Multiple sclerosis (MS): symptoms, diagnosis, types and treatment

The NHS says there are lots of possible symptoms and that everyone with MS is affected differently. NHS inform describes them as unpredictable: some people's symptoms develop and worsen over time, while for others they come and go. Periods when symptoms get worse are called relapses, and periods when they improve or disappear are remissions.

These symptoms are common and can be caused by many other conditions, so having them does not definitely mean you have MS, but the NHS says it is important to get them checked.

NHS inform says that in around 1 in 4 cases the first noticeable symptom is a problem with one eye (optic neuritis), which can cause temporary loss of vision lasting days to weeks, colour blindness, and eye pain that is worse when moving the eye.

• Extreme tiredness (fatigue), which NHS inform says tends to get worse towards the end of the day, in hot weather, after exercise and during illness.

• Eye or vision problems, such as blurred vision or eye pain.

• Numbness or tingling in different parts of the body.

• Feeling off balance, dizzy or clumsy.

• Muscle cramps, spasms, stiffness and weakness.

• Needing to pee more often or not being able to control when you pee; constipation is the most common bowel problem (NHS inform).

• Problems with memory, concentration, learning and planning.

• Sexual problems, including a dry vagina or erection problems.

• Pain, and low mood or anxiety (NHS inform).

It can be hard to tell if you have MS because some of the symptoms are like those of other conditions, and NHS inform says other possible causes may need to be ruled out first. If your GP thinks you could have MS, they will refer you to a neurologist, a brain and nerve specialist.

The NHS says there is no single test to diagnose MS. At the appointment the neurologist will ask about your symptoms and may arrange the tests below. The neurologist may need to monitor your symptoms and test results for some time before they can diagnose which type you have, and NHS inform says it can take a few years to make an accurate diagnosis of progressive MS because the condition usually worsens slowly.

MS is a lifelong condition that affects the brain and spinal cord and can cause symptoms such as problems with vision, arm or leg movement, sensation or balance, according to NHS inform. It can sometimes cause serious disability, but in many cases it is possible to treat symptoms.

NHS inform explains that MS is an autoimmune condition in which the immune system attacks the myelin sheath, the layer that surrounds nerves and helps electrical signals travel from the brain to the rest of the body. The attacks cause patches of inflammation (plaques or lesions) that disrupt messages travelling along the nerves, which leads to the symptoms. When the inflammation goes away it can leave scarring (sclerosis), and frequent and repeated attacks can lead to permanent damage.

The NHS describes 3 main types of MS. They affect everyone differently. NHS inform notes that once you have a diagnosis your neurologist may be able to identify the type based on the pattern of your symptoms and the results of an MRI scan.

The NHS says there is currently no cure for MS, but there are treatments that can slow the progression of MS and help ease symptoms. The type of treatment depends on the type of MS and your symptoms, and you will probably need different treatments over time. You will be supported by different healthcare professionals, which may include a specialist MS nurse, a neurologist, a physiotherapist and an occupational therapist.

NHS inform explains disease-modifying therapies: medicines that can help reduce the number and severity of relapses in some people, reduce damage and scarring to the myelin sheath and might help slow worsening disability. They are not suitable for everyone with MS and are only prescribed to those with relapsing remitting MS, secondary progressive MS who meet certain criteria, or primary progressive MS who meet certain criteria such as new lesions found on MRI.

The NHS also lists steroid medicine to reduce swelling and help nerves work better, muscle relaxants for spasms, cramps or stiffness, medicines for pain, vision problems and other symptoms, medicine to improve walking, and biological medicines if disease-modifying therapies have not worked.

NHS inform says to contact your specialist MS nurse or GP practice if you think you are having a relapse. Sometimes an infection can cause a flare-up of symptoms rather than a relapse, so the nurse or GP will check for other possible causes.

Treatment for a relapse might involve a five-day course of steroid tablets taken at home. NHS inform says steroids can speed up your recovery from a relapse but do not prevent further relapses or stop MS getting worse over time, and are given for a short period to avoid side effects, which could include infection, mood disturbance, stomach ulceration, osteoporosis, weight gain and diabetes.

You will also be offered treatment and support for the symptoms of MS, and every person's needs will be different. The NHS and NHS inform describe the following.

• Fatigue: advice on exercise, healthy sleep patterns and energy-saving techniques; fatigue management courses or CBT may help (NHS inform).

• Vision problems: NHS inform says MS-related visual problems often improve on their own, usually within a few weeks, and severe symptoms may be treated with steroids.

• Muscle spasms and stiffness: physiotherapy, and medicines such as baclofen, gabapentin or tizanidine if severe.

• Mobility problems: an exercise programme supervised by a physiotherapist, mobility aids and home adaptations assessed by an occupational therapist.

• Pain: painkillers, TENS, or neuropathic painkillers for nerve pain.

• Bladder and bowel problems: medication, advice from a continence nurse or physiotherapist, and treatment of constipation.

• Low mood and anxiety: antidepressants or therapy such as CBT.

• Thinking and memory: cognitive rehabilitation activities to improve memory, concentration and thinking (NHS).

• Sexual problems: advice and treatments, such as for erectile dysfunction or vaginal dryness.

The NHS says it is not clear what causes MS. NHS inform says it is not caused by anything you have done and it is not clear whether you can prevent it. It is likely to be partly caused by genes you inherit and partly by outside factors that may trigger the condition.

The NHS lists things that make you more likely to get MS: being aged 20 to 50, being a woman, having a brother, sister or parent with MS, smoking (people who smoke are about twice as likely to develop MS) and having had the Epstein-Barr virus, which causes glandular fever. NHS inform adds that MS is more common in countries far from the equator, which may mean a lack of sunlight and low vitamin D levels play a role, though it is not clear whether vitamin D supplements can help prevent it, and that the chance of a sibling or child of someone with MS also developing it is around 2 to 3%.

None of these factors means a person will definitely develop MS. NHS inform says MS is not directly inherited.

The NHS says MS is different for everyone and that no one can predict how much it will affect you. For some people MS only has a small impact on daily life, which means they can continue with work and usual activities; others have more severe symptoms. Symptoms can affect mobility, and you may need to adapt your life by using mobility aids, reducing working hours or needing more help around the home.

The NHS adds that MS treatments are improving, so if you are diagnosed today you can expect a better quality of life than was possible before. Most people with MS live into old age, although life expectancy, on average, is a few years less than the general population.

MS can be a difficult condition to live with, both physically and emotionally. As well as support from your doctor and MS nurse, the NHS says you may find it helpful to get support from other people with MS, either at a local support group or online, and points to the MS Society, MS Trust and MS-UK.

The NHS says to see a GP if you think you have symptoms of MS. It says to call 999 or go to A&E if you have sudden weakness or numbness in 1 arm, loss or blurring of vision, or problems with balance and co-ordination, because these could be signs of a stroke and need urgent medical attention. Do not drive to A&E; ask someone to drive you or call 999.

If you already have MS and think you are having a relapse, contact your MS nurse or GP practice.

On the NHS, a GP refers you to a neurologist, and ongoing care is coordinated by an MS team that can include a specialist nurse, physiotherapist and occupational therapist. Disease-modifying therapies are prescribed by specialist teams to people who meet the criteria described by NHS inform. NICE guideline NG220 covers diagnosing and managing MS in adults, including symptom management, comprehensive review, managing relapses and disease-modifying therapies.

A private neurology appointment can speed up assessment and MRI, but long-term treatment and follow-up are usually arranged through a specialist MS service. Whichever route you use, ask who will coordinate your care and how to contact the MS team in a relapse.