People with MS often have cognitive changes such as difficulty processing information, planning, making decisions and understanding and remembering things. This can impact their work, leisure and personal life.
Other health conditions can cause similar symptoms to MS, so it’s important that your doctor investigates any new symptom you have.
Symptoms of multiple sclerosis vary depending on which parts of the central nervous system are affected. For example, MS attacks the myelin sheaths that wrap around nerve fibers in the brain and spinal cord (the body’s message center). This causes numbness, difficulty moving arms or legs, problems with balance and coordination, eye trouble such as double vision or eye pain, bowel or bladder issues like constipation or loss of control over urination, tremors or spasticity, and speech or language difficulties. Fatigue is a common problem.
When you have new symptoms, see your doctor right away. It’s important to rule out other reasons for your symptoms, such as a pinched nerve or illness. Your doctor may also want to get new MRI scans or other tests.
If your doctor suspects you have MS, he or she will probably start with a test called an MRI. The MRI will show areas of scar tissue, called plaques, in different parts of your brain and spinal cord. These plaques occur when your immune system attacks myelin and other parts of the central nervous system, and they appear as white spots on MRI images.
Another way your doctor can tell if you have MS is by looking at your history. People who have had MS for a long time usually have the form of the disease known as relapsing-remitting MS. This means that you have episodes of symptoms and periods of inactivity, called remissions. It can take weeks, months or even years between relapses. Other forms of MS include progressive MS, which causes a gradual and steady decline in function; Marburg variant MS, which causes rapid symptoms and disability; and Balo’s concentric ring sclerosis, which is characterized by rings of myelin damage in the brain.
Various treatment options can help reduce fatigue and improve other symptoms of MS. Treatments can include exercise, vitamin D supplements, stress management programs, medication to ease attacks and relieve symptoms, and rehabilitation therapy which helps you learn to cope with your changing abilities. Your neurologist and MS nurse can help you find the right treatments for you.
The symptoms of MS are caused by the nerves in the brain and spinal cord being damaged. They can affect any part of the body and include: Muscle weakness, numbness or tingling (a pins and needles feeling), problems with your bladder, speech and vision and balance and co-ordination. Symptoms often come and go, so it can be hard to know when you should see your doctor. If you have any symptoms that worry you, it’s important to seek help early as treatment can help reduce the damage and speed up recovery.
Your doctor may refer you to a specialist in conditions that affect the nervous system (neurologist). Before making a diagnosis, they will rule out other reasons for your symptoms, such as a stroke, tumour or infection. They will ask you about your family history, any other medical problems and any symptoms you have had in the past. Your neurologist will also examine you and carry out tests to check your balance, movement, vision and the strength of your arms and legs. They will also check how well your brain is sending and receiving signals with a series of tests called evoked potentials.
If you have had at least two attacks of MS-like symptoms, known as a relapse, your doctor can make a diagnosis of MS. They will use MRI scans to look for areas of damage to the myelin sheath in your brain and spinal cord, as these can be seen with these scans. They will also take a sample of the liquid that cushions your brain and spinal cord, called cerebrospinal fluid (CSF), to test for certain proteins that are found in people with MS.
Other tests that can be used to help with the diagnosis of MS include an eye test, which can detect problems like blurred vision. They can also use magnetic resonance spectroscopy (MRS), which uses strong magnets and radio waves to produce detailed images of the inside of your body, including the brain and spinal cord. This can show if there is any damage or inflammation in these areas.
A neurologist will test how well your central nervous system is working, checking things like muscle coordination, balance, vision, strength, reflexes and sensation. They might also carry out a spinal tap (lumbar puncture), which involves inserting a needle into your spine to withdraw fluid that may show abnormal levels of certain proteins associated with MS. They will also look at images of your brain and spinal cord taken by magnetic resonance imaging (MRI). This will help them see if there are any signs of MS such as lesions.
