Encyclopaedia


Multiple sclerosis

Introduction

Multiple sclerosis (MS) is the most common neurological condition in young adults in the UK, affecting around 100,000 people.

There are three main types of MS:

  • relapsing remitting MS
  • secondary progressive MS
  • primary progressive MS

About the disease

MS is a condition of the central nervous system (the brain and spinal cord). The central nervous system controls the body's actions and activities, such as movement and balance.

Each nerve fibre in the central nervous system is surrounded by a substance called myelin. Myelin helps messages from the brain to travel quickly and smoothly to the rest of the body.

In MS, the myelin becomes damaged. This disrupts the transfer of these messages.

Who is affected

MS can occur at any age, but symptoms are mostly first seen between the ages of 20 and 40. Women are more than twice as likely to develop MS as men.

Outlook

MS is a lifelong condition, but it is not terminal. Most people with MS can expect to live as long as someone without the condition. However, a minority of patients (about 20%) with MS have a considerably shortened life.

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Symptoms

The central nervous system (brain and spinal cord) controls all your body's actions. When MS causes damage to the nerve fibres that carry messages to and from your brain, symptoms can occur in any part of your body.

There are many different symptoms of MS and they affect each person differently. Some of the most common symptoms include:

  • numbness and tingling
  • blurring of vision
  • problems with mobility and balance
  • muscle weakness and tightness

Most people with MS only have a few of these symptoms and it is very unlikely that someone would develop all possible symptoms.

The symptoms of MS are unpredictable and some people's symptoms develop and worsen steadily over time, while for other people they come and go periodically. Periods when your symptoms get worse are known as relapses. Periods when your symptoms improve or disappear are known as remissions.

Visual problems

In a quarter of cases of MS, the first symptom is inflammation (swelling) of the optic nerve, which transmits visual information to the brain. This is known as optic neuritis and usually only affects one eye. It causes pain behind your eyeball, loss of vision and colour blindness.

MS can also cause double vision, pain in both eyes and difficulty focusing (known as nystagmus).

Muscle spasms and spasticity

MS can cause damage to the nerve fibres in your central nervous system. This can cause your muscles to contract tightly and painfully (spasm). Your muscles may also become stiff and resistant to movement, which is known as spasticity.

Pain

Pain is common in MS. The two types of pain that can occur as a result of MS are neuropathic and musculoskeletal pain.

  • Neuropathic pain is caused by damage to the nerve fibres in your central nervous system. It can be stabbing pains, extreme skin sensitivity or burning sensations. 
  • Musculoskeletal pain is not caused directly by MS, but can occur if there is excess pressure on your muscles or joints as a result of spasms and spasticity.

Mobility problems

MS can affect your balance and co-ordination. It can make walking and moving around difficult, particularly if you also have muscle weakness and spasticity.

  • You may experience difficulty with co-ordination, called ataxia.
  • Shaking of the limbs (tremor) is rare but can be severe.
  • Dizziness can happen late on and can make you feel as if your surroundings are spinning (vertigo).

Cognitive problems

Cognitive problems refer to problems with mental processes, such as thinking and learning. These usually occur when MS is severe. The problems may be temporary or permanent. You may have trouble remembering and learning new things, problems with attention and concentration, slowed or confused speech, and reduced mental speed.

Emotional problems

If you have MS, you may find yourself laughing or crying for no reason, and you may also be more likely to experience depression or anxiety.

Fatigue and tiredness

Extreme tiredness (fatigue) may be your main symptom of MS. You may find that fatigue causes your other symptoms (such as problems with balance, vision and concentration) to get worse.

Bladder problems

MS can make your bladder either overactive or underactive. If it is overactive, your bladder may contract when it is not full, causing incontinence. If it is underactive, you may find that your urine flow is interrupted and your bladder does not feel empty.

Bowel problems

MS often causes constipation but may also cause bowel incontinence.

Types of multiple sclerosis

The symptoms of MS are unpredictable. Some people's symptoms develop and get worse over time, while other people's symptoms come and go periodically.

Periods when your symptoms get worse are known as relapses. Periods when your symptoms improve or disappear are known as remissions.

A relapse in MS is defined as a period of at least 24 hours in which new symptoms appear or previous ones worsen. Relapses can occur at any time and may vary in severity. Sometimes, a short-lived worsening of your symptoms can be caused by other factors, such as hot weather or exercise. This does not necessarily mean that you are having a relapse.

