central nervous system. The results of the MRI scan confirm a diagnosis in over nine out of 10 people who have MS.

The procedure is painless and usually takes between 10 and 30 minutes. A standard MRI scanner is like a giant tube or tunnel. You may feel claustrophobic when going into the tunnel and the machine is noisy.

Tell your neurologist if you have any concerns about this experience.

Evoked potentials test

An evoked potentials test involves placing small electrodes on your head. These monitor how your brain waves respond to what you see and hear. It is painless and can show whether it takes your brain longer than normal to receive messages.

Lumbar puncture

A lumbar puncture is also sometimes called a spinal tap. A sample of your cerebrospinal fluid (the fluid that surrounds your brain and spinal cord) is taken using a needle inserted into the area around your spinal cord.

This is done under local anaesthetic, which means that you will be awake, but the area the needle goes into will be numbed. The sample is tested for antibodies, the presence of which means that your immune system has been fighting a disease in your central nervous system.

A lumbar puncture is usually only needed if other tests for MS are inconclusive.

Blood tests

Blood tests are usually performed to rule out other causes of your symptoms, such as vitamin deficiencies. In addition, antibody tests may be required, for example to rule out a very similar condition called neuromyelitis optica (NMO).

Diagnosing the different types of multiple sclerosis

Once a diagnosis of MS has been made, your neurologist may be able to identify which type of MS you have.

However, this often only becomes clear over time as the symptoms of MS are so varied and unpredictable.

A diagnosis of relapsing remitting multiple sclerosis (RRMS) may be made if:

• you have two relapses of your symptoms more than 30 days apart
• you have one relapse and an MRI scan shows new myelin damage or scarring three months later

A diagnosis of secondary progressive multiple sclerosis (SPMS) may be made if:

• you have had relapses of your symptoms in the past
• you have become steadily more disabled for at least six months, with or without relapses

MS never starts out as secondary progressive. However, it is possible for someone to be told they have this type if they have had unexplained symptoms for some time.

A diagnosis of primary progressive multiple sclerosis (PPMS) may be made if you have had no previous relapses of your symptoms, and:

• you have become steadily more disabled for at least one year
• an MRI scan shows damage and scarring to myelin
• a lumbar puncture shows antibodies in the fluid surrounding your brain and spinal cord

In rare cases, some people with primary progressive multiple sclerosis can have relapses. This can make it even harder to clearly identify what type of MS they have.

Brain

The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.

Inflammation

Inflammation is the body’s response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Lesions

A lesion is an abnormal change in an organ or body tissue because of injury or disease.

MRI

MRI stands for magnetic resonance imaging. It is the use of magnets and radio waves to take detailed pictures of inside the body.

Multiple sclerosis (MS) affects nerves in the brain and spinal cord, causing a wide range of symptoms including problems with muscle movement, balance and vision.

Each nerve fibre in the brain and spinal cord is surrounded by a layer of protein called myelin, which protects the nerve and helps electrical signals from the brain travel to the rest of the body. In MS, the myelin becomes damaged.

This disrupts the transfer of these nerve signals, causing a wide range of potential symptoms, such as:

• loss of vision – usually only in one eye
• spasticity – muscle stiffness that can lead to uncontrolled muscle movements
• ataxia – difficulties with balance and co-ordination
• fatigue – feeling very tired during the day

Read more about the symptoms of multiple sclerosis.

Types of multiple sclerosis

Around eight out of 10 people with MS are diagnosed with the relapsing remitting type of MS.

Someone with relapsing remitting MS will have flare-ups of symptoms, known as relapses. These can last from a few days to a few months.

These will be followed by periods where symptoms are mild or disappear altogether. This is known as remission and can last for days, weeks or sometimes months.

Usually after around 15 years, around half of people with relapsing remitting MS will go on to develop secondary progressive MS.

In secondary progressive MS, symptoms gradually worsen over time. Some people may still have relapses, but without full recovery from symptoms.