The treatment options for MS include medication to control your symptoms, lifestyle changes and exercise to improve mobility and fitness. A neurologist will recommend different treatments depending on what type of MS you have. If you have relapsing-remitting MS, there are several disease-modifying therapies (DMTs) that can reduce relapses and slow down progression of the condition.
One of these is glatiramer acetate, which works by changing the balance of immune cells in your body. The most common side effects are flu-like symptoms, but these fade with continued treatment. The other commonly used DMT is interferon beta, which affects the way certain molecules regulate your immune system. Side effects include a feeling of being unwell, depression and elevated liver enzymes.
Corticosteroids, which are used to treat flare-ups of MS, reduce inflammation and speed up the repair of damaged nerves by inhibiting the production of inflammatory chemicals in your brain. They can cause serious side effects such as weight gain, thinning of the bones and increased risk of infection.
Alternative and complementary treatments can also help manage symptoms, such as massage, yoga, Pilates or breathing exercises which can relax tight muscles, and spasticity, a stiffness in the joints which can result from MS. There are also dietary supplements, vitamins and herbs that can have an impact.
If you have progressive or very active MS, your neurologist may suggest a combination of drugs to decrease the chance of relapses and reduce your symptoms. One drug, ocrelizumab (Ocrevus), treats both relapsing-remitting and primary-progressive forms of the disease.
You should see your neurologist at least once a year to discuss your symptoms and review your medication. If your symptoms are causing you distress or interfere with your daily life, don’t wait until your next appointment – ask to be seen sooner.
There’s no cure for MS, but treatments can improve symptoms and help people with MS live full lives. These include medications that slow down the disease, treat attacks, or relieve pain. Other options, such as exercise, acupuncture, and cognitive therapy, can also ease symptoms.
Some people develop a more severe form of MS that can lead to progressive loss of function. This can mean trouble walking, vision problems, and problems with bladder or bowel control. People with this form of the disease may need a feeding tube to get nourishment if they can’t eat or drink on their own.
Even though MS is a chronic condition, it can be possible to live a normal life, with good support from family and friends. People with the disease should continue to try to keep active, eat a balanced diet, and stay well hydrated. They should avoid smoking and avoid stress, which can make their symptoms worse.
It’s important for people with MS to talk about their feelings and ask for help when they need it. They should also tell their close family and friends about the disease, and give them as much information as they feel comfortable with. People caring for someone with MS should take steps to look after themselves, too.
A diagnosis of any illness can be emotional and overwhelming. Seeking mental support from family, friends, other people with MS, or a professional counselor can be helpful.
Some people may need help with daily living activities, such as cooking, bathing, and cleaning. If you or someone you care about has these challenges, ask your local authority for a care and support assessment.
Many people with MS find that their symptoms improve with time, especially if they’re taking medication to manage them. Others find their symptoms become more frequent or severe over time. This is why it’s important to monitor your symptoms and talk to your doctor about treatment options. New research is constantly changing the way doctors think about and treat this condition. You can learn more about the latest findings in MS research from NIH’s RePORTER website.
People with MS often experience problems with their balance, movement and sensation. These can be very worrying, especially if they occur suddenly.
Early symptoms include fatigue and vision problems. If you have these symptoms and also have a fever or infection, it’s worth seeing your doctor straight away. They might refer you to a specialist neurologist.
Fatigue is a common and very disabling symptom in people with MS. It may occur in up to 80% of people with MS and can happen at any time during the disease course. It has also been shown to be more disabling than other symptoms such as pain and vision changes. Fatigue is defined as an overwhelming sense of tiredness and lack of energy that can cause you to be unable to carry out your usual activities. It can be a feeling that can last a long time, or it can come and go. It can interfere with your work, family and social life.
It is thought that fatigue in MS is partly caused by damage to the nerves and partly due to other conditions that occur alongside MS, such as sleep disturbances and depression. The fatigue also may be a result of the medications that you take. Many of the drugs used to treat bladder dysfunction, spasticity and pain can make you feel tired. Read the warnings on your pill bottle and talk to your doctor about whether they could be causing your MS fatigue.
