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Multiple sclerosis


Multiple sclerosis (MS) affects nerves in the brain and spinal cord, causing a wide range of symptoms including problems with muscle movement, balance and vision.

Each nerve fibre in the brain and spinal cord is surrounded by a layer of protein called myelin, which protects the nerve and helps electrical signals from the brain travel to the rest of the body. In MS, the myelin becomes damaged.

This disrupts the transfer of these nerve signals, causing a wide range of potential symptoms, such as:

  • loss of vision – usually only in one eye
  • spasticity – muscle stiffness that can lead to uncontrolled muscle movements
  • ataxia – difficulties with balance and co-ordination
  • fatigue – feeling very tired during the day

Read more about the symptoms of multiple sclerosis.

Types of multiple sclerosis

Around eight out of 10 people with MS are diagnosed with the relapsing remitting type of MS.

Someone with relapsing remitting MS will have flare-ups of symptoms, known as relapses. These can last from a few days to a few months.

These will be followed by periods where symptoms are mild or disappear altogether. This is known as remission and can last for days, weeks or sometimes months.

Usually after around 15 years, around half of people with relapsing remitting MS will go on to develop secondary progressive MS.

In secondary progressive MS, symptoms gradually worsen over time. Some people may still have relapses, but without full recovery from symptoms.

The least common form of MS is primary progressive MS. In this type, symptoms gradually get worse over time and there are no periods of remission.


There is currently no cure for MS but there are a number of treatments that can help.

Relapsing remitting MS can be treated with disease-modifying drugs. These are designed to reduce the number of relapses someone has. They may also be able to slow the progression of MS. But they are not suitable for all people with MS.

Some of these drugs can also be used for treating secondary progressive MS, if someone is still experiencing relapses.

At the moment, there is no treatment that can slow the progress of primary progressive MS.

There are also a wide range of treatments, including physiotherapy, that can help relieve symptoms and make day-to-day living easier. Steroids can also be used to speed up recovery from relapses.

Read more about the treatment of multiple sclerosis.


MS is known as an autoimmune condition. This is where something goes wrong with the immune system (the body’s defence against infection) and it mistakenly attacks healthy body tissue – in this case, the myelin covering of nerves.

This can cause multiple sections of the brain and spinal column to become damaged and hardened (sclerosis), which can disrupt the nerve signals passing through these areas.

Exactly what causes the immune system to act in this way is unclear, but most experts think a combination of genetic and environmental factors are involved.

Read more about the possible risk factors and causes of multiple sclerosis.

Who is affected

It is estimated that there are currently around 100,000 people with MS in the United Kingdom.

MS is most commonly diagnosed in people aged 20-40, although it can happen at any age. Children can also get MS, although this is rare.

For reasons that are unclear, MS is twice as common in women than men, and more common in white people than black and Asian people


MS can be a challenging and frustrating condition to live with but new treatments over the past 20 years have considerably improved the quality of life of people with the condition.

MS is not fatal, but some complications which can arise from more severe MS, such as pneumonia, can be.

As a result, the average life expectancy for people with MS is around five to 10 years lower than the population at large. This gap appears to be getting smaller, perhaps because of improved medical care.

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The central nervous system (brain and spinal cord) controls all of your body's actions. When MS damages 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:

  • extreme tiredness (fatigue)
  • 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 unlikely someone would develop all possible symptoms.

The symptoms are unpredictable. Some people's MS symptoms develop and increase steadily over time, while for others, they come and go periodically.

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

Visual problems

In around one in five cases of MS, the first noticeable symptom is problems with one of your eyes. You may experience:

  • some loss of vision in the affected eye – this can range from mild to severe (total loss of vision occurs in 1 in 35 cases)
  • colour blindness
  • eye pain; usually made worse when moving the eye
  • flashes of light when moving the eye

These symptoms are the result of optic neuritis, which is inflammation (swelling) of the optic nerve that transmits visual information to the brain. This normally only affects one eye.

Other visual problems that can occur in MS include:

  • double vision
  • eye pain in both eyes
  • involuntary eye movements (usually from side to side), known as nystagmus

Abnormal sensations

Abnormal sensations can also be a common initial symptom of MS. This can take the form of numbness or tingling in different parts of your body.

Muscles in your arms and legs may also feel unusually weak.

Muscle spasms and spasticity

If messages between your brain and muscles are disrupted, this can cause problems with muscle movements. It can cause muscles to contract tightly and painfully (spasm) or your muscles may also become stiff and resistant to movement, known as spasticity.


