Multiple Sclerosis (MS)

Multiple sclerosis, usually shortened to MS, is a condition that affects the brain and spinal cord — together known as the central nervous system.

In MS, the immune system, which normally protects the body from infection, mistakenly attacks the protective covering around the nerves. This covering is called myelin. When myelin is damaged, the messages travelling between the brain and the rest of the body can be slowed, disrupted or blocked altogether. That is why MS can cause such a wide range of symptoms, from problems with vision to numbness, weakness or fatigue.

MS is not infectious. It cannot be caught from another person and cannot be passed on to anyone else.

Symptoms and their severity vary enormously from one person to another. Not everyone experiences the same problems, and many people have long periods with few or no troublesome symptoms. Some people find MS has little effect on daily life for many years; others need more support. MS is often described as unpredictable, which is one of the hardest parts of living with it.

MS symptoms may come and go, change over time, or affect different parts of the body at different times. Someone may have several of the symptoms below, or only one or two.

• Extreme tiredness or fatigue — an overwhelming exhaustion that is not relieved by rest, and one of the most common MS symptoms.
• Blurred or double vision, or a loss of clarity in one eye.
• Pain in or behind an eye, often worse when moving the eye.
• Numbness, tingling or altered sensations — pins and needles, burning, or skin that feels strange to the touch.
• Muscle weakness, stiffness or spasms, sometimes with painful cramping.
• Problems with balance, coordination or walking, including unsteadiness or dragging a foot.
• Tremor — shaking of a hand, arm or the head.
• Dizziness or a sense that the room is spinning.
• Bladder or bowel problems — urgency, needing the toilet often, difficulty emptying the bladder, or constipation.
• Pain — either nerve pain or musculoskeletal pain from changes in movement and posture.
• Difficulties with memory, concentration or processing information — sometimes described as “brain fog”.
• Changes in mood, including depression, anxiety or emotional ups and downs.
• Speech or swallowing difficulties — slurred or slower speech, or coughing while eating and drinking.

These symptoms can have many different causes and do not automatically mean someone has MS. Tiredness, tingling and blurred vision are all common and are far more often caused by something else. Even so, persistent or unexplained symptoms are always worth having checked by a GP.

MS does not follow one single course. Doctors describe several broad patterns, and the way MS behaves can change over a person’s lifetime.

Relapsing remitting MS

The most common pattern at diagnosis. There are periods of new or worsening symptoms, known as relapses or flare-ups, followed by periods of partial or complete recovery (remission). Between relapses, symptoms may settle a great deal or disappear entirely.

Secondary progressive MS

Some people who have had a relapsing-remitting pattern later find that disability gradually increases over time, with fewer or no clear relapses. This is called secondary progressive MS. It does not happen to everyone, and modern treatments have changed the picture for many people.

Primary progressive MS

A smaller number of people find that symptoms and disability gradually increase from the beginning, usually without distinct relapses and remissions.

No two people follow exactly the same course. Being given one of these labels does not predict how any individual will get on, and a neurologist will review the picture over time.

There is no single simple test that confirms MS. A diagnosis is made by a neurologist who puts together several different pieces of information.

A neurologist may use:

• A discussion of symptoms and medical history — including symptoms that happened months or years ago and settled again.
• A neurological examination — checking eye movements, balance, coordination, strength, reflexes and sensation.
• MRI scans of the brain and sometimes the spinal cord, to look for areas of damage to myelin.
• Blood tests to rule out other conditions that can cause similar symptoms.
• A lumbar puncture in some cases — a sample of fluid taken from the lower back and examined for signs of immune activity.
• Tests measuring how quickly messages travel along nerves, known as evoked potential tests.

Diagnosis can take time. Many other conditions cause similar symptoms, and a neurologist may need to see how things change before reaching a conclusion. That waiting period can be stressful, and it is reasonable to ask the team what happens next and who to contact meanwhile. Our GP Services page explains how appointments and referrals usually work.

There is currently no cure for MS. However, treatment and support can manage symptoms, reduce relapses for some people, and help people stay independent and well. Care is usually shared between a neurologist, an MS nurse, a GP and a range of therapists.

