Multiple Sclerosis (MS) is a disease affecting the Central Nervous System (CNS), which includes the brain and spinal cord. In this disease, the immune system attacks the CNS. The symptoms and severity of the disease vary from person to person. Still, with appropriate treatment and management, a good quality of life can be maintained in most cases.¹

Understanding multiple sclerosis

Multiple Sclerosis (MS) is a chronic autoimmune disease where your body's immune system mistakenly targets your nervous system, leading to a range of neurological symptoms impacting the quality of life of those with MS.¹

MS is less frequent in people assigned male at birth (AMAB) than in those assigned female at birth (AFAB). It may lower one's life expectancy. However, modern medicines can limit the disease progression or its symptoms.¹

Characteristics of multiple sclerosis

Currently, the underlying cause of MS is unknown.¹ Research has shown that several genetic and environmental factors can increase the risks of developing MS.^1,2 

Based on the onset of the symptoms and how they present over time, MS is classified into four clinical types:¹

• Relapsing/ remitting MS (RRMS)
• Progressive relapsing MS (PRMS)
• Secondary progressive MS (SPMS)
• Primary progressive MS (PPMS)

RRMS is the most common, making up around 85-90% of cases.¹ In brief, those affected by RRMS experience short-term periods of functional decline (relapses) followed by a partial or complete return to normal function (remission). In between the relapses, there is often no evident decline in function.

In the remaining types (PRMS, SPMS, PPMS), there is ongoing damage to the nervous system throughout the disease.¹

What happens in multiple sclerosis?

Your nervous system is encased in a layer of a fatty substance called myelin. In MS, the immune system attacks the myelin layer (sheath) surrounding the nerves, degrading it until the nerves no longer work properly. This process is demyelination.

Figure 1. A nerve cell: the building blocks of the nervous system. Arnold Reinhold. Wikimedia Commons [Internet]. Available from: Wikimedia Commons

The regions of the nerves that become scarred or without myelin sheath are called plaques. This scarring of the sheath is called sclerosis and is the signature characteristic of MS that can be identified using magnetic resonance imaging (MRI) techniques.³ 

These plaques lead to neurological symptoms that are variable and present in ranging levels of severity.³

Impact of sclerosis on the nervous system

The central nervous system comprises the brain and spinal cord.⁴ Whereas the peripheral nervous system, made of nerves branching from the spinal cord, connects with the rest of the body.

The brain controls the various parts of the body by communicating between these two systems with electrical impulses.⁴ As mentioned above, a myelin layer:⁴ 

• Protects the central nervous system from damage
• Helps the system transmit signals correctly and efficiently to and from the brain. 

Attacks by the immune system cause inflammation of the nerves and prevent the protective myelin layer from insulating them. This makes it harder for the nerves to correctly and efficiently transmit their electrical signals. Over time the scarring makes the nerve cells more damaged and liable to die.⁴

This prevents the brain from communicating properly with the rest of the body via the nervous system.⁴ This therefore leads to the neurological symptoms that those affected by MS experience.

Common symptoms and challenges faced by MS patients

Common symptoms include:⁵

• Problems with thinking, learning and planning
• Difficulty walking
• Difficulty controlling the bladder
• Tiredness
• Muscle stiffness and spasms
• Vision problems
• Numbness or tingling in different parts of the body
• Problems with balance and coordination

These symptoms can lead to many challenges for people with MS. Many of these symptoms are likely to have knock-on effects, impacting the lives of those affected in many more ways than just the initial symptom.^5,6 

For context, a decline in cognitive abilities (thinking, learning, and planning) leads to a limitation in activities that an individual can participate in (e.g., learning music or reading), which could lead to a loss of independence and community participation.⁵

Reduced ability to perform routine activities associated with daily living can be invisible to others, can be isolating, and reduce independence, thereby lowering the quality of life experienced by people with MS.⁶ While MS makes life harder for those living with it, there are treatments for both the disease as a whole and for individual symptoms.

Though most treatments cannot cure the disease or repair the damage already done, these treatments can greatly improve the quality of life for those living with MS by managing the symptoms. 

Treatment and management of multiple sclerosis

It is vital to initiate treatment immediately after the diagnosis of MS. The goals of treatment include:⁵

• Decreasing abnormalities observed during MRI screening of damaged nerves in the brain or spinal cord
• The long-term goal is to prevent SPMS

Some emerging therapies, such as disease-modifying therapies (DMTs), may be able to halt or reverse the progress of the disease but have serious, sometimes life-threatening side effects.⁷ 

Mainstream treatments

Many treatments are available, but their tolerance and effectiveness vary between individuals. While there is no guaranteed cure, advancements in research have improved recovery periods and healing of the sclerotic areas. 

Some of the most common mainstream treatment methods used to manage MS directly are:

• Disease-moderating therapies (DMTs) 
• Haematopoietic stem cell transplantation (HSCT)

Other standard treatment options directed towards alleviating the symptoms include:

• Physiotherapy
• Steroidal medications
• Anti-fatigue medications
• Pain-relieving medications
• Muscle relaxant medications
• Cannabis

Complementary and alternative medicines

In addition to mainstream treatments, a range of other options are generally grouped under the umbrella term ‘complementary and alternative therapies' (also known as complementary and alternative medicines or CAMs). These treatments usually take a more holistic approach and are often not clinically tested and researched. 

CAMs are sometimes used alongside mainstream treatments (complementary) and sometimes as a sole treatment (alternative). Some CAMs, such as aromatherapy, can be used in both complementary and alternative formats.

If you are interested in exploring CAMs as a treatment option, please consult your GP or medical professional, as some therapies may interfere with other medications you may be taking.

Generic management

Finally, there are generic ways to help manage MS symptoms and their impacts through exercise, diet, and other lifestyle changes (e.g., stopping smoking or starting physiotherapy). 

As the symptoms endured by people with MS influence their quality of life, participation, safety, and overall comfort, proactive symptom management, will allow them to continue living life to the fullest during the course of the disease.⁸

In addition, there are charities (MS Society, MS Trust), governmental support schemes, and online communities all available in the UK to connect with. 

FAQs

What does MS do to a person?

MS can present as four different clinical types, with two grouped into main forms: acute attacks or gradual progression. However, each type presents similar symptoms across the progression of the disease. Some common symptoms are problems with balance and coordination, numbness or tingling, and muscle stiffness and spasms.

Over time, these can get more severe and potentially lead to reductions in comfort and independence. However, symptom management and treatment plans can successfully minimise these effects.

What are the four common symptoms of MS?

Common symptoms of MS are mobility problems, pain, muscle stiffness and spasms, numbness or tingling, problems with thinking, learning, and planning, and bladder problems. However, many of these can be caused by other conditions. Please see your GP or medical professional if you are worried you might have MS.

What is the cause of getting MS?

The exact cause of MS is not currently clear. However, research has indicated that it is likely caused by a mix of infectious, environmental, and genetic factors.¹

Summary

MS is a disease impacting the CNS, causing a range of symptoms. It is a chronic autoimmune disease that currently has no proven cure. In recent years, to manage the ongoing symptoms of people living with MS, vast steps have been made to develop a cure and treatments. The current mainstream treatments allow most patients to maintain a reasonable quality of life, with a minimal decrease in life expectancy in most cases.

There are also a number of CAMs available to people who are inclined towards non-mainstream approaches. If you are living with MS or suspect that you may have it, it is of utmost importance to consult with your healthcare provider. They can guide you towards the most suitable treatment options, including exploring alternative therapies. Communities and organisations are set up to help support and educate those affected by the disease. Remember, you are not alone.