Around half of people with MS experience pain, which can take two forms:

  • Neuropathic pain – caused by damage to the nerve fibres in the brain and spinal cord. It can be a stabbing pain, extreme skin sensitivity, or a burning sensation.
  • Musculoskeletal pain – this is not caused directly by MS, but can occur if there is excess pressure on muscles or joints as a result of spasms and spasticity.

Mobility problems

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

  • ataxia – difficulty with co-ordination
  • tremor – shaking of the limbs, which is rare, but can be severe
  • dizziness and vertigo can happen late on and can make you feel as if your surroundings are spinning

Extreme tiredness (fatigue)

Feeling extremely tired (fatigue) is a common symptom of MS that many people describe as one of the most troublesome.

It is estimated as many as 9 out of 10 people with MS will experience episodes of fatigue.

People with MS have reported feeling an overwhelming sense of weariness where even the most simple physical or mental activity seems to be a tremendous struggle to carry out.

Fatigue may be worse in hot weather, after exercising, or during illness.

Problems with thinking, learning and planning

Around half of people with MS have problems with thinking, learning and planning (known as cognitive dysfunction). They may experience:

  • problems understanding and using language
  • a shortened attention span
  • problems learning and remembering new things (long-term memory is usually unaffected)
  • problems understanding and processing visual information, such as reading a map
  • difficulty with planning and problem solving – people often report that they know what they want to do, but can’t grasp the method of how to do it
  • problems with reasoning, such as mathematical laws or solving puzzles

Mental health issues

Around half of all people with MS experience at least one episode of depression at some point in their life.

It is unclear whether the depression arises from the damage to the brain caused by MS, or due to the stress of having to live with a long-term condition, or both.

Anxiety can also be a problem for people with MS, possibly due to the unpredictable nature of the condition.

Some people with MS can sometimes experience rapid and severe mood swings, suddenly bursting into tears, laughing or shouting angrily for no apparent reason.

Sexual problems

MS can have an effect on sexual function.

Men with MS often find it hard to obtain or maintain an erection (erectile dysfunction). They may also find it takes a lot longer to ejaculate when having sex or masturbating, and may even lose the ability to ejaculate altogether.

For women, problems include difficulty reaching orgasm as well as decreased vaginal lubrication and sensation.

Both men and women with MS may find they are less interested in sex than they were before. This could be directly related to the MS, or it could be the result of living with the condition.

Bladder problems

Bladder problems are common in MS.

These may include:

  • difficulty emptying the bladder completely
  • having to urinate more frequently
  • having a sudden, urgent need to urinate which can lead to unintentionally passing urine (urge incontinence)
  • having to get up frequently during the night to pass urine (nocturia)

Bowel problems

Many people with MS have problems with their bowel.

Constipation is the most common problem, it affects around half of people with MS. They may pass stools much less frequently than normal, and find this difficult.

Bowel incontinence is less common but is often linked to constipation. If a stool becomes stuck, it can irritate the wall of the bowel, causing it to produce more fluid and mucus that can leak out of the anus (back passage).

Speech and swallowing difficulties

Around a third of people with MS experience difficulty chewing or swallowing (dysphagia) at some point. In some cases, speech may also become slurred, or difficult to understand.

However, for most people with MS, speech and swallowing symptoms are mild and only last for a few minutes at a time. They are often at their worst during a relapse.

Benign MS

In a small number of cases a person has a small number of relapses followed by a complete recovery. This is known as benign MS.

A diagnosis of benign MS can only be made with confidence if you have been largely free of symptoms for more than 20 years.

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The exact reason why someone develops multiple sclerosis (MS) is not known. What is known so far suggests it is caused by a combination of environmental and genetic factors.

Autoimmune condition

MS is an autoimmune condition. This means 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 can disrupt the messages travelling along nerve fibres. It can slow them down, jumble them, send them down a different nerve fibre, or stop them from getting through completely.

When the inflammation goes away, it can leave behind scarring of the myelin sheath (known as sclerosis). These attacks can eventually start to destroy the myelin sheath (demyelination), which can damage the underlying nerve fibre.

Why do people develop multiple sclerosis?

It is not understood what causes the immune system to attack myelin, although there are several theories. Most experts agree that MS is probably caused by a combination of genetic and environmental factors. This means it's partly caused by genes you inherit from your parents and partly caused by 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 people who are related to someone with MS are more likely to develop it.

Researchers have found that if one twin develops MS then the second twin has around a one in four chance of also developing MS.

The chance of a brother, sister or child of a person with MS also developing MS themselves is less than one in 30.

It's possible 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.

Sunlight and vitamin D

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

It’s possible that people living further from the equator are exposed to less sunlight and, therefore, have less vitamin D in their bodies. 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.