Fatigue can be difficult for family and friends to understand, and they may mistakenly believe that you are lazy or don’t want to do things. Educating them about MS and its effects is a good way to help them understand it better. It’s also important to discuss how your fatigue affects you and what makes it worse. This can help you and your family develop strategies for dealing with it. For example, you might find that exercising or avoiding caffeine and sugar helps you feel less tired. Keeping a healthy diet and drinking enough fluids can help as well.
Muscle weakness is another symptom that can be present in people with multiple sclerosis. This happens when the brain, spinal cord and nerves are damaged, so they cannot send signals that cause muscles to contract normally. This can lead to a loss of muscle strength that makes it harder to move or lift things. Some people may feel this symptom in one area of the body, but others may notice that all their muscles are weaker than usual.
The problem with muscle weakness is that it often happens little by little over time, so people may not realize how much they are losing until they find it difficult to get out of a chair or open a jar of pickles. It can also occur when a person is very hot or has been exercising for long periods of time.
There are many things that can make a person feel weaker, such as fatigue, pain and lack of sleep. It is important for doctors to determine whether the weakness is due to these factors or because of multiple sclerosis. This can be done by examining the person, checking for symptoms, and doing tests.
The most common signs of muscle weakness in people with multiple sclerosis are tingling and numbness, especially in the face, legs and arms. They can also experience the sensation of an electric shock when they move their neck, known as Lhermitte’s sign. They may also have trouble with their bladder, including the inability to empty the bladder or the feeling that they need to urinate immediately. They may also have difficulty walking, and some types of MS such as Marburg variant can cause fast progression of symptoms.
People with MS may have problems with their vision, such as blurred or doubled vision. This is caused by damage to the myelin sheath, a layer that covers nerve fibers in the central nervous system (brain and spinal cord). When this protective covering is damaged, it causes messages sent from the eyes to the brain to be delayed or disrupted. The exact cause of this damage isn’t known, but experts believe it’s due to a combination of genetic and environmental factors.
Symptoms of MS can be difficult to diagnose, as they can mimic the symptoms of many other health conditions. If you’re experiencing these symptoms, it’s important to see your doctor right away. Your healthcare provider will ask you questions about your past symptoms and perform a physical exam. They will also do a neurological examination to look for any signs of muscle weakness or problems with balance, sensation, or speech. They may also want to do a spinal tap — a small amount of fluid is taken from your spine, which can show abnormal blood cells or proteins related to MS. They may also order an MRI to get detailed pictures of your brain and spinal cord.
Most people with MS are diagnosed with relapsing-remitting MS. This means that they have episodes of new or worsening symptoms, called relapses, followed by periods of remission. However, some people’s symptoms gradually worsen without any relapses. This is called secondary progressive MS. Whether you have relapsing-remitting or secondary progressive MS, it’s likely that your doctor will recommend medications to reduce your symptoms and slow the progression of the disease. These medications can include corticosteroids, which reduce inflammation and suppress your immune system. Other medications that are used to manage symptoms of MS include difenoxin, interferon beta, glatiramer acetate, and natalizumab.
For many people living with MS, problems with their voice or how they speak are also a symptom of the condition. This is partly due to the fact that when myelin breaks down during a MS attack, nerves are damaged and are unable to transmit messages normally. The result is a variety of symptoms including slurred speech, swallowing issues, and difficulty remembering specific words (dysphasia).
Slurred speech is the most common of these problems and it is usually caused by weakness or poor coordination of muscles in the throat, mouth, and tongue. This can be very frustrating for individuals as they are unable to communicate their needs or wants to others. Swallowing changes may include an inability to chew or a feeling of having food stuck in their throat. In some cases, eating may become very difficult and can lead to social isolation if an individual struggles to get through the process of ordering meals in restaurants.