The least common form of MS is primary progressive MS. In this type, symptoms gradually get worse over time and there are no periods of remission.

Treatment

There is currently no cure for MS but there are a number of treatments that can help.

Relapsing remitting MS can be treated with disease-modifying drugs. These are designed to reduce the number of relapses someone has. They may also be able to slow the progression of MS. But they are not suitable for all people with MS.

Some of these drugs can also be used for treating secondary progressive MS, if someone is still experiencing relapses.

At the moment, there is no treatment that can slow the progress of primary progressive MS.

There are also a wide range of treatments, including physiotherapy, that can help relieve symptoms and make day-to-day living easier. Steroids can also be used to speed up recovery from relapses.

Read more about the treatment of multiple sclerosis.

Causes

MS is known as an autoimmune condition. This is where something goes wrong with the immune system (the body’s defence against infection) and it mistakenly attacks healthy body tissue – in this case, the myelin covering of nerves.

This can cause multiple sections of the brain and spinal column to become damaged and hardened (sclerosis), which can disrupt the nerve signals passing through these areas.

Exactly what causes the immune system to act in this way is unclear, but most experts think a combination of genetic and environmental factors are involved.

Read more about the possible risk factors and causes of multiple sclerosis.

Who is affected

It is estimated that there are currently around 100,000 people with MS in the UK.

MS is most commonly diagnosed in people aged 20-40, although it can happen at any age. Children can also get MS, although this is rare.

For reasons that are unclear, MS is three times as common in women than men, and more common in white people than black and Asian people.

Outlook

MS can be a challenging and frustrating condition to live with but new treatments over the past 20 years have considerably improved the quality of life of people with the condition.

MS is not fatal, but some complications that can arise from severe MS, such as pneumonia, can be.

As a result, the average life expectancy for people with MS is around five to 10 years lower than the population at large. This gap appears to be getting smaller, perhaps because of improved medical care.

Relationships and support

Having a baby

Fertility

Being diagnosed with MS shouldn’t affect your ability to have children. However, some of the medication prescribed for MS may affect fertility in both men and women. If you’re considering starting a family, discuss it with your healthcare team, who can offer advice.

Pregnancy

Women with MS can have a normal pregnancy and deliver a healthy baby. Some women find that they are less likely to have a relapse of symptoms during the pregnancy but may have an increased risk of relapse after the pregnancy. Women with MS can have a normal birth and breastfeed afterwards.

You may need to continue taking medication throughout your pregnancy. However, some medication shouldn’t be taken during pregnancy, so it’s important to discuss this with your healthcare team.

Want to know more?

• Multiple Sclerosis Society: MS and pregnancy
• Multiple Sclerosis Trust: Starting a family

Money and financial support

If you have to stop work or work part time because of your MS, you may find it hard to cope financially. You may be entitled to one or more of the following types of financial support:

• If you have a job but can’t work because of your illness, you’re entitled to Statutory Sick Pay from your employer.
• If you don’t have a job and can’t work because of your illness, you may be entitled to Employment and Support Allowance.  
• If you’re aged 64 or under and need help with personal care or have walking difficulties, you may be eligible for Personal Independence Payment or Disability Living Allowance
• If you’re aged 65 or over, you may be able to get Attendance Allowance. 
• If you’re caring for someone with MS, you may be entitled to Carer’s Allowance.
• You may be eligible for other benefits if you have children living at home or if you have a low household income.

Want to know more?

• Multiple Sclerosis Society: Benefits, work and money 
• Multiple Sclerosis Trust: Work
• Multiple Sclerosis Trust: Benefits and tax credits
• Carers Direct: Benefits for carers
• Carers Direct: Benefits for the person you care for
• GOV.UK: Benefits and financial support
• Money Advice Service

Driving

If you’ve been diagnosed with MS, you must tell the Driver and Vehicle Licensing Agency (DVLA) and also inform your insurance company.