Smoking is another factor that appears to increase someone’s risk of developing MS. It is not yet clear exactly why this is, although one theory is that the chemicals in the cigarette smoke affect the immune system.

Viral infection

Another theory is that a virus may be involved in the development of MS. The Epstein-Barr virus (EBV) has been the subject of most of the current studies.

MS is thought to be an autoimmune condition, where the body's own immune system attacks healthy tissue. One possible explanation is that a virus might cause a strong response from the immune system, which leads it to target healthy parts as well as the virus.

More research is needed to further understand how EBV may increase the risk of developing MS.

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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 MS, you should see a neurologist within six weeks.

Read more about waiting times in the NHS.

Diagnostic tests

Diagnosing MS is complicated because no single laboratory test can positively diagnose it.

Several conditions have symptoms similar to those of MS, so your neurologist may rule them out first.

It may also not be possible to confirm a diagnosis if you have had only one ‘attack’ of MS-like symptoms. A diagnosis can usually only be made with confidence once there is evidence of at least two separate attacks.

To confirm 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 your nerve pathways are damaged.

Magnetic resonance imaging (MRI) scan

An MRI scan creates a detailed image of your brain and spinal cord.

MRI scans can show whether there is any damage or scarring of the myelin in your central nervous system. The results of the MRI scan confirm a diagnosis in over nine out of 10 people who have MS.

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.

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

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.

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 very similar condition called neuromyelitis optica (NMO).

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.

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

  • you have two relapses of your symptoms more than 30 days apart
  • 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
  • you have become steadily more disabled for at least six months, with or without relapses

MS never starts out as secondary progressive. However, it is possible for someone to be told they have this type if they have had unexplained symptoms for some time.

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 antibodies in the fluid surrounding your brain and spinal cord

In rare cases, some people with primary progressive multiple sclerosis can have relapses. This can make it even harder to clearly identify what type of MS they have.

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The National Institute for Health and Clinical Excellence (NICE) has published a clinical guideline for MS. The guideline provides comprehensive evidence-based information on the benefits and limitations of various methods of diagnosing, treating and caring people with MS. This helps health professionals and patients decide on the most appropriate treatment.

The NICE guideline states that if you have MS, you should have access to a specialist neurological rehabilitation team. This is because MS is a complex disorder that can impact on many aspects of your life so you will need to receive treatments from a number of different health professionals working together.

Members of your care team may include:

  • a neurologist (a specialist in treating conditions that affect the nervous system)
  • a physiotherapist
  • a speech and language therapist
  • an occupational therapist
  • a continence adviser
  • a psychologist
  • a social worker
  • a pharmacist
  • a specialist MS nurse who will often serve as a point of contact

You should have a way of contacting your team, for example by calling an MS specialist nurse. You should have someone who gives you reliable information about MS and its symptoms and treatments, and the wider issues that can affect people with MS and their family or carers.

Treatment overview

There is no cure for MS, but treatments can relieve symptoms and reduce the number of relapses someone has.

If your symptoms are mild, you may not need treatment unless you experience a relapse.

Treatment for MS can be split into three main categories:

  • treatment for relapses of MS symptoms (steroids)
  • treatment for specific MS symptoms
  • treatment to reduce the number of relapses (disease-modifying medicines)

MS relapses

If you think you are having a relapse, you should see your GP or MS specialist nurse. Sometimes a flare up of symptoms can be caused by something other than a relapse, such as an infection, so your GP or nurse needs to check for other possible causes.

If your symptoms are the result of a relapse, you may be given a three to five day course of a high-dose steroid, called methylprednisolone, to help speed up your recovery. This can be given either orally as tablets, or intravenously (injected into a vein). You may receive the treatment in hospital or at home.

It's not fully understood how steroids 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 reduce the amount of fluid around any nerve fibre damage.

While steroids can be useful in helping you recover from a relapse, they do not affect the outcome of the relapse. They also do not alter the course of the disease or prevent further relapses.

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

Specific MS symptoms

If you have MS, you may have several different symptoms, which can vary in severity. There are treatments that can relieve each specific symptom, although some symptoms are more easily treated than others.

Visual problems

MS-related visual problems will often improve on their own, usually within a few weeks, so you may not need any treatment. However, if your symptoms are particularly severe, you may be prescribed steroids to help speed up recovery.

If you have problems with eye movement (nystagmus), you may be prescribed medication such as gabapentin, baclofen or clonazepam.

Muscle spasms and spasticity

Muscle spasms and spasticity can be improved with physiotherapy. Stretching movements can help prevent spasticity (stiffness). You may be referred to a physiotherapist trained in MS treatment if muscle spasms and spasticity are restricting your movements.

