Multiple sclerosis
Multiple sclerosis, or MS, is a disease in which the immune system attacks the body's own nerve tissue.
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Medicines commonly prescribed for Multiple sclerosis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CAPSULE, 120 mgActive substance: dimethyl fumarateManufacturer: Reddy Pharma Iberia S.A.Prescription requiredDosage form: CAPSULE, 240 mgActive substance: dimethyl fumarateManufacturer: Aurovitas Spain, S.A.U.Prescription requiredDosage form: CAPSULE, 240 mgActive substance: dimethyl fumarateManufacturer: Glenmark Arzneimittel GmbhPrescription required
Multiple sclerosis, or MS, is a disease in which the immune system attacks the body's own nerve tissue. The target is myelin, the fatty sheath around nerve fibres that works like the insulation on a wire: while it is intact the signal travels fast and true, and where it has been destroyed the signal slows, garbles or fails to arrive at all. That is where the odd assortment of complaints comes from, complaints that at first glance have nothing to do with one another: one day the vision in one eye clouds over, another day a leg goes numb, another day the balance gives way. The name has nothing to do with memory or old age: "multiple" here means scattered across different places in the brain and spinal cord. The illness usually begins between the ages of twenty and forty, and it affects women two to three times more often. It cannot yet be cured, but over thirty years it has gone from a sentence to a condition whose course can be slowed appreciably, and the earlier treatment starts, the more it achieves.
How it usually begins
The first sign is usually a single thing rather than a bouquet. The best known is inflammation of the optic nerve: over hours or days the vision in one eye clouds as though seen through a misted pane, colours wash out, red above all, and moving the eye hurts. The second common opening is numbness or pins and needles climbing up a leg and taking in half the trunk like a belt; the third is weakness in an arm or a leg; the fourth is double vision and dizziness with unsteadiness.
Then come the things people are reluctant to mention: a sudden urgent need to pass urine and leaking, constipation, trouble with erections and vaginal dryness, difficulty reaching orgasm. Fatigue deserves its own place — not ordinary tiredness but the sort that means sitting down after a shower. It is one of the commonest complaints in MS and one of the most underrated.
Two signs are worth knowing because they are fairly characteristic. A jolt like an electric shock running down the spine when the head is bent forward. And the worsening of every symptom in heat, in a hot bath or with a fever, which passes on cooling down and is not a new relapse.
A relapse and what imitates it
A relapse means new or clearly worsened neurological symptoms lasting more than twenty-four hours and arising without a fever or an infection behind them. They do not appear instantly but over hours and days, hold steady for some weeks and then recede, fully or partly.
Far more often than a true relapse comes its double. A urine infection, a cold with a temperature, a hot day, a sauna, a run of bad nights, serious stress — and old symptoms that had faded return briefly at full strength. This is not fresh damage to a nerve: damaged fibres simply conduct worse when the body warms up. The distinction matters because the response differs. A true relapse sometimes calls for steroids, whereas the double clears by itself once the temperature comes down, the infection is treated or the person cools off. So the first moves after a sudden worsening are to take the temperature and test the urine.
How the diagnosis is reached
The diagnosis is made by a neurologist, and it rests not on one test but on a pattern: where the areas of damage are and when they appeared. The main tool is an MRI scan of the brain and spinal cord, usually with contrast. It shows the lesions themselves, and the contrast tells recent ones from old, which often makes it possible to prove the disease is not in its first month even when there is only one complaint.
A lumbar puncture — taking a small amount of spinal fluid from the lower back with a needle — looks for particular protein bands, a sign of inflammation inside the nervous system. Evoked potentials measure how fast a signal travels from the eye or the ear to the brain and pick up slowing where the person notices nothing. Blood tests are there for something else: to rule out the conditions that impersonate MS — vitamin B12 deficiency, thyroid disorders, borreliosis, systemic diseases, and also the related conditions with antibodies against aquaporin, where the treatment is quite different.
It is worth knowing what not to expect of the tests, too. A CT scan does not see MS lesions, and a normal one rules nothing out. There is no single blood test "for multiple sclerosis". And the other way round: a few bright spots on a scan done for headaches are not in themselves a diagnosis, because similar findings turn up in migraine and simply with age. Only a neurologist, who sees the whole picture, can make sense of that.