Other difficulties with speech can occur when lesions in various parts of the brain cause changes to normal speech patterns. These include a type of speech problem known as scanning dysarthria where the regular “melody” of the person’s speech is disrupted and there are unusually long pauses or syllables within words.
All of these problems with speech can be managed in different ways depending on the individual situation. A speech and language therapist can work with an MS patient to find strategies that are most suited to their own circumstances. This might involve learning how to use a communication device such as a sign language or finding ways of improving the quality of the voice by practicing exercises that focus on breath support and vocal production. It might also include taking certain medications that can help with tremors which can directly impact the way that people speak and are understood by others.
A change in mood is a common symptom that affects many people with MS. This is often called emotional lability and can manifest as sudden and unpredictable changes in your emotions. You may cry or laugh easily, have a hard time controlling your anger or experience inappropriate behaviour like sexual aggressiveness. This can have a negative impact on your relationships with your family and friends.
Emotional lability is related to the nerve damage caused by MS, especially in the areas of the brain that control your emotions. Sometimes your inner feelings aren’t matched by your outward expression, so you might react to a sad event with laughter or with tears. You can also have a difficult time identifying the causes of your emotions: the triggers that make you cry or laugh might not be clear, and they could appear out of proportion to the situation.
Mood changes can also be brought on by grief and sadness, stress and anxiety or depression. It is normal to feel these emotions as you come to terms with the losses and challenges that MS brings. They might also be triggered by an infection, heat or exercise or by the fatigue that can come with MS.
Rarely, your Mood changes might be accompanied by episodes of euphoria. This is more likely to happen if you have advanced MS with lots of lesions and brain shrinkage. Euphoria can also be a side effect of some drugs used to treat MS. Talk to your doctor about this symptom. He or she can help you find ways to deal with it. If the euphoria is severe, you might need to seek medical attention.
There’s no cure for multiple sclerosis, but treatments can decrease the number of MS attacks (relapses) and slow the long-term disability progression. Medications may reduce fatigue, relieve muscle spasms and improve bladder and bowel control.
Many conditions can cause symptoms similar to those of MS, such as trigeminal neuralgia and optic neuritis. Getting an accurate diagnosis is important to get the right treatment.
Medications are an important part of managing MS, and they can help treat relapses and change the course of the disease. There are several different drugs that can help manage symptoms, complications and relapses, as well as reduce the damage caused by MS. Medications are sometimes called disease-modifying therapies, or DMTs, because they work to lower the damage and disability caused by the disease by changing how your body works.
DMTs affect the immune system and can help stop or reverse the destruction of the myelin sheath, which surrounds your nerve cells and helps them transmit signals quickly and effectively. They also help reduce the amount of new lesions, or areas of damage and scarring in the brain and spinal cord (as seen on MRI scans), which cause your symptoms to flare up.
There are currently eight self-injected medications that have been approved by the FDA for treating relapsing-remitting MS (RRMS), and one IV drug that has been approved for use in people with relapsing-remitting or progressive MS (PPMS). These medications, which are all immunomodulators, do not make you feel better right away, and they don’t address specific MS symptoms, but they can reduce the number and severity of relapses and the speed at which your disability worsens over time.
If you have a flare up of symptoms, your doctor or MS nurse may prescribe steroids or other medications to help reduce inflammation and help your body heal. You should always follow your doctor’s instructions when taking any medication.
Another treatment option is plasmapheresis, which involves separating blood cells from plasma and returning the plasma to your body along with fresh plasma or a plasma substitute. Plasmapheresis can help to reduce the number of relapses and improve the quality of life of people with RRMS, as well as prevent or delay a second clinical attack (relapse) in those who have clinically isolated syndrome (CIS), the first symptom that many people experience before being diagnosed with MS.
Remember, that if you have a flare up it is important to see your GP or MS nurse as soon as possible. It could be an infection or something else that is causing your symptoms to flare up, so it’s worth getting checked out.