There are three types of MS. They are characterised by the pattern of relapse and remission that the symptoms follow.

  • Relapsing remitting MS (RRMS)
    Relapsing remitting MS (RRMS) is the most common type of MS. It is characterised by numerous relapses and remissions. Relapses may last for days, weeks or months. You may experience new symptoms each time, or a recurrence of previous ones. After each relapse, you may recover completely. However, many people's symptoms improve but do not disappear altogether.
  • Secondary progressive MS (SPMS)
    Secondary progressive MS (SPMS) follows on from RRMS. It is characterised by a steady worsening of symptoms, with or without relapses. Studies show that most people with RRMS go on to develop this form of MS, on average 15-20 years after the onset.
  • Primary progressive MS (PPMS)
    Primary progressive MS (PPMS) is the rarest form of MS. If you have this form of MS, symptoms will get steadily worse with no distinct relapses or remissions.

Benign MS (BMS)

If you have had no symptoms for 10 to 15 years, you may be told that you have benign MS (BMS). Benign MS is characterised by a small number of relapses followed by a complete recovery each time. There is no guarantee that MS is ever gone for good and it is even possible to have a relapse after many years of no symptoms.

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Causes

Multiple sclerosis (MS) occurs because of damage to the nerve fibres of the central nervous system. Your central nervous system consists of your brain and spinal cord and is responsible for controlling every action, conscious and unconscious, of your body.

When you perform an action, your brain sends messages to the appropriate part of your body through the nerve fibres in your spinal cord. These nerve fibres are covered by a substance called myelin. Myelin insulates the nerve fibres and helps carry messages to and from your brain quickly and smoothly. In MS, the myelin around your nerve fibres becomes damaged. This disturbs the messages coming to and from your brain.

MS is an autoimmune condition. This means that your immune system mistakes the myelin for a foreign substance and attacks it. The myelin becomes inflamed in small patches (called plaques or lesions), which can be seen on an MRI scan. This process is called demyelination.

Demyelination disrupts the messages travelling along nerve fibres. It can slow them down, jumble them, accidentally send them down a different nerve fibre or stop them from getting through at all.

When the inflammation goes away, it can leave behind scarring of the myelin sheath and sometimes damage to the underlying nerve cell. The progressive types of MS are due to the accumulated damage to these nerve cells.

Why do people develop multiple sclerosis?

MS is an autoimmune condition in which your immune system attacks myelin on the nerve fibres of your central nervous system. It is not understood what causes this autoimmune response, although there are several theories.

Most experts agree that MS is probably caused by a combination of genetic and environmental factors. This means that it's partly due to the genes you inherit from your parents and partly due to outside factors that may trigger the condition.

Genetic factors

MS is not defined as a genetic condition because there is no single gene that causes it. It's not directly inherited, although research has shown that people who are related to someone with MS are more likely to develop it. For example, if your mother has MS, you're 40 times more likely to develop it than normal. However, the chances of MS occurring more than once in a family are still very small, and there is only a 2% chance of a child developing MS when a parent has it.

It's likely that different combinations of genes make developing MS more likely, and research into this is continuing. However, genetic theories cannot explain the wide variation in occurrences of MS throughout the world.

Environmental factors

Research into MS around the world has shown that it's more likely to occur in countries that are far from the equator. For example, MS is relatively common in the UK, North America and Scandinavia, but hardly ever occurs in Malaysia or Ecuador.

Bacteria and viruses

The reason for the distribution of MS around the world is not fully understood, but it's thought that MS could be triggered by a particular bacteria or virus that thrives in a cooler environment. Some experts believe that a common childhood infection in these cooler countries may disturb the immune system or trigger an autoimmune response in some people, which develops into MS.

As yet, no bacteria or virus has been identified to back up this theory. However, research has shown that people over the age of 15 who move away from countries nearer the equator to a cooler climate have a lower risk of developing MS than those who were born there.

Vitamin D

Other research has focused on the idea that people living further from the equator are exposed to less sunlight and, therefore, have less vitamin D in their body. Some studies have found a link between lower levels of vitamin D and incidence of MS.

Some researchers have suggested that vitamin D supplements may reduce the risk of MS. However, this has not been proven.

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Diagnosis

If you have unexplained symptoms that are similar to those of multiple sclerosis (MS), see your GP. If your GP suspects MS, they will ask you for a detailed medical history, including past signs and symptoms as well as the current state of your health.

Your GP can refer you to a neurologist (a specialist in conditions of the central nervous system). If your GP suspects that you have MS, you should see a neurologist within six weeks.

