What You Need To Know About Multiple Sclerosis

What is MS?

Multiple sclerosis is a disease in which the body’s own immune system decides to attack the central nervous system (CNS), made up of the brain, spinal cord and optic nerves. The immune system causes inflammation that damages myelin – the fatty substance that surrounds and insulates the nerve fibers – and the specialised cells that make myelin, as well as the nerve fibers themselves. Without myelin, crucial signals between the brain and the body become slowed or disrupted.

MS starts in one of two ways: with individual relapses or with gradual progression. The most common type is ‘relapsing remitting’ MS (affecting over eight out of ten people diagnosed with the condition), which causes episodes of new or worsening symptoms known as ‘relapses’. These typically worsen over a few days, last for anything from days to weeks to months, and then slowly improve over a similar time period. Relapses often occur without warning but are sometimes associated with a period of illness or stress.

After many years (usually decades), many (but not all) people with relapsing remitting MS go on to develop ‘secondary progressive’ MS. With this type, symptoms gradually worsen over time without obvious attacks, but some people continue to have infrequent relapses during this stage. Around half of people with relapsing remitting MS will develop secondary progressive MS within 15-20 years, and the risk of this happening increases the longer you have the condition.

Just over one in ten people with the condition have ‘primary progressive’ MS, where symptoms gradually worsen and accumulate over several years, and there are no periods of remission – though people often have periods where their condition appears to stabilise.

What are the symptoms?

The symptoms of MS vary widely from person to person and can affect any part of the body. According to the Multiple Sclerosis Trust, the most common symptoms are fatigue, stumbling, unusual feelings in the skin such as numbness or tingling, slowed thinking and vision problems.

The NHS also lists symptoms including:

• Muscle spasms, stiffness and weakness
• Difficulty walking
• Problems with balance and co-ordination
• Problems with thinking, learning and planning
• Depression and anxiety
• Speech and swallowing difficulties
• Bladder and bowel problems

Most people with MS only have a few of these symptoms.

How is it diagnosed?

MS is difficult to diagnose, as doctors have to rule out other health conditions first and numerous tests are needed – there is no single test that can diagnose it. The MS Trust also says it is “sometimes a question of watching and waiting to see how your symptoms develop, as this can help distinguish MS from other conditions”.

If your GP thinks you could have MS, you'll be referred to a neurologist (a specialist in conditions of the nervous system), who will check for abnormalities, changes or weakness in your vision, eye movements, hand or leg strength, balance and co-ordination, speech and reflexes. They may then suggest further tests such as a magnetic resonance imaging (MRI) scan to check for features of MS.

How is it treated?

There's currently no cure for MS, but a number of treatments can help control the condition – new treatments over the past 20 years have considerably improved peope's quality of life. The treatment needed depends on each patient’s specific symptoms and difficulties, and may include treating relapses with short courses of steroid medication to speed up recovery, or tackling individual symptoms with specialised treatments – for example, people with fatigue may be prescribed amantadine (a drug typically given to ease symptoms of Parkinson’s disease), while muscle spasms can be treated with physiotherapy.

Disease-modifying therapies can also help to slow or reduce the overall worsening of disability in people with relapsing remitting MS, and in people with secondary progressive MS who are still having relapses. MS itself is rarely fatal, but the average life expectancy for people with MS is around five to ten years lower than average – although this gap appears to be getting smaller all the time.

What causes MS?

Exactly what causes the immune system to act in this way is unclear, but most experts think a combination of genetic and environmental factors is involved. Research has found that having a family member with MS raises the risk of developing it – and in some rare cases, MS can be caused by a single genetic mutation, however not everyone with the mutation develops MS. In these cases, scientists believe something else – like a virus, a lack of vitamin D or smoking – sets the disease in motion.

The incidence of MS is higher in North America, southern Australia, and northern Europe, suggesting that the farther you live from the equator, the greater your risk of developing multiple sclerosis. Researchers think this link is due to sun exposure or, more specifically, vitamin D levels in the body. Vitamin D is known as the ‘sunshine vitamin’ because the human body generates it in response to sunlight – and studies show adequate vitamin D levels may play a role in protecting against MS.

As for other possible causes, suffering from concussion between the ages of 11 and 20 is associated with a higher risk of MS, and individuals who have had more than one concussion are at an even higher risk. A new study has also found a link between MS and exposure to sheep, as they can pass on a particular toxin with links to the disease.

Is it preventable?

Though scientists haven't yet figured out a way to prevent multiple sclerosis, there are some things you can do to reduce the risk:

Stop smoking: Growing evidence suggests that smoking not only increases the risk of developing MS but it also increases the severity and hastens the progression of the disease. Given its many health benefits, quitting smoking should be the first step for anyone wanting to prevent disease.
Add vitamin D to your diet: Many doctors believe vitamin D is the biggest diet-related factor in the possible prevention of MS. It’s naturally present in fatty fish, egg yolks, cheese and beef liver, and is added to milk, juices and cereal products.
Drink more coffee: A 2016 study published in the Journal of Neurology, Neurosurgery and Psychiatry found that a high consumption of coffee is associated with a lower risk of developing MS.
Have a glass of red wine: Resveratrol, a compound in red wine, could help reduce the chance of MS due to its anti-inflammatory effects on the brain. Moderate alcohol consumption has also been linked to a lower risk of developing MS.
Try intermittent fasting: The 5:2 diet – in which fewer calories than normal are consumed for several days per week – may be effective at reducing disease severity in MS, although whether such a diet could help prevent MS in those who are genetically susceptible is currently unknown.
Have a healthy BMI: Being overweight (having a body mass index of more than 25) significantly increases your chances of developing MS. One study found people with higher BMI levels had increased levels of the hormone leptin, which regulates weight, appetite and immune response – but leptin also promotes inflammatory responses in the body, which could explain the link between obesity and MS.
 
For more information or advice, visit MS Society and MS Trust