• Disease-modifying treatments — for suitable people, these can reduce how often relapses happen and how severe they are. A neurologist decides whether they are appropriate and which one to use.
• Steroids for some relapses — a short course may be offered to help symptoms settle more quickly during a significant relapse.
• Medicines for individual symptoms — for example for muscle spasms, nerve pain, bladder problems or fatigue.
• Physiotherapy — for movement, strength, walking, balance, stiffness and reducing the risk of falls.
• Occupational therapy — practical advice, equipment and adaptations so that washing, dressing, cooking, working and hobbies stay manageable.
• Speech and language therapy — support for changes in speech and for swallowing difficulties.
• Support with bladder, bowel or swallowing problems — specialist continence and dietetic services can help a great deal, and these problems are very treatable.
• Pain and fatigue management — including pacing, energy-saving techniques and specialist pain services.
• Mental-health support — depression and anxiety are common alongside MS and are treatable. Talking therapies are available on the NHS.
• MS nurses and specialist neurology teams — a valuable first point of contact for questions, changes in symptoms and treatment reviews.
• Rehabilitation and suitable physical activity — regular activity, at a level that suits the individual, helps with strength, mood, fatigue and confidence.

Treatment decisions are always made with the specialist team. This page does not give doses, and no one should start, stop or change medication on their own.

You may also find our Physical Activity and Mental Health pages useful alongside this one.

An MS relapse normally means new symptoms, or a clear worsening of existing symptoms, that lasts more than 24 hours and has no other explanation — such as an infection or a rise in body temperature.

It is very common for existing MS symptoms to feel temporarily worse without this being a new relapse. Things that can cause that include:

• Heat — hot weather, a hot bath or shower, or getting overheated during exercise.
• Tiredness and lack of sleep.
• Stress or emotional strain.
• An infection, such as a chest infection or a urinary tract infection.

When the cause is dealt with — cooling down, resting or treating the infection — symptoms usually go back to how they were before.

Telling the difference is not always straightforward, and it is not something to work out alone.

Small practical steps can make everyday life easier:

• Plan rest around demanding activities. Pacing — spreading tiring tasks across the day or week and building in breaks before you are exhausted — is one of the most effective ways to manage MS fatigue.
• Keep physically active within your own abilities. Activity helps strength, balance, mood and fatigue. A physiotherapist can suggest what is safe and realistic for you.
• Reduce fall and trip risks at home — clear clutter, secure loose rugs and trailing cables, improve lighting on stairs and landings, and consider grab rails.
• Ask for physiotherapy or occupational-therapy advice early rather than waiting for a crisis. A GP or the MS team can refer you.
• Keep an up-to-date medication list with names, strengths and times. Carry a copy and take it to every appointment or hospital admission.
• Seek help with bladder, bowel, pain, fatigue or mood symptoms. These are common, they are not something to simply put up with, and there is a great deal that can be done about them.
• Ask about workplace adjustments. MS is generally treated as a disability under the Equality Act 2010, so employers are expected to consider reasonable adjustments such as flexible hours, rest breaks, home working or changes to duties.
• Check your driving responsibilities. You must tell the DVLA (or DVA in Northern Ireland) if you are diagnosed with MS and it may affect your driving — see GOV.UK — Multiple sclerosis and driving. Many people continue to drive, sometimes with adaptations.
• Support for partners, relatives and carers matters too. Carers can ask their local council for a carer’s assessment, and both the MS Society and the MS Trust offer information and helplines for families as well as for the person with MS.

If someone is coming out of hospital, our Care After Hospital page explains what support should be arranged. Our Find Local Services page can help you locate a GP, pharmacy or other local service, and our Benefits & Pensions page covers financial support that may be available.

• NHS — Multiple sclerosis
• MS Society — What is MS?
• MS Society — MS in the UK statistics
• MS Trust
• NICE guideline NG220 — Multiple sclerosis in adults: management

Important notice: Sixpence Support UK provides general information only. This page is not a diagnosis, medical advice, or a replacement for assessment and treatment by a qualified healthcare professional. Always speak to a GP, an MS nurse, a pharmacist or another qualified health provider about your own symptoms, medicines and circumstances. In an emergency, call 999.