Diagnostic tests

Diagnosing MS is complicated because no single laboratory test can positively diagnose it. Several conditions have symptoms that are similar to those of MS, so your neurologist may rule them out first.

To confirm a diagnosis of MS, your neurologist may carry out a number of tests.

Neurological examination

Your neurologist will look for changes or weakness in your eye movements, leg or hand co-ordination, balance, speech and reflexes. This will show whether any of your nerve pathways are damaged.

Magnetic resonance imaging (MRI) scan

A magnetic resonance imaging (MRI) scan creates a detailed image of your brain and spinal cord. The procedure is painless and usually takes between 10 and 30 minutes. A standard MRI scanner is like a giant tube or tunnel. You may feel claustrophobic when going into the tunnel and the machine is noisy. Tell your neurologist if you have any concerns about this experience.

MRI scans can show whether there is any damage or scarring of the myelin in your central nervous system. Over 90% of people with MS are diagnosed using an MRI scan.

Evoked potentials test

An evoked potentials test involves placing small electrodes on your head. These monitor how your brain waves respond to what you see and hear. It is painless and can show whether it takes your brain longer than normal to receive messages.

Lumbar puncture

A lumbar puncture is also sometimes called a spinal tap. A sample of your cerebrospinal fluid (the fluid that surrounds your brain and spinal cord) is taken using a needle inserted into the area around your spinal cord.

This is done under local anaesthetic, which means that you will be awake but the area that the needle goes into will be numbed. The sample is tested for antibodies, the presence of which means that your immune system has been fighting a disease in your central nervous system.

A lumbar puncture is usually only needed if other tests for MS are inconclusive, or for a diagnosis of primary progressive MS.

Blood tests

Blood tests are usually performed to rule out other causes of your symptoms, such as vitamin deficiencies. In addition, antibody tests may be required, for example to rule out a special type of MS called Devic's disease.

Diagnosing the different types of multiple sclerosis

Once a diagnosis of MS has been made, your neurologist may be able to identify which type of MS you have.

However, this often only becomes clear over time as the symptoms of MS are so varied and unpredictable. This is particularly true of benign MS (BMS), which can only be diagnosed once you have been free of symptoms for 10-15 years.

A diagnosis of relapsing remitting multiple sclerosis (RRMS) may be made if:

  • you have two relapses of your symptoms more than 30 days apart, or
  • you have one relapse and an MRI scan shows new myelin damage or scarring three months later

A diagnosis of secondary progressive multiple sclerosis (SPMS) may be made if:

  • you have had relapses of your symptoms in the past, and
  • you have become steadily more disabled for at least six months, with or without relapses

A diagnosis of primary progressive multiple sclerosis (PPMS) may be made if you have had no previous relapses of your symptoms, and:

  • you have become steadily more disabled for at least one year
  • an MRI scan shows damage and scarring to myelin
  • a lumbar puncture shows that there are antibodies in the fluid surrounding your brain and spinal cord

Uncertain diagnosis

In some cases, your neurologist may not be able to say for certain whether you have MS. This can happen when the test results are unclear, for example if your symptoms and lumbar puncture results point towards MS but there is no sign of myelin damage on the MRI scan.

If this is the case, your neurologist may tell you that you have possible MS. You may have to wait for your symptoms to relapse before a definite diagnosis can be made.

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Treatment

There is no cure for multiple sclerosis (MS), but there are many treatments available which can relieve the many symptoms and relapses, and may help to slow the progression of the condition.

If you have benign MS (BMS) or your symptoms are very mild, you may not need treatment unless you eventually experience a relapse.

Specialist healthcare services for multiple sclerosis

As MS is such a varied and unpredictable condition, each person who has MS will need a different level of medical care and treatment. Once you have been diagnosed with MS, you should have a thorough assessment involving specialist nurses, physiotherapists, occupational therapists, speech and language therapists and social workers, who make up a specialist neurological rehabilitation team.

Depending on the amount of care you need, you will receive treatment from one, several or all the members of your local neurological rehabilitation team. They can also help you learn to care and treat yourself as much as possible. Your first point of contact with your rehabilitation team will usually be a specialist MS nurse.

Every person who has MS should have access to healthcare professionals trained in treating MS, as well as their GP.

Medical and complementary treatments for multiple sclerosis

The treatment for MS can be split into four main categories:

  • treatment for relapses of MS symptoms (steroids),
  • treatment for specific MS symptoms,
  • treatment to slow the progression of MS (disease-modifying medicines), and
  • complementary therapies.

