Multiple Sclerosis

Multiple Sclerosis (MS) is a long-term inflammatory condition of the central nervous system (brain and spinal cord). It happens when the body’s immune system mistakenly attacks myelin – the protective coating around nerve fibres – leading to scarring (“sclerosis”) and disrupted signals between the brain and the rest of the body.

MS can cause a wide range of symptoms, including problems with movement, balance, vision, sensation, bladder and bowel control, fatigue and cognition. It is one of the most common causes of serious neurological disability in adults of working age in the UK.

At The Royal Buckinghamshire Hospital, we provide specialist inpatient neurorehabilitation for people living with MS, focusing on symptom management, maintaining independence and supporting quality of life at different stages of the condition.

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Types of Multiple Sclerosis

MS is usually classified into several main types, depending on how symptoms evolve over time:

• Relapsing–remitting MS (RRMS)
  • The most common form at diagnosis.
  • Symptoms flare up in relapses (attacks or episodes) followed by periods of remission, when symptoms partly or completely improve.
• Secondary progressive MS (SPMS)
  • Some people with RRMS later develop SPMS, where there is a more steady progression of disability over time, with or without superimposed relapses.
• Primary progressive MS (PPMS)
  • From onset, symptoms gradually worsen over time without distinct relapses and remissions.
• Clinically isolated syndrome (CIS)
  • A first isolated episode of neurological symptoms caused by inflammation or demyelination in the central nervous system. Some people with CIS later go on to develop definite MS, while others do not.

The type of MS you have influences treatment options, monitoring and rehabilitation goals, but all types can benefit from symptom-focused support and neurorehabilitation.

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Symptoms

MS affects people very differently. Symptoms can come and go, change over time and vary in severity. Common symptoms include:

Movement and Balance

• Weakness or heaviness in one or more limbs
• Stiffness, spasticity and muscle spasms
• Poor balance or coordination (ataxia)
• Tremor
• Difficulties with walking (gait problems), tripping or falls

Sensation and Pain

• Numbness, pins and needles or altered sensation
• Electric shock sensations down the back or into limbs (Lhermitte’s sign)
• Neuropathic pain (burning, shooting, stabbing pain)
• Sensitivity to temperature, especially heat

Vision

• Blurred or dim vision, usually in one eye at a time (optic neuritis)
• Pain behind the eye, made worse by eye movements
• Double vision (diplopia)
• Reduced contrast or colour vision

Fatigue and Cognition

• Overwhelming fatigue that is out of proportion to activity
• Difficulty concentrating or multitasking
• Slower processing speed and “brain fog”
• Problems with memory, planning and decision-making

Bladder, Bowel and Sexual Function

• Urinary urgency, frequency or incontinence
• Difficulty emptying the bladder fully
• Constipation or bowel incontinence
• Changes in sexual function

Mood and Emotional Changes

• Low mood and depression
• Anxiety
• Emotional lability (sudden or inappropriate laughing/crying)
• Changes in confidence and self-identity

Symptoms may be triggered or worsened by heat, infection, stress or fatigue, and can significantly affect daily life, work and family roles.

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Causes and Risk Factors

The exact cause of MS is not fully understood, but it is considered an autoimmune condition in which the immune system attacks myelin in the central nervous system. It likely arises from an interaction between genetic susceptibility and environmental factors.

Factors associated with a higher risk of MS include:

• Genetics – having a close relative (parent or sibling) with MS increases risk slightly.
• Previous Epstein–Barr virus (EBV) infection (the virus that causes glandular fever).
• Female sex – MS is more common in women than men.
• Smoking – associated with increased risk of developing MS and faster progression.
• Low vitamin D and reduced sunlight exposure – may contribute to susceptibility.

MS is not contagious, and there is currently no way to completely prevent it, but modifying risk factors such as smoking and vitamin D deficiency may be helpful as part of a broader management plan.

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Diagnosis

Diagnosing MS can be complex because many of the symptoms overlap with other neurological conditions. Diagnosis is usually made by a neurologist using a combination of clinical assessment and specialist tests.

The process may include:

• Detailed history and neurological examination
  • Documenting previous episodes of neurological symptoms
  • Looking for evidence of lesions affecting different parts of the central nervous system, at different times
• MRI scans of the brain and spinal cord
  • To identify areas of inflammation and demyelination (plaques or lesions)
  • MRI findings are central to modern diagnostic criteria
• Lumbar puncture (spinal tap)
  • To analyse cerebrospinal fluid for signs of inflammation
• Evoked potentials
  • Electrical tests assessing how quickly signals travel along visual or sensory pathways

Diagnosis is based on evidence that there has been “dissemination in space and time” – in other words, inflammatory lesions in more than one part of the central nervous system, occurring on more than one occasion.