You won’t necessarily have to stop driving. You will be asked to complete a form providing more information about your condition, as well as details of your doctors and specialists. The DVLA will use this to decide whether you are fit to drive.

Want to know more?

• DVLA: Fitness-to-drive standards
• Multiple Sclerosis Trust: Driving and transport
• Multiple Sclerosis Society: driving and mobility
• Rica guide: Motoring with MS

The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.

The information in the Map has been approved by the UK’s leading clinical experts, is based on the best available clinical evidence, and is continually updated. To take advantage of this unique resource go to:

Map of Medicine: multiple sclerosis

 

 

The central nervous system (brain and spinal cord) controls all of your body’s actions. When MS damages the myelin coating around the nerve fibres that carry messages to and from your brain, symptoms can occur in any part of your body.

There are many different symptoms of MS and they affect each person differently. Some of the most common symptoms include:

• extreme tiredness (fatigue)
• numbness and tingling
• blurring of vision
• problems with mobility and balance
• muscle weakness and tightness

Most people with MS only have a few of these symptoms and it is unlikely someone would develop all possible symptoms.

The symptoms are unpredictable. Some people’s MS symptoms develop and increase steadily over time, while for others, they come and go periodically.

These periods when symptoms get worse are known as relapses. Periods when symptoms improve or disappear are known as remissions.

Visual problems

In around one in five cases of MS, the first noticeable symptom is problems with one of your eyes. You may experience:

• some loss of vision in the affected eye – this can range from mild to severe (total loss of vision occurs in one in 35 cases)
• colour blindness 
• eye pain; usually made worse when moving the eye
• flashes of light when moving the eye

These symptoms are the result of optic neuritis, which is inflammation (swelling) of the optic nerve that transmits visual information to the brain. This normally only affects one eye.

Other visual problems that can occur in MS include:

• double vision
• eye pain in both eyes
• involuntary eye movements (usually from side to side), known as nystagmus

Abnormal sensations

Abnormal sensations can also be a common initial symptom of MS. This can take the form of numbness or tingling in different parts of your body.

Muscles in your arms and legs may also feel unusually weak.

Muscle spasms and spasticity

If messages between your brain and muscles are disrupted, this can cause problems with muscle movements. It can cause muscles to contract tightly and painfully (spasm) or your muscles may also become stiff and resistant to movement, known as spasticity.

Pain

Around half of people with MS experience pain, which can take two forms:

• Neuropathic pain – caused by damage to the nerve fibres in the brain and spinal cord. It can be a stabbing pain, extreme skin sensitivity, or a burning sensation.
• Musculoskeletal pain – this is not caused directly by MS, but can occur if there is excess pressure on muscles or joints as a result of spasms and spasticity.

Mobility problems

MS can affect balance and co-ordination. It can make walking and moving around difficult, particularly if you also have muscle weakness and spasticity. You may experience:

• ataxia – difficulty with co-ordination
• tremor – shaking of the limbs, which is rare, but can be severe
• dizziness and vertigo can happen late on and can make you feel as if your surroundings are spinning

Extreme tiredness (fatigue)

Feeling extremely tired (fatigue) is a common symptom of MS that many people describe as one of the most troublesome.

It is estimated that as many as nine out of 10 people with MS will experience episodes of fatigue.

People with MS have reported feeling an overwhelming sense of weariness where even the most simple physical or mental activity seems to be a tremendous struggle to carry out.

Fatigue may be worse in hot weather, after exercising, or during illness.

Problems with thinking, learning and planning

Around half of people with MS have problems with thinking, learning and planning (known as cognitive dysfunction). They may experience:

• problems understanding and using language
• a shortened attention span
• problems learning and remembering new things (long-term memory is usually unaffected)
• problems understanding and processing visual information, such as reading a map
• difficulty with planning and problem solving – people often report that they know what they want to do, but can’t grasp the method of how to do it
• problems with reasoning, such as mathematical laws or solving puzzles

Mental health issues

Around half of all people with MS experience at least one episode of depression at some point in their life.