Treatment for MS relapses (steroids)

Whenever you experience a relapse of your MS symptoms, you should see your GP or specialist MS nurse. As a recurrence of your symptoms can be due to a secondary cause, such as an infection, your GP or nurse must first identify what is causing the relapse, before treating it accordingly.

If your symptoms are due to a relapse, you may be given a 3-5 day course of high dose steroids, also known as methylprednisolone, to help speed up your recovery. These can be given either orally as tablets or intravenously (injected into a vein), and you may receive the treatment either in hospital or at home.

It is not fully understood how steroids help to speed up your recovery from a relapse, but they are thought to suppress your immune system so that it no longer attacks the myelin in your central nervous system. They may also help to reduce the amount of fluid around any nerve fibre damage.

As steroids may cause long-term side effects, such as osteoporosis (weak and brittle bones), weight gain, and diabetes, you cannot take them for more than three weeks at a time, and you cannot take more than three courses of treatment in one year.

Treatments for specific MS symptoms

If you have MS, you may have several different symptoms which may vary in severity. There are treatments available which can relieve each specific symptom, although some symptoms are more easily treated than others. However, it is very unlikely that anyone with MS would develop all of the possible symptoms.

Visual problems

If your visual problems are mild, such as trouble reading, see your optician for an eye test, as the problem may not be due to MS.
However, if your visual problems are more severe or related to nystagmus (difficulty focusing), you may be prescribed medication called gabapentin.

Muscle spasms and spasicity

Muscle spasms and spasicity can be improved with physiotherapy, as motions such as stretching can help to prevent spasicity (stiffness) occurring. You may be referred to a physiotherapist trained in MS if you find that muscle spasms and spasicity are restricting your movements.

If your muscular spasms and spasicity are more severe, you may be prescribed a medicine which can relax your muscles and reduce spasms. This will usually be either baclofen or gabapentin, although there are also stronger medicines, such as tizanidine, diazepam, clonazepam and dantrolene. These medicines all have side effects, such as dizziness, weakness, nausea, and diarrhoea, so you should discuss which would be best for you with your GP or MS nurse.

In rare cases, medicines may not be enough to control muscle spasms and spasicity. If this is the case, you may be referred for specialist treatment. This may involve wearing special splints or weights on your legs, or having medication injected into the fluid surrounding your spinal cord.

Neuropathic pain

Neuropathic pain is caused by damage to your nerves, and is usually sharp and stabbing. It can also occur as extreme skin sensitivity or a burning sensation. This type of pain can be treated using the medicines gabapentin, or carbamazapine, or with an antidepressant called amitriptyline.

Musculoskeletal pain

You will probably have musculoskeletal pain if you experience muscle spasms and spasicity, as it is caused by excess pressure and stiffness in your joints.

A physiotherapist may be able to help with musculoskeletal pain by suggesting exercise techniques or better seating positions. If your pain is more severe, you may be prescribed painkillers (analgesics), antidepressants (which can also help with pain), or a procedure which stimulate your nerve endings. This is known as transcutaneous nerve stimulation (TENS).

Mobility problems

As with musculoskeletal pain, mobility problems are usually the result of muscle spasms and spasicity. You may find that you joints tighten, making it hard to move around.

If you experience mobility problems, it is best to try and prevent muscle spasms and spasicity in the first place, with physiotherapy or medication (see above). It is possible for your muscles to tighten to the point where it is painful and difficult to move at all, which is known as a contracture.

If this occurs, you may need to do special stretching exercises with plaster casts and removable splints. You may also be prescribed injections of botulinum toxin, which can help to relax your muscles.

There are also medicines, exercises and equipment which can help to relieve a tremor (ataxia) or dizziness caused by MS, which are available from your neurological rehabilitation team.

Cognitive problems (difficulty with thought, memory and speech)

If you experience cognitive problems, any treatment you receive will be fully explained and recorded, so that it is clear to you.

You should be referred to a clinical psychologist, who can assess your problems and suggest ways to manage them. You may also receive treatment from a speech therapist if necessary.

Emotional problems

If you experience emotional outbursts, such as laughing, or crying, for no apparent reason, you should be assessed by a healthcare professional trained in MS symptoms, such as a clinical psychologist. They may suggest treatment with an antidepressant, although if you do not want this, learning techniques, to control your emotions can also help.