Cognitive rehabilitation therapy helps people who have cognitive impairments as a result of MS. These impairments may include problems with memory, attention, and reasoning skills. The goal of cognitive rehabilitation therapy is to help people overcome these impairments so they can better function in their everyday lives. There are several different approaches to this type of therapy.
Some of these therapies use a combination of medications and other techniques. For example, some therapies include using exercise to improve balance and flexibility. Other therapies involve relearning specific tasks that have been lost, such as writing and speaking. In some cases, a person will use an electronic device to help him remember things or to communicate with others.
Many people with multiple sclerosis also try complementary treatments and therapies to feel better. Some of these therapies are not proven to be effective, but some people find them helpful. A doctor can tell you which ones might be right for you.
There are medications that can help with some of the most common symptoms of MS, including fatigue, pain, and depression. Some of these medications are antidepressants, such as duloxetine or gabapentin, and some are pain relievers, such as amitriptyline or carbamazepine. These medicines are sometimes taken with a prescription, but other times you can buy them over-the-counter.
Disease-modifying therapies are a group of medications that can lessen the number of MS relapses and reduce the amount of damage or scarring to the nerve sheaths. These drugs can also slow the rate of disability accumulation. They are prescribed to people with relapsing-remitting MS and some people with primary progressive or secondary progressive MS who have relapses. These medicines can have serious side effects, and they are not right for everyone with MS.
New MS treatments are being developed all the time. Some of them are being tested in clinical trials, which are carefully monitored to ensure that they are safe and effective. If you are interested in taking part in a clinical trial, speak with your doctor. There are 61 MS studies that need volunteers in the UK, and your doctor can help you find one that is right for you.
Physical therapy can help build strength and ease the pain, spasms and mobility issues that come with MS. Your therapist can teach you exercises that focus on flexibility, range of motion and balance, as well as show you how to use devices such as walkers and wheelchairs. Exercises can also include yoga, tai chi and stationary bicycling. Sleep problems can be a common symptom of MS, so your doctor may recommend sleep tests to rule out conditions such as obstructive sleep apnea.
Getting plenty of rest, eating healthfully and exercising regularly can help manage symptoms and improve your quality of life. Your therapist can help you develop an exercise plan that suits your condition and needs, such as walking, swimming or low-impact aerobics. A specialized form of exercise called aquatherapy — or “recreational aquatic therapy” — is available for people with MS who have trouble participating in traditional gym programs. This involves lying in a tub of warm water and performing movements designed to reduce fatigue, improve strength and balance, and encourage social interaction.
If you have a relapsing-remitting type of MS, your neurologist might prescribe a disease-modifying drug (DMT) to slow down progression of the disease. These drugs curb the immune system, so it doesn’t attack the protective sheath that surrounds your nerves. You will need blood work to check for side effects, which can include flu-like symptoms, infections and liver damage.
In clinical trials, these medications have decreased relapse rates and slowed disability progression in people with relapsing-remitting MS. Another treatment option is ocrelizumab (Ocrevus), an antibody that targets B cells, which are responsible for attacking your myelin sheath. This DMT has been shown to significantly decrease relapses and speed up recovery in people with relapsing-remitting and primary-progressive multiple sclerosis.
Your neurologist might also consider ozanimod (Zeposia) or siponimod (Ponvory), which are oral drugs that decrease relapses and brain lesions. Cladribine (Mavenclad) is an FDA-approved medication that decreases relapses and slows progression in people with relapsing-remitting or secondary progressive MS. Your doctor may also prescribe corticosteroids to reduce inflammation and pain.
For some people, social support is an important part of their MS treatment. Studies have shown that having a good network of support can help with fatigue, depression, pain, and cognitive problems. It can also be helpful in finding out about new treatments and support groups. You can find support groups through your doctor, local MS societies, or online forums. You can also get a referral to see a therapist or counselor. Your insurance might cover these costs.
In addition, some people use complementary and alternative medicine (CAM) alongside their prescription medications. CAM may include things like massage, herbal remedies, and acupuncture. These methods can help with some of the side effects of the medications, like bloating, nausea, and diarrhea. It is best to talk to your doctor before trying CAM. They will be able to advise you on what is safe and will not interfere with your prescriptions.