Other conditions (such as neuromyelitis optica spectrum disorders, vascular, metabolic or structural disease) need to be ruled out before a diagnosis of MS is confirmed.

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Treatment and Management

There is no cure for MS at present, but there are many effective treatments and strategies to:

• Reduce the frequency and severity of relapses
• Slow disease activity in relapsing forms of MS
• Manage symptoms and maintain function
• Support emotional wellbeing and quality of life

Management is usually led by a neurologist and MS team, following national and international guidelines.

Disease-Modifying Therapies (DMTs)

For relapsing forms of MS, disease-modifying therapies aim to reduce new inflammatory activity and relapses. These include:

• Injectable therapies
• Oral tablets
• Infusions (intravenous treatments)

DMTs are usually prescribed and monitored in specialist MS centres, with regular MRI and clinical review.

Relapse Management

Acute relapses may be treated with:

• High-dose corticosteroids (oral or intravenous) to shorten the duration of symptoms
• Rehabilitation and therapy input to help recovery

Not all relapses require steroids; decisions are individualised.

Symptom Management

Many symptoms can be improved with targeted treatment, for example:

• Spasticity and spasms – physiotherapy, stretching, postural management, oral medications and, in some cases, botulinum toxin
• Pain – neuropathic pain medications, physio, occupational therapy and psychology
• Bladder and bowel dysfunction – medication, pelvic floor strategies, catheter or continence support, bowel programmes
• Fatigue – energy management, graded activity, sleep strategies, sometimes medication
• Mobility and balance problems – neurophysiotherapy, walking aids, orthotics, functional electrical stimulation (FES) and strength training
• Mood and cognition – psychological therapies, medication when appropriate, cognitive rehabilitation

Rehabilitation and Self-Management

Rehabilitation is central to living well with MS and often involves:

• Neurophysiotherapy – gait, balance, strength and mobility
• Occupational therapy – activities of daily living, energy conservation, work and home adaptations
• Speech and language therapy – communication, swallowing and cognitive-communication support
• Neuropsychology and psychology – adjustment, coping, mood and fatigue management

Regular review enables treatment plans to adapt as needs change over time.

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How We Can Help at The Royal Buckinghamshire Hospital

At The Royal Buckinghamshire Hospital, we provide consultant-led inpatient neurorehabilitation for adults with MS who have significant functional limitations, complex symptoms or rehabilitation needs that cannot be managed in the community alone.

We typically work with people who:

• Have experienced a recent relapse or step change in function and need intensive rehabilitation
• Are living with progressive MS and complex issues such as spasticity, mobility problems, falls, fatigue, pain and cognitive changes
• Need multidisciplinary input to support safe discharge home, work or education
• Have plateaued in outpatient therapy but still have realistic rehabilitation goals

Our Multidisciplinary Approach

Programmes are tailored to each person and may include:

• Rehabilitation medicine – overall clinical leadership, spasticity and symptom management, coordination with neurology and MS teams
• Neurophysiotherapy – mobility, balance, transfers, strength, spasticity and posture
• Occupational therapy – self-care, domestic tasks, fatigue and energy management, equipment and home adaptations, vocational planning
• Speech and language therapy – communication, cognitive-communication and swallowing
• Neuropsychology / clinical psychology – support with mood, adjustment, anxiety, cognition and self-management
• Specialist nursing and rehabilitation assistants – implementing 24-hour rehabilitation approaches and promoting independence on the ward

We also provide:

• Education on MS and long-term self-management
• Support and information for family and carers
• Clear, practical recommendations for ongoing community services, equipment, care and follow-up after discharge

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When to Seek Medical or Urgent Help

This page offers general information and is not a substitute for personal medical advice.

You should contact your GP, neurologist or MS nurse if:

• You notice new or worsening symptoms that persist for more than 24–48 hours (especially if they differ from your usual fluctuations)
• Fatigue, pain, mood changes or bladder/bowel problems are significantly affecting daily life
• You are struggling with mobility, falls, work or caring responsibilities and think you may need more intensive rehabilitation

You should seek urgent medical help (999 / emergency department) if you experience:

• Sudden weakness, numbness, loss of vision, severe imbalance or difficulty speaking that is rapidly worsening
• Chest pain, severe shortness of breath or other symptoms that could indicate a medical emergency
• Symptoms suggestive of a serious infection (for example, fever and confusion), particularly if you are on immune-modulating treatments

Your usual care team can advise on managing relapses, adjusting disease-modifying therapies and whether a specialist rehabilitation programme at The Royal Buckinghamshire Hospital may be appropriate at a particular stage of your MS.