If your muscular spasms are more severe, you may be prescribed a medicine that can relax your muscles and reduce spasms. This will usually be either baclofen or gabapentin, although there are alternative medicines, such as tizanidine, diazepam, clonazepam and dantrolene.

These medicines all have side effects, such as dizziness, weakness, nausea and diarrhoea, so discuss which would be best for you with your GP or MS specialist nurse.

Medicines and physiotherapy may not be enough to control muscle spasms and spasticity. 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 carbamazepine, or with an antidepressant called amitriptyline.

Musculoskeletal pain

Living with MS can cause stresses and strains to the muscles and nerves in your body.

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 or antidepressants (which can also help with pain). Alternatively, you may have a device that stimulates your nerve endings, known as a transcutaneous electrical nerve stimulation (TENS) machine.

Mobility problems

Mobility problems are often the result of muscle spasms and spasticity or muscle weakness. They can also be caused by problems with balance or dizziness.

The treatment you receive for your mobility problems will depend on what is causing them.

If you have mobility problems, it's best to try to prevent muscle spasms and spasticity in the first place with physiotherapy or medication (see above). Your muscles can tighten to the point where it's 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 relax your muscles.

Muscle weakness can be helped by strengthening exercises or learning to compensate for weakness by using other muscles.

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

Cognitive problems (difficulty with thought and memory)

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

You should be referred to a clinical psychologist, who will assess your problems and suggest ways to manage them.

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. This could be a clinical psychologist. They may suggest treatment with an antidepressant. If you do not want antidepressants, learning techniques to control your emotions can help.

People with MS who have depression can be treated with antidepressants. If you often feel anxious or worried, your GP or neurologist may prescribe antidepressants or benzodiazepines, which are a type of tranquilliser that have a calming effect. Clinical psychologists can help you with depression by using psychotherapy, such as cognitive behavioural therapy (CBT). If you have severe or persistent depression, you may be referred to a psychiatrist for further advice.

Fatigue and tiredness

Many people with MS experience extreme tiredness. Your GP or MS specialist nurse should assess this to see if there's another reason for your fatigue other than MS, such as medication or poor diet.

If your fatigue is caused by MS, you may be prescribed medication called amantadine, although it may only have a limited effect. You should also be given general advice on ways to manage 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. This will help make the need to pass urine more predictable. If these medicines do not work, you may be prescribed a newer medicine called mirabegron. The need to pass urine frequently at night can be treated with a medicine called desmopressin.

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

You may be referred to a continence adviser or urologist, who can offer specialist treatment and advice, such as botulinim toxin, 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.

More severe constipation may need to be treated with suppositories, which are inserted into your bottom, or an enema. An enema involves having a liquid medication rinsed through your bottom and large bowel, 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.

Disease modifying medicines

MS cannot be cured, but if you have relapsing remitting MS there are treatments that can reduce the number and severity of relapses. These treatments may also help slow the progression of MS, although research into their long-term effects is limited.

There are a number of different medicines available, depending on criteria such as the number of relapses you have had.

Disease-modifying medicines reduce the amount of damage and scarring to the myelin in your central nervous system, which cause MS relapses.

Disease-modifying medicines are not suitable for everyone with MS. They are only prescribed to patients with relapsing remitting MS (RRMS) and secondary progressive MS (SPMS) who meet certain criteria.

Interferon beta

The types of interferon beta licensed for use in the UK are interferon beta-1a (Avonex and Rebif) and interferon beta-1b (Betaferon and Extavia). All four brands of interferon beta are given by injection.

You may be offered treatment with one of the interferon betas if you have had at least two relapses in the past two years. They can also be prescribed to people with secondary progressive MS who are still having relapses, as long as those relapses are the main cause of their increasing disability.

All interferons can cause mild side effects, such as flu-like symptoms (headaches, chills and mild fever) for 48 hours after they are injected. Interferon beta is not suitable for people 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're pregnant while taking interferon beta, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

Glatiramer acetate

One brand of glatiramer acetate, called Copaxone, is licensed for use in the UK. Glatiramer acetate 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. Glatiramer acetate is only licensed for use by people with relapsing remitting MS (RRMS).

You may be offered treatment with glatiramer acetate if you have had at least two relapses in the past two years.

Like interferon beta, glatiramer acetate is not suitable for people 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're pregnant while taking glatiramer acetate, see your GP or MS nurse as soon as possible to discuss an alternative treatment.


Teriflunomide, branded as Aubagio, is an oral tablet taken once a day. It is generally well tolerated, although some people may have side effects including liver problems, nausea, headaches, diarrhoea, and hair thinning or loss.