It is unclear whether the depression arises from the damage to the brain caused by MS, or due to the stress of having to live with a long-term condition, or both.

Anxiety can also be a problem for people with MS, possibly due to the unpredictable nature of the condition.

Some people with MS can sometimes experience rapid and severe mood swings, suddenly bursting into tears, laughing or shouting angrily for no apparent reason.

Sexual problems

MS can have an effect on sexual function.

Men with MS often find it hard to obtain or maintain an erection (erectile dysfunction). They may also find it takes a lot longer to ejaculate when having sex or masturbating, and may even lose the ability to ejaculate altogether.

For women, problems include difficulty reaching orgasm as well as decreased vaginal lubrication and sensation.

Both men and women with MS may find they are less interested in sex than they were before. This could be directly related to the MS, or it could be the result of living with the condition.

Bladder problems

Bladder problems are common in MS.

They may include:

• difficulty emptying the bladder completely
• having to urinate more frequently
• having a sudden, urgent need to urinate which can lead to unintentionally passing urine (urge incontinence)
• having to get up frequently during the night to pass urine (nocturia)

Bowel problems

Many people with MS have problems with their bowel.

Constipation is the most common problem, affecting around half of people with MS. They may pass stools much less frequently than normal, and find this difficult.

Bowel incontinence is less common but is often linked to constipation. If a stool becomes stuck, it can irritate the wall of the bowel, causing it to produce more fluid and mucus that can leak out of the anus (back passage).

Speech and swallowing difficulties

Around a third of people with MS experience difficulty chewing or swallowing (dysphagia) at some point. In some cases, speech may also become slurred, or difficult to understand.

However, for most people with MS, speech and swallowing symptoms are mild and only last for a few minutes at a time. They are often at their worst during a relapse.

 

Treatment overview

Treatment for MS relapses

Treatment for specific MS symptoms

If you have MS, you may have several different symptoms, which can vary in severity. There are treatments that can relieve each specific symptom, although some symptoms are more easily treated than others.

Visual problems

MS-related visual problems will often improve on their own, usually within a few weeks, so you may not need any treatment. However, if your symptoms are particularly severe, you may be prescribed steroids to help speed up recovery.

If you have problems with eye movement (nystagmus), you may be prescribed medication such as gabapentin, baclofen or clonazepam.

Muscle spasms and spasticity

Muscle spasms and spasticity can be improved with physiotherapy. Stretching movements can help prevent spasticity (stiffness). You may be referred to a physiotherapist trained in MS treatment if muscle spasms and spasticity are restricting your movements.

If your muscular spasms are more severe, you may be prescribed a medicine that can relax your muscles and reduce spasms. This will usually be either baclofen or gabapentin, although there are alternative medicines, such as tizanidine, diazepam, clonazepam and dantrolene.

These medicines all have side effects, such as dizziness, weakness, nausea and diarrhoea, so discuss which would be best for you with your GP or MS specialist nurse.

Read more information about specific medications on the multiple sclerosis medicines guide.

Medicines and physiotherapy may not be enough to control muscle spasms and spasticity. If this is the case, you may be referred for specialist treatment. This may involve wearing special splints or weights on your legs, or having medication injected into the fluid surrounding your spinal cord.

Neuropathic pain

Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also occur as extreme skin sensitivity, or a burning sensation. This type of pain can be treated using the medicines gabapentin or carbamazepine, or with an antidepressant called amitriptyline.

Musculoskeletal pain

Living with MS can cause stresses and strains to the muscles and nerves in your body.

A physiotherapist may be able to help with musculoskeletal pain by suggesting exercise techniques or better seating positions.

If your pain is more severe, you may be prescribed painkillers or antidepressants (which can also help with pain). Alternatively, you may have a device that stimulates your nerve endings, known as a transcutaneous electrical nerve stimulation (TENS) machine.

Mobility problems

Mobility problems are often the result of muscle spasms and spasticity or muscle weakness. They can also be caused by problems with balance or dizziness.