Many people with relapsing remitting MS have periods of no disease activity (remission) in between their relapses. These periods might last a few months or years. Then, symptoms might return and start to worsen again. It is not known why this happens. However, some researchers think that certain social determinants might play a role in how the disease progresses.
For example, people from low-income backgrounds are more likely to have a worse outcome when diagnosed with MS. This might be because they are less likely to attend their appointments or to have a health-care plan. Other factors could be differences in symptom severity, which might not be picked up by the doctors. This is why it is important to get your health-care needs reviewed regularly.
Research into the influence of a person’s social circumstances on their MS outcomes is growing. But, there are many barriers to understanding this issue in more detail. These include: low enrolment of minoritized populations in clinical trials; limited data about disease progression, especially in relation to social determinants; and reference scores and norms that are based on white control groups.
There are four main types of MS. Doctors classify them based on the course of the disease, early symptoms and severities, and how many brain lesions are present at diagnosis.
Relapsing-remitting MS is the most common form of the disease. It’s characterized by attacks (called relapses) followed by periods of improved or no symptoms — called remissions.
Relapsing-Remitting MS (RRMS) is the most common type of multiple sclerosis. It’s the form that most people are first diagnosed with. In this form, you have attacks or flare-ups of symptoms — also called relapses — that are followed by periods of recovery or remission. RRMS can be harder to treat than other types of MS, but there are medications that can help reduce your symptoms and prevent relapses.
During an MS attack or relapse, the myelin sheath that wraps around nerve fibres is damaged. Without myelin, nerve fibres can’t send signals as quickly or easily. This can cause a variety of symptoms, depending on which parts of the central nervous system are affected. Some of the most common symptoms include blurred vision, difficulty walking, and a feeling of being squeezed by a tight band or hug.
When you have a relapse, your symptoms come on very suddenly and may last for hours or days. They may get progressively worse. In some cases, you might need to stay in hospital if your symptoms are very severe. After your relapse, you might need time to recover before you can return to work or school.
About 85% of people with MS have RRMS at some point in their lives. The relapsing-remitting label doesn’t predict how your MS will progress, but it can help your doctor find the best treatment for you.
Your doctor will take a history of your symptoms and perform a physical exam to rule out other conditions. They might also do brain scans, such as an MRI, to look for signs of demyelination. They may also order spinal fluid tests to see if you have any inflammation or infection. They might also use other tests, such as evoked potential tests, to watch how nerves respond to visual or electrical stimuli.
Treatment for relapsing-remitting MS usually involves taking medicines to reduce nerve inflammation. These are called disease modifying therapies, or DMTs. The most commonly used DMTs for RRMS are glatiramer acetate, interferon beta, and methylprednisolone acetate. They are given orally or intravenously. They can help slow the progression of your MS, but they won’t cure it.
Many people with RRMS will eventually move to this progressive form of the disease. It can be characterized by a gradual worsening of symptoms without relapses or new activity on an MRI scan. This is believed to be due to increased accumulation of myelin damage and loss, and higher levels of axonal degeneration. It is thought that this progression can be partly slowed by effective treatments of MS (see below).
There are no clear clinical, imaging, immunologic, or pathologic criteria to mark the transition from RRMS to SPMS. Some experts believe that this change occurs in about half of all people with RRMS after 10 years of the diagnosis, while others feel that it can happen earlier or later.
During relapses and remissions in RRMS, there are times when the body’s attacks on the myelin sheath cease or stop (remit). These periods are called “resting” or “active” periods. During active periods, the neurologist may monitor your condition by checking for signs of inflammation (a relapse) or new lesions on MRI. These are often accompanied by the resumption of symptoms, but they will not last as long as before.
