Multiple sclerosis (MS): what's the outlook?

Multiple sclerosis (MS) is a life-long condition that affects the brain and spinal cord and can cause a wide range of both physical and psychological symptoms. In this article, expert consultant neurologist, Dr Anke Hensiek explains how MS can affect a patient’s quality of life, what challenges they face and what treatments are available that can help.

Can MS be more symptomatic in some people than others?

Multiple sclerosis (MS) is an unpredictable disease and its severity varies considerably between individuals. It is increasingly recognised that a significant number of MS sufferers (at least 10-20%) have a benign disease course in which they only have very little symptoms, even decades after their diagnosis. However, on the other end of the spectrum is a small proportion of patients with severe disease who accumulate significant disability within a short time. Most patients with MS have symptoms that range between these two extremes. Depending on the type of MS the patient has, the symptoms may come and go or get gradually worse over time.

In addition to differences in disease severity, the symptoms of MS can also vary from person to person and affect any part of the body. Common symptoms that occur in multiple sclerosis include:

• Fatigue
• Muscle stiffness
• Spasms
• Weakness
• Numbness or tingling
• Coordination problems
• Visual problems
• Mobility problems
• Bladder dysfunction
• Sexual disfunction
• Memory problems

Which risk factors can indicate the severity of symptoms?

MS is a highly variable disease and at the time of diagnosis, it is difficult to predict what will happen in the future. However, certain factors have been linked to a better prognosis. These include

• female rather than male gender
• earlier age at onset
• a low lesion load on MRI at presentation

Furthermore, disease severity seems to be on average milder in individuals who have sensory and visual rather than movement abnormalities as their initial symptoms, and those who don’t have very frequent relapses at the beginning of their disease. Patients who make a full recovery from their initial relapses and whose examination remains essentially normal five years after the onset of the disease also seem to be in a better prognostic group.

What happens to a person's quality of life with MS?

MS is a chronic disease that affects young people, often at a time when they are making major life choices, such as which career path to take or whether they want to settle down and start a family. Similarly, if MS is diagnosed in later life when the patient already has a family, they may worry about how their work may be affected or how they are going to support their children financially.

Neurological symptoms caused by MS can interfere with a person’s ability to go about their usual day-to-day activities, work and take part in leisure activities. Furthermore, there may be symptoms such as mood disturbances, anxiety, worry about the future, pain, fatigue or cognitive problems which are not always visible to others, but can have a significant impact on a person’s quality of life. This may not only be difficult for the person who sufferers with MS but also for their family and friends.

Many issues that reduce the quality of life in multiple sclerosis can be improved through medical therapies, environmental adjustments or specialist advice. It is therefore important that MS suffers are supported by an experienced multidisciplinary team of medical and nonmedical therapists in order to stay active and be able to manage and maintain their quality of life.

Can a person with MS live a regular life span?

MS itself is rarely fatal and the vast majority of MS sufferers who receive the right care and support have a normal life expectancy. However, a small proportion of people severely affected by MS can, unfortunately, die earlier as a result of complications from the disease; For example, very disabled patients have a higher risk of chest and urine infections or swallowing problems, which reduces the average life expectancy slightly by around 5-10 years.

There are many new and improved treatments available now so this average reduction in life expectancy is gradually reducing.

How can it be managed?

There is currently no cure available for MS, however, there has been very significant progress in the treatment of MS in the last decade, including various new disease-modifying therapies which are tailored-made for the individual and reduce the chances of MS deteriorating. These treatments generally affect the way the immune system works and can come in the form of injections, infusions or tablets. They are usually only prescribed in specialist centres and not all types of MS respond to these medications, so patients must have an assessment and discussion with their neurologist to evaluate whether they would benefit from these therapies.

Apart from specific treatment for MS itself, it is important to manage the symptoms that MS can cause. This includes treating relapses with steroid medicines to help recovery or medications to treat certain symptoms such as spasms, bladder problems or pain. Some symptoms caused by MS such as fatigue, memory problems, mood disturbance or pain may be more difficult to recognize and manage. It is therefore important that individuals with MS are managed holistically by a team of experienced therapists which include an MS specialist nurse and if required a physio and other therapists. All MS patients should be under the care of a neurologist with experience in MS therapy to receive the most up-to-date, effective and personalised treatment.

If you have been diagnosed with MS and would like to see a specialist neurologist, visit Dr Anke Hensiek’s Top Doctors profile and book an appointment to see her.