Depression in people with MS can be treated with antidepressants just as with anyone else. If you often feel anxious or worried, a clinical psychologist may prescribe antidepressants or benzodiazepines, which are a type of tranquilliser that have a calming effect. If you are prescribed benzodiazepines, it is likely that you will be closely monitored, as this medicine can be addictive.

Fatigue and tiredness

Many people with MS experience extreme tiredness, and your GP, or MS nurse, should first assess this, to see if there is any other reason for your fatigue other than MS, such as a medication, or poor diet.

If your fatigue is due to MS, you may be prescribed a medication called amantadine, although it may only have a limited effect. You should also be given general advice on ways to prevent fatigue, such as exercise and energy saving techniques.

Bladder problems

If you have an overactive bladder, you may be prescribed an anti-cholinergic medicine, such as oxybutynin or tolterodine, which will help to make the need to pass urine more predictable. The need to pass urine frequently can be treated with a medicine called desmopressin.

If you have an underactive bladder which is not emptying properly, you may be fitted with a catheter. This is a small tube inserted into your urinary opening that drains away any excess urine.

However, if your bladder problems are more severe, you may be referred to a continence specialist, who can offer specialist treatment and advice, such as bladder exercises or electrical treatment for your bladder muscles.

Bowel problems

It may be possible to treat mild to moderate constipation by changing your diet or taking laxatives. However, more severe constipation may need to be treated using suppositories (tablets which are inserted and dissolved inside your rectum), or by having an enema. This involves a liquid medication being rinsed through your rectum and colon, which softens and flushes out your stools.

Bowel incontinence can be treated with anti-diarrhoea medication, or by doing pelvic floor exercises to strengthen your rectal muscles.

Treatment to slow the progression of MS

MS cannot be cured but there are treatments which can reduce the number and severity of relapses. They may also help to slow the progression of the condition, although research into their long-term effects is limited.

Disease-modifying medicines

These treatments are injected into your muscle or under your skin, and they can only be prescribed by a neurologist who is part of a specialist neurological rehabilitation team. Your MS nurse can help you with the injections until you feel ready to carry them out yourself.

Disease-modifying medicines work by reducing the amount of damage and scarring to the myelin in your central nervous system, which causes MS relapses.

Disease-modifying medicines are not suitable for everyone with MS; they are only prescribed for the treatment of relapsing remitting MS (RRMS) and secondary progressive MS (SPMS). This is because people with these types have the highest number of relapses. For more information about the eligibility of disease-modifying medicines, see the 'Selected links' section.

The different types of disease-modifying medicines are outlined below.

Beta interferons (Avonex, Betaferon and Rebif)

There are three brands of beta interferon licensed for use in the UK; Avonex, Betaferon and Rebif. On average, beta interferons can reduce the number and severity of MS relapses by a third.

Avonex is injected once a week into your muscle, Betaferon is injected under your skin every other day, and Rebif is injected under your skin three times a week. Beta interferons can all cause mild side effects, such as flu-like symptoms (headaches, chills, mild fever) for 48 hours after they are injected.

All three beta interferons are licensed to be used by those with relapsing remitting MS (RRMS). Those with secondary progressive MS (SPMS) are licensed to use Betaferon only.

Beta interferons are not suitable for those under the age of 18, or women who are pregnant or breastfeeding. Both women and men are advised to stop using them at least three months before trying for a baby. If you find out that you are pregnant while you are taking a beta interferon, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

Glatiramer acetate (Copaxone)

There is one brand of glatiramer acetate which is licensed for use in the UK, which is called Copaxone. Glatiramer acetate has no effect on the severity of MS relapses, although, on average, it can reduce the number of relapses by a third.

Copaxone is injected under the skin every day. It does not usually cause any noticeable side effects, although in rare cases, it may cause tightness in your chest. Copaxone is only licensed to be used by people who have relapsing remitting MS (RRMS).

Like beta interferons, Copaxone is not suitable for those under the age of 18, or women who are pregnant or breastfeeding. Both women and men are advised to stop using it at least three months before trying for a baby. If you find out that you are pregnant while you are taking Copaxone, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

Natalizumab (Tysabri)

Natalizumab (Tysabri) is the most recently licensed disease-modifying medicine for MS relapses in the UK, under the brand name Tysabri. On average, natalizumab can reduce the number of MS relapses by two thirds, and can slow the progression of the condition by approximately half.

Tysabri is injected under the skin once every 28 days. However, it can cause several side effects, including headaches, nausea and vomiting and an itchy rash.