The most common cause of this progression is the destruction of myelin sheaths by oligodendrocytes. The myelin sheaths are responsible for the speed and efficiency of nerve impulse transmission, but once they are damaged they can slow down or even stop transmission altogether. This leads to the development of scar tissue, or sclerosis, giving the disease its name.
Once myelin sheaths are lost, they cannot regenerate. The axons (nerve fibers) within the lesion will continue to function but without the protective myelin sheath, and over time the axons may become degenerated leading to permanent nerve damage. When the axons are damaged they also stop transmitting properly. This can lead to a variety of symptoms and impairments including muscle weakness, balance problems, spasticity, fatigue, depression, and memory issues.
It is important to keep in mind that most people with RRMS who develop SPMS will have a milder course of the disease than their parents, siblings, or other first-degree relatives. This is because people who are more genetically predisposed to developing MS are more likely to develop this form of the disease. There are a number of disease-modifying therapies (DMTs) that can help slow the progression of the disease, but so far only Mavenclad (Cladibrine), and Mayzent (Siponimod) have been specifically approved for this purpose.
About 10-15 of every 100 people diagnosed with MS have PPMS. Unlike RRMS, there are no relapses with this type of MS and symptoms get steadily worse over time. This is called progression and it usually starts at the outset of MS.
There is a range of PPMS symptoms but the most common is progressive disability. You may experience weakness, problems with balance and vision or tingling or pins and needles in your hands or feet. Your mobility can also be affected and it’s not uncommon for you to need a walking aid or wheelchair. In some cases, the disease will progress to a stage where you can’t walk at all and may be fully paralysed.
Your healthcare provider can diagnose PPMS by doing a physical exam and asking about your history of symptoms. Your healthcare provider may also order an MRI scan of your brain and spinal cord. They might also do a spinal tap (lumbar puncture) to collect a sample of your fluid and look for signs of MS in it. Other tests may include optical coherence tomography (OCT), which looks at the nerve fibers in your eyes, and visual evoked potentials (VEP), which measure how well your optic nerves are working.
Symptoms of PPMS tend to get progressively worse, although there can be periods of stability or short-term minor improvements. Your healthcare professional will talk to you about how your symptoms are changing and help you manage them.
It’s recommended that you see your healthcare professional at least once a year. However, if you have a major change in your symptoms it might be better to see them more often. Keeping a simple diary of your symptoms can be helpful, too. It’s a good idea to note when they start, how bad they are and when they improve.
Currently, there is only one DMD, called Ocrevus (ocrelizumab), available for PPMS. It’s only suitable if you have been diagnosed with PPMS for 15 years or less, and are able to walk more than 20 metres (with or without a walking aid). Currently, this is the only DMD that has been proven to slow the progression of PPMS.
In this form of the disease, a person experiences a single episode of symptoms that are attributed to inflammation and loss of myelin sheaths (demyelination) in one area of the brain or spinal cord. Myelin sheaths are the structures that wrap around nerves in the central nervous system and help transmit nerve signals from the brain to the rest of the body. When the sheaths are damaged, messages are interrupted and can cause symptoms affecting the brain, eyes or spine.
A neurologist will carry out tests to assess whether you have CIS, and will look for evidence of previous episodes in your health records. You may have a magnetic resonance imaging (MRI) scan of your brain and spinal cord, and might be given a dye to make the white patches caused by demyelination show up more clearly on the scan. You might also have a test to check your blood pressure and to see whether there are abnormalities in the white matter of the brain.
CIS is the first attack of symptoms in MS, and some people never experience any further episodes. If the neurologist decides that you have CIS, they will consider starting you on disease-modifying therapies (DMT) to delay or prevent the onset of full MS.
The neurologist will decide on the most appropriate treatment for you depending on the results of your MRI scan and how you feel. They will discuss the benefits, risks and costs with you, as well as how likely you are to develop a progressive or relapsing-remitting MS.
We don’t know what causes CIS, but we do know that it is more common in people who have a close relative with MS and in those living far from the equator. It’s also more common in women than in men.