The treatment you receive for your mobility problems will depend on what is causing them.

If you have mobility problems, it’s best to try to prevent muscle spasms and spasticity in the first place with physiotherapy or medication (see above). Your muscles can tighten to the point where it’s painful and difficult to move at all, which is known as a contracture.

If this occurs, you may need to do special stretching exercises with plaster casts and removable splints. You may also be prescribed injections of botulinum toxin, which can help relax your muscles.

Muscle weakness can be helped by strengthening exercises or learning to compensate for weakness by using other muscles.

There are medicines, exercises and equipment that can relieve a tremor (ataxia) or dizziness caused by MS. These are available from your neurological rehabilitation team.

Cognitive problems (difficulty with thought and memory)

If you experience cognitive problems, any treatment you receive will be fully explained and recorded so that it’s clear to you.

You should be referred to a clinical psychologist, who will assess your problems and suggest ways to manage them.

Emotional problems

If you experience emotional outbursts, such as laughing or crying for no apparent reason, you should be assessed by a healthcare professional trained in MS symptoms. This could be a clinical psychologist. They may suggest treatment with an antidepressant. If you do not want antidepressants, learning techniques to control your emotions can help.

People with MS who have depression can be treated with antidepressants. If you often feel anxious or worried, your GP or neurologist may prescribe antidepressants or benzodiazepines, which are a type of tranquilliser that have a calming effect. Clinical psychologists can help you with depression by using psychotherapy, such as cognitive behavioural therapy (CBT). If you have severe or persistent depression, you may be referred to a psychiatrist for further advice.

Fatigue and tiredness

Many people with MS experience extreme tiredness. Your GP or MS specialist nurse should assess this to see if there’s another reason for your fatigue other than MS, such as medication or poor diet.

If your fatigue is caused by MS, you may be prescribed medication called amantadine, although it may only have a limited effect. You should also be given general advice on ways to manage fatigue, such as exercise and energy-saving techniques.

Bladder problems

If you have an overactive bladder, you may be prescribed an anti-cholinergic medicine, such as oxybutynin or tolterodine. This will help make the need to pass urine more predictable. If these medicines do not work, you may be prescribed a newer medicine called mirabegron. The need to pass urine frequently at night can be treated with a medicine called desmopressin.

If you have an underactive bladder that is not emptying properly, you may need to be fitted with a catheter. This is a small tube inserted into your urinary opening that drains away any excess urine.

You may be referred to a continence adviser or urologist, who can offer specialist treatment and advice, such as botulinim toxin, bladder exercises or electrical treatment for your bladder muscles.

Bowel problems

It may be possible to treat mild to moderate constipation by changing your diet or taking laxatives.

More severe constipation may need to be treated with suppositories, which are inserted into your bottom, or an enema. An enema involves having a liquid medication rinsed through your bottom and large bowel, which softens and flushes out your stools.

Bowel incontinence can be treated with anti-diarrhoea medication or by doing pelvic floor exercises to strengthen your rectal muscles.

Disease-modifying medicines

MS cannot be cured, but if you have relapsing remitting MS there are treatments that can reduce the number and severity of relapses. These treatments may also help slow the progression of MS, although research into their long-term effects is limited.

There are a number of different medicines available, depending on criteria such as the number of relapses you have had.

Disease-modifying medicines reduce the amount of damage and scarring to the myelin in your central nervous system, which cause MS relapses.

Disease-modifying medicines are not suitable for everyone with MS. They are only prescribed to patients with relapsing remitting MS (RRMS) and secondary progressive MS (SPMS) who meet certain criteria.

Want to know more?

• Multiple Sclerosis Society: Disease-modifying drugs
• Multiple Sclerosis Trust: Disease-modifying drug therapy (PDF, 696kb)
• MS Decisions

Interferon beta

The types of interferon beta licensed for use in the UK are interferon beta-1a (Avonex and Rebif) and interferon beta-1b (Betaferon and Extavia). All four brands of interferon beta are given by injection.

