What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is a chronic illness that affects your central nervous system. It is a progressive autoimmune disease, meaning it gets worse over time.

The cells that make up your nerves are surrounded by a layer called myelin. This layer protects your nerves and helps them send signals quickly from your brain to the rest of your body.

In MS, your immune system attacks the myelin layer and damages it. This leads to exposed and scarred nerves. When this happens, your nerves can't send signals around your body properly. The number and location of these scarred areas can lead to neurological and physical symptoms.

MS is more common in females and usually starts between ages 20 to 40. It is thought to affect 1 in 1000 people in Australia.

What are the types of multiple sclerosis?

There are 4 common types of MS.

Relapsing-remitting MS (RRMS)

This is the most common type of MS.

In RRMS, new symptoms may show up or existing symptoms may worsen over days, weeks or months. This is known as a 'relapse'. A relapse is followed by a partial or sometimes complete recovery, known as 'remission'.

In RRMS this pattern continues, with relapses followed by periods of remission.

Primary progressive MS (PPMS)

About 1 in every 10 people with MS have PPMS. In this type, symptoms slowly get worse, without separate attacks or periods of remission.

There may be times when your symptoms are stable and don't get worse or better.

Secondary progressive MS (SPMS)

SPMS can happen after years of having RRMS.

After an initial period of relapse and remission, symptoms gradually get worse, without remission. About 1 in 2 people with RRMS go on to develop SPMS. This usually happens 10 years after MS begins.

Clinically isolated syndrome (CIS)

The first episode of MS symptoms (an MS attack) followed by recovery is called clinically isolated syndrome (CIS). This episode may last days or weeks. It may be an isolated event or you may go on to have more episodes.

Usually, you need at least 2 episodes of symptoms to be diagnosed with MS. Many people with CIS will eventually have more episodes and be diagnosed with RRMS.

What are the symptoms of multiple sclerosis?

MS symptoms depend on which part of your central nervous system is affected and how much myelin has been damaged.

The symptoms of MS vary widely from person to person. They may also come and go. The timing and length of symptoms may be unpredictable.

MS may affect your ability to control your body. You might have:

• muscle cramps and stiffness
• weakness or paralysis (trouble moving parts of your body)
• tremor (shaking)
• difficulty with coordination and balance
• trouble with talking and swallowing

Vision problems are common, often in just one eye. You might notice:

• blurred or double vision
• blind spots
• colours look different
• pain when moving your eye

Other common symptoms may include:

• tiredness
• vertigo (dizziness)
• unusual sensations — such as pins and needles, nerve pain and sensitivity to heat
• bladder and bowel problems — such as incontinence, diarrhoea and constipation
• problems with sexual function
• changes in memory, concentration or thinking
• depression or anxiety

MS symptoms in females

MS can affect sexual function in females, including:

• reduced libido (sex drive)
• pain during sex
• vaginal dryness

People with MS often find that their symptoms pause or improve during pregnancy. This may be followed by an increase in MS attacks in the time after giving birth.

Speak to your doctor if you have MS and are planning a pregnancy.

What causes multiple sclerosis?

The cause of MS is not known. However, several environmental and genetic factors may increase your risk, including:

• having a close relative with MS or another autoimmune disease
• low vitamin D levels
• living further away from the equator — this may be due to lower vitamin D levels from less exposure to sunlight
• having had Epstein-Barr virus (glandular fever)
• smoking
• living with obesity

When should I see my doctor?

Symptoms of MS may be hard to recognise because they are common in many other conditions. They may start as isolated episodes, which makes it even harder to notice as a problem.

See your doctor if you are worried about possible signs of MS, such as:

• vision problems
• numbness, tingling or unusual feelings in your limbs
• difficulty moving your body
• issues with balance

How is multiple sclerosis diagnosed?

Your doctor may use a combination of tests to diagnose MS. If they think you may have MS, they will refer you to a neurologist. A neurologist can check how different parts of your nervous system are working.

Your neurologist may ask you questions about your symptoms and medical history. This helps them understand if you have had any MS episodes in the past. They may also do neurological tests.

An MRI of your brain and spinal cord is the best way to find areas of damage and scarring. You might also need:

• blood tests
• a lumbar puncture (spinal tap)
• tests to measure your nerve activity

It can be hard to diagnose MS because there is no single test for it. You may be diagnosed if there is proof of damage:

• in different parts of your central nervous system
• at different times
• with no explanation other than MS

How is multiple sclerosis treated?

There is currently no cure for MS, but treatments can help slow the disease and improve your quality of life. The best treatment depends on your symptoms and type of MS.

Medicines may help ease symptoms, such as:

• muscle stiffness
• pain
• bladder or bowel problems
• tiredness
• depression and anxiety

Immunotherapies

Medicines that target your immune system are called 'disease modifying therapies' or 'immunotherapies'. They help reduce how often you have relapses and make them less severe.

These treatments also protect the myelin layer from more damage. The goal is to see no new scarring when an MRI is done.

These medicines are usually used for people with RRMS. They can also help slow down or stop RRMS from turning into SPMS. There are several types of immunotherapies, but they may have serious side effects.

Treatment for relapses

Steroid medicines may reduce inflammation in your central nervous system. If you have a relapse, steroids can help make your symptoms less severe.

Talk to your neurologist about the right treatment options for you. It's especially important to speak with your neurologist if you are planning a pregnancy. They can discuss your chance of a relapse and make sure your treatment is safe for your baby.

Living with multiple sclerosis

You can learn to adapt and live a normal and active life with MS. The focus is on managing your symptoms, maintaining muscle function and finding ways to handle daily challenges.

Strategies to help with your symptoms may include:

• regular exercise — to improve a range of symptoms
• physiotherapy — for muscle problems
• continence products — for bladder or bowel issues
• counselling — for depression or anxiety
• cognitive rehabilitation — to improve your memory and thinking
• vitamin D supplements — ask your doctor or pharmacist before using supplements

One of the main symptoms is tightness and stiffness of your muscles. This can be managed with medicines, stretching, exercises and physiotherapy.

What are the complications of multiple sclerosis?

As MS becomes worse, it may lead to complications, such as:

• problems from immobility, such as infections and pressure sores
• vision impairment
• fatigue (extreme tiredness)
• depression
• osteoporosis (weakened bones)
• urinary tract infection

Can multiple sclerosis be prevented?

MS cannot be prevented, but knowing what might trigger an episode or make the condition worse can help. Triggers may include:

• infection
• physical trauma
• giving birth
• stress
• change in climate

Each person responds differently to these triggers.

Vaccination for preventable diseases can help lower your risk of developing MS or making it worse. Talk to your doctor about vaccination. The timing of some vaccines may be different if you have MS.

Resources and support

MS Australia offers:

• information about MS
• support and services
• information and support for families, friends and other carers

Shift.ms offers an app to connect and manage multiple sclerosis — you can get support and find answers.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Other languages

• You can find information about MS in other languages on the MS Australia website.