The three patterns of the illness
In most people the illness begins as relapsing-remitting: attacks alternate with periods when symptoms go away or ease off markedly, and in between life goes on as usual. In time, some move into a secondary progressive form: clear-cut attacks become rare, but disability accumulates quietly of its own accord. Less commonly, in roughly one person in ten, the disease is progressive from the outset, with no relapses and no remissions, advancing slowly and most often starting with weakness in the legs.
Naming the pattern straight away is not always possible: sometimes a neurologist needs a year or two of watching symptoms and repeating scans. That is not procrastination but necessity, because the choice of treatment follows from the pattern.
What treatment consists of
Treatment is three different things and they are worth keeping apart. The first is the drugs that modify the course of the disease. They do not repair what is already damaged, but they cut the number of relapses and the appearance of new lesions and so postpone the build-up of lasting disability. There are many of them, differing in strength, route and risks: tablets, injections under the skin, infusions every few months. The choice is made with the neurologist, weighing how active the disease is, age, plans for pregnancy and other illnesses, and here time works against waiting.
The second is treating the relapse itself. A short course of high-dose steroids speeds recovery from a severe relapse, but does not change the later course of the disease, which is why it is not given for every worsening. A mild relapse often settles on its own.
The third, and in daily life perhaps the most important, is work on the symptoms. There are drugs that ease muscle spasticity, treatments for the bladder and bowel, medicines for burning nerve pain, help for depression and anxiety, and approaches to fatigue. Rehabilitation counts for just as much: exercise therapy and physiotherapy for weakness and walking problems, occupational therapy, speech and language therapy when speech or swallowing falter, training for attention and memory, and where needed a stick, a splint or a wheelchair, which are not a sign of defeat but a way to keep independence and stay upright.
What is in a person's own hands
Not everything in this illness is decided by medication. Smoking is the best-proven of the things that can be changed: in smokers MS both begins more often and progresses faster, and stopping shifts the outlook at any stage. Vitamin D is worth measuring and, if it is low, topping up at a dose agreed with a doctor.
Exercise used to be thought harmful in MS; that advice is out of date. Regular activity within one's capacity improves strength, balance and mood and, counter-intuitively, reduces fatigue specifically. In hot weather it pays to keep cool: a cool shower, water, air conditioning, light clothing — that is how the symptoms that flare with heat are kept in check.
Urine infections are treated promptly rather than left to run, because they are a frequent cause of false worsenings. Vaccination against flu and other infections is needed, but some disease-modifying drugs place restrictions on live vaccines, so the schedule is agreed with the neurologist. Pregnancy is entirely possible and on the whole rather favourable for the course of the illness, though some of the medicines are incompatible with conception and breastfeeding: it needs planning in advance and together with the doctor, not announcing after the fact.
When waiting is not an option
An ambulance is called on the single European emergency number 112 if symptoms have come on suddenly, within minutes: the face droops, an arm falls, speech goes, vision blacks out. That kind of onset is not typical of multiple sclerosis, whose symptoms unfold over hours and days, but it is typical of a stroke, and there is no time to spend working it out. Having MS is no protection against stroke or anything else.
The same day, though without an ambulance, contact a doctor if:
- passing urine has become impossible although the bladder is full — that is retention and it needs attention today;
- a fever has appeared alongside the worsening of familiar symptoms: the infection is looked for first;
- swallowing has become difficult, or food and water go down the wrong way;
- both legs have weakened abruptly, bowel control has gone, or the area between the legs has become numb;
- eye pain and loss of vision are increasing rather than levelling off;
- thoughts that life is not worth living have appeared: depression is common in MS and can be treated.
Online consultation
A remote appointment is useful at every stage of multiple sclerosis, though in different ways. Before diagnosis it helps to work out whether the complaints fit a picture that needs a neurologist, and which investigations to arrive with, so that months are not lost on random tests. After diagnosis it is the way to raise the things it feels awkward to spend a scarce specialist appointment on: how to tell a relapse from a hot day, what to do about fatigue, how to help the bladder, whether new cold remedies sit well with the treatment, whether flying is all right, what to say at work.
Plans for pregnancy and vaccination are a subject of their own: both are settled in advance and calmly rather than at the last minute. The appointment is useful for family too, who need to understand what is happening and how to help without turning help into supervision.
The limits are worth naming honestly. Testing reflexes, coordination and strength by hand cannot be done through a screen, the diagnosis is not made online, and disease-modifying drugs are started and changed by the neurologist alone. And with sudden weakness, a drooping face and loss of speech, with retention of urine or with choking, what is needed is an ambulance rather than an appointment.
This material is for information only and does not replace medical advice.
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