You may be offered treatment with teriflunomide if you have had at least two relapses in the past two years.

Teriflunomide is not suitable for people with severe liver problems, people 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're pregnant while taking teriflunomide, see your GP or MS nurse as soon as possible to discuss an alternative treatment.


Natalizumab, branded as Tysabri, is injected into a vein (intravenously) once every 28 days. It can cause several side effects, including headaches, nausea and vomiting, and an itchy rash. In rare cases, natalizumab has been linked to an increased risk of progressive multifocal leukoencephalopathy (PML). PML is a rare but serious condition that breaks down myelin on nerve fibres, in a similar way to MS. It can cause problems with vision and speech and, eventually, paralysis.

You may be offered treatment with natalizumab if you have had either:

  • an increase in the severity or number of relapses, despite treatment with one of the interferon betas or glatiramer acetate
  • two or more relapses in one year and an increase in lesions, shown on an MRI scan

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


Fingolimod, branded as Gilenya, is an oral tablet taken once a day. It is generally well-tolerated, although some people may experience side effects including an increased risk of infections, a problem with vision known as macular oedema, and liver problems. When you take the first dose of fingolimod, it can cause your heart rate to slow down or become irregular. Because of this you would take the first dose in hospital so you can be monitored.

You may be offered fingolimod if you are still having relapses despite treatment with one of the interferon betas.

Fingolimod is not suitable for people with certain heart problems, people 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're pregnant while taking teriflunomide, see your GP or MS nurse as soon as possible to discuss an alternative treatment.

Clinical trials

Much progress has been made in MS treatment thanks to clinical trials, where new treatments and treatment combinations are compared with standard ones.

All clinical trials in the UK are carefully overseen to ensure they are worthwhile and safely conducted. Participants in clinical trials sometimes do better overall than those in routine care.

If you're asked to take part in a trial, you will be given an information sheet about the trial. If you want to take part, you will be asked to sign a consent form. You can refuse to take part or withdraw from a clinical trial without it affecting your care.

Complementary and alternative therapies

Some people with MS find complementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of MS. However, there is very little or no clinical evidence to show they are effective in controlling MS symptoms.

Many people think that complementary treatments have no harmful effects. However, they can be harmful and, as with any complementary or alternative treatment, it's never a good idea to use them instead of the medicines prescribed by your doctor. If you decide to use an alternative treatment along with your prescribed medicines, it's important to let your doctor know.


It has been suggested that a diet high in linoleic acid may reduce the duration and severity of MS relapses and slow the progression of the condition. However, there isn’t enough medical evidence to recommend this treatment.

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Living with

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


Self-care is an integral part of daily life. It means you take responsibility for your own health and wellbeing, with support from 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 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 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.

Relationships and support:

Coming to terms with a long-term condition such as MS can put a strain on you, your family and your friends. It can be difficult to talk to people about your condition, even if they're close to you.

Dealing with the deterioration of symptoms, such as increasing difficulty with movement and tremors, can make people with MS very frustrated and depressed. Inevitably, their spouse, partner or carer will feel anxious or frustrated, too.

Be honest about how you feel and let your family and friends know what they can do to help. Don't feel shy about telling them that you need some time to yourself, if that's what you want.


If you have any questions, your GP or MS nurse may be able to reassure you. You may find it helpful to talk to a trained counsellor or psychologist, or to someone at a specialist helpline. Your GP surgery will have information on these.

Some people find it helpful to talk to other people who have MS, either at a local support group or in an internet chatroom.

Having a baby:


Being diagnosed with MS shouldn't affect your ability to have children. However, some of the medication prescribed for MS may affect fertility in both men and women. If you're considering starting a family, discuss it with your healthcare team, who can offer advice.


Women with MS can have a normal pregnancy and deliver a healthy baby. Some women find that they are less likely to have a relapse of symptoms during the pregnancy but may have an increased risk of relapse after the pregnancy. Women with MS can have a normal birth and breastfeed afterwards.

You may need to continue taking medication throughout your pregnancy. However, some medication shouldn’t be taken during pregnancy, so it's important to discuss this with your healthcare team

Money and financial support

If you have to stop work or work part time because of your MS, you may find it hard to cope financially. You may be entitled to one or more of the following types of financial support:


If you've been diagnosed with MS, you must tell the Driver and Vehicle Licensing Agency (DVLA) and also inform your insurance company.

You won't necessarily have to stop driving. You will be asked to complete a form providing more information about your condition, as well as details of your doctors and specialists. The DVLA will use this to decide whether you are fit to drive.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 03/03/2015 14:21:55

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