In very rare cases, Tysabri has also been linked to an increased risk of progressive multifocal leukoencephalopathy (PML). PML is a rare but serious condition which breaks down myelin on nerve fibres, in a similar way to that of MS. It can cause problems with vision and speech, and eventually, paralysis.

Tysabri is only licensed to be used by those who still have highly active relapsing remitting MS (RRMS) after treatment with a beta interferon, or those who have rapidly evolving RRMS. Rapidly evolving RRMS is defined by:

  • two or more severe relapses within one year, and
  • two consecutive MRI scans which show increased damage and scarring to myelin.

Tysabri is not suitable for those under the age of 18 or over the age of 65, those who have cancer, or those with a weakened immune system, such as those who are HIV positive.

Linoleic acid

Linoleic acid is an essential fatty acid, which is found naturally in several foods. There is some medical evidence that suggests that a diet rich in linoleic acid may help to reduce the duration and severity of MS relapses, and slow the progression of MS.

If you have MS, see your GP, or dietician, for advice about increasing your intake of linoleic acid. You should aim to incorporate 17-23g of linoleic acid into your daily diet, although this may not be advisable if you are overweight.

Linoleic acid is found in:

  • sunflower spread and oil,
  • safflower or sesame seed oils,
  • nuts and seeds, such as walnuts, brazil nuts, peanuts and almonds,
  • certain supplements, including blackcurrant seed oil, grape seed oil and evening primrose oil.

Complementary therapies for MS

There are many complementary treatments and therapies which claim to ease the symptoms of MS. Some of the most common of these include:

  • acupuncture - the insertion of thin needles into certain parts of the body to restore health,
  • homeopathy - which uses remedies made from ingredients such as plants and minerals, to stimulate the body's own healing process,
  • reflexology - a form of massage which focuses on reflex areas on the hands and feet, and
  • yoga - a type of exercise that concentrates on different stretches and deep breathing techniques.

Although there are many complementary therapies available for MS, there is very little medical evidence to show that they are effective in controlling MS symptoms.

However, many people with MS find that complementary therapies help them to feel better. There is some evidence, although it is limited, that the following complementary therapies may help to promote general health and well-being in people with MS:

  • reflexology,
  • massage,
  • t'ai chi - a form of martial art which involves slow, rhythmic movements,
  • magnetic field therapy - a therapy which uses magnets to improve the body's processes, and
  • neural therapy - in which small amounts of local anaesthetic are injected under the skin to improve the body's flow of energy.

Other healthcare issues for people with MS

Immunisations

If you have MS, you should have any of the usual travel vaccinations when you go abroad. You should also ensure that you have an annual flu jab, as getting flu can make MS symptoms worse.

Pregnancy

Having MS does not mean that you cannot have a baby. In fact, being pregnant reduces your risk of relapses.

Women with MS can have a normal pregnancy and breastfeed afterwards if they want to. Pain medication used in childbirth does not affect MS.

Anaesthetics

All types of anaesthetic are safe to use for people with MS.

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Medicines Guide

Please see the Medicines for Multiple sclerosis guide on the NHS Choices website. The link provides information on individual medicines associated with multiple sclerosis. 

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Living with

Living with multiple sclerosis 

A diagnosis of MS is life changing. You may need long-term treatment to control your symptoms and you may have to adapt the way you do daily tasks.

Self-care

Self-care is an integral part of daily life. It means that you take responsibility for your own health and wellbeing, with support from the people involved in your care. Self-care includes the things you do each day to stay fit, maintain good physical and mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions. People living with long-term conditions can benefit enormously if they receive support for self-care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life, and be more active and independent.

Regular reviews

Because MS is a long-term condition, you'll be in regular contact with your healthcare team. A good relationship with the team means that you can easily discuss your symptoms or concerns. The more the team knows, the more they can help you.

Keeping well

Everyone with a long-term condition such as MS is encouraged to get a flu jab each autumn to protect against flu (influenza). It's also recommended that they get an anti-pneumoccocal vaccination. This is a one-off injection that protects against a specific serious chest infection called pneumococcal pneumonia.

Healthy eating and exercise

Regular exercise and a healthy diet are recommended for everyone, not just people with MS. They can help prevent many conditions, including heart disease and many forms of cancer. Try to eat a balanced diet, containing all the food groups, to give your body the nutrition it needs. Exercising regularly can help relieve stress and reduce fatigue.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.

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