You may be offered treatment with one of the interferon betas if you have had at least two relapses in the past two years. They can also be prescribed to people with secondary progressive MS who are still having relapses, as long as those relapses are the main cause of their increasing disability.

All interferons can cause mild side effects, such as flu-like symptoms (headaches, chills and mild fever) for 48 hours after they are injected. Interferon beta is not suitable for people under the age of 18 or women who are pregnant or breastfeeding. Both women and men are advised to stop using it at least three months before trying for a baby. If you find out that you’re pregnant while taking interferon beta, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

Glatiramer acetate

One brand of glatiramer acetate, called Copaxone, is licensed for use in the UK. Glatiramer acetate is injected under the skin every day. It does not usually cause any noticeable side effects, although in rare cases it may cause tightness in your chest. Glatiramer acetate is only licensed for use by people with relapsing remitting MS (RRMS).

You may be offered treatment with glatiramer acetate if you have had at least two relapses in the past two years.

Like interferon beta, glatiramer acetate is not suitable for people under the age of 18, or women who are pregnant or breastfeeding. Both women and men are advised to stop using it at least three months before trying for a baby. If you find out that you’re pregnant while taking glatiramer acetate, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

Teriflunomide

Teriflunomide, branded as Aubagio, is an oral tablet taken once a day. It is generally well tolerated, although some people may have side effects including liver problems, nausea, headaches, diarrhoea, and hair thinning or loss.

You may be offered treatment with teriflunomide if you have had at least two relapses in the past two years.

Teriflunomide is not suitable for people with severe liver problems, people under the age of 18 or women who are pregnant or breastfeeding. Both women and men are advised to stop using it at least three months before trying for a baby. If you find out that you’re pregnant while taking teriflunomide, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

Natalizumab

Natalizumab, branded as Tysabri, is injected into a vein (intravenously) once every 28 days. It can cause several side effects, including headaches, nausea and vomiting, and an itchy rash. In rare cases, natalizumab has been linked to an increased risk of progressive multifocal leukoencephalopathy (PML). PML is a rare but serious condition that breaks down myelin on nerve fibres, in a similar way to MS. It can cause problems with vision and speech and, eventually, paralysis.

You may be offered treatment with natalizumab if you have had either:

• an increase in the severity or number of relapses, despite treatment with one of the interferon betas or glatiramer acetate
• two or more relapses in one year and an increase in lesions, shown on an MRI scan

Natalizumab is not suitable for people under the age of 18 or over the age of 65, people with cancer, or people with a weakened immune system, such as those who are HIV positive.

Fingolimod

Fingolimod, branded as Gilenya, is an oral tablet taken once a day. It is generally well-tolerated, although some people may experience side effects including an increased risk of infections, a problem with vision known as macular oedema, and liver problems. When you take the first dose of fingolimod, it can cause your heart rate to slow down or become irregular. Because of this you would take the first dose in hospital so you can be monitored.

You may be offered fingolimod if you are still having relapses despite treatment with one of the interferon betas.

Fingolimod is not suitable for people with certain heart problems, people under the age of 18 or women who are pregnant or breastfeeding. Both women and men are advised to stop using it at least three months before trying for a baby. If you find out that you’re pregnant while taking fingolimod, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

Want to know more?

• Multiple Sclerosis Society: Beta interferon and glatiramer acetate
• Multiple Sclerosis Society: Natalizumab 
• Association of British Neurologists’ guidelines for prescribing in multiple sclerosis (PDF, 123kb)
• NICE: Natalizumab for the treatment of adults with highly active relapsing-remitting multiple sclerosis (PDF, 168kb)
• NICE: Teriflunomide for relapsing remitting multiple sclerosis (PDF, 263kb)
• NICE: fingolimod for the treatment of highly active relapsing-remitting multiple sclerosis (PDF, 323kb)

Clinical trials

Complementary and alternative therapies for MS

Diet to modify MS