Multiple sclerosis: early symptoms, diagnosis and modern treatment

What is multiple sclerosis?

Nerve fibres in the brain and spinal cord are wrapped in an insulating layer called myelin, which allows signals to travel quickly. In multiple sclerosis the immune system mistakenly attacks the myelin, causing patches of inflammation known as lesions or plaques. Messages along the affected nerves slow down or are interrupted, and over time the nerve fibres themselves can be damaged.

MS is one of the most common neurological conditions in young adults and affects women more often than men. The exact cause is unknown. It probably results from a combination of genetic susceptibility and environmental factors, including previous Epstein-Barr virus infection, smoking, low vitamin D levels and obesity in adolescence. MS is not contagious and is not directly inherited, although the risk is slightly higher in close relatives.

You can read about other conditions of the nervous system in our neurology guide.

Types of MS

Neurologists also describe whether MS is active (new relapses or new MRI lesions) and whether it is progressing. This guides treatment choices.

Symptoms of multiple sclerosis

Symptoms depend on which parts of the nervous system are affected. A relapse usually develops over hours to days and lasts at least 24 hours. Common symptoms include:

• optic neuritis – blurred vision in one eye, pain on moving the eye, colours appearing washed out;
• numbness or tingling in the limbs or body;
• weakness in an arm or leg and muscle stiffness (spasticity);
• balance problems, unsteady walking or dizziness;
• double vision;
• severe fatigue out of proportion to effort;
• bladder problems (urgency, frequency, incomplete emptying), bowel and sexual difficulties;
• problems with concentration and memory, low mood;
• an "electric shock" sensation down the back when bending the neck (Lhermitte's sign).

Heat – a hot bath or a fever – can temporarily worsen existing symptoms. This is not the same as a new relapse.

How MS is diagnosed

No single test confirms MS on its own. A neurologist uses the international McDonald criteria, showing that damage has occurred in different parts of the nervous system at different times, and rules out other conditions.

• MRI of the brain and spinal cord, usually with contrast – the key test; it shows lesions and whether any are active (see MRI and CT).
• Lumbar puncture – a sample of cerebrospinal fluid is checked for oligoclonal bands, a sign of inflammation within the central nervous system.
• Visual evoked potentials – measure how quickly signals travel along the optic nerve.
• Blood tests – to exclude other causes such as vitamin B12 deficiency, infections and other autoimmune diseases.

Numbness and tingling have many other causes, such as peripheral neuropathy or a slipped disc, which is why assessment by a neurologist matters.

Treatment of multiple sclerosis

There is currently no cure for MS, but treatment is far more effective than it was 20 years ago. It has three main strands.

1. Treating relapses

Severe relapses are usually treated with a short course of high-dose corticosteroids over a few days to speed recovery. Plasma exchange is sometimes used for very severe relapses that do not respond.

2. Disease-modifying therapies (DMTs)

These medicines reduce the number of relapses and new lesions and, to some extent, the accumulation of disability. They include injectable, oral and infusion treatments with different levels of effectiveness and risk – from immunomodulators to monoclonal antibodies that target particular immune cells. For some people with highly active disease, specialist centres may discuss autologous haematopoietic stem cell transplantation. The choice is made by the neurologist together with you, taking into account disease activity, pregnancy plans, other conditions and monitoring needs.

3. Symptom management and rehabilitation

Spasticity, pain, fatigue, bladder problems and depression can each be treated specifically. Physiotherapy, occupational therapy and regular physical activity help maintain strength, balance and independence.

Living with MS

Most people with MS continue to work, travel and have a family life. It helps to:

• stop smoking – smoking is linked to faster progression;
• keep a healthy weight and a varied diet; vitamin D levels can be checked and topped up on medical advice;
• plan pregnancy with your neurologist, as some medicines need to be stopped or changed beforehand;
• keep vaccinations up to date as advised, particularly before some immunosuppressive treatments;
• pace activity and rest to manage fatigue;
• seek support from patient organisations, a psychologist or a specialist MS nurse.

Regular reviews and MRI scans help detect "silent" disease activity so that treatment can be changed in time.

When to see a doctor

See your GP, who can refer you to a neurologist, if you have blurred vision in one eye with pain on eye movement, numbness or weakness lasting more than a day or two, double vision or unexplained balance problems.

If you already have MS, contact your MS team about new or clearly worsening symptoms lasting over 24 hours, particularly if you have no fever or infection. Call 112 (or your local emergency number) for sudden weakness on one side of the body, slurred speech or a drooping face – these may be signs of a stroke and need emergency care.

Second opinions and treatment abroad / in Türkiye

MS treatment is long-term and is usually best delivered in your home country, because it needs regular monitoring, blood tests and MRI scans. Some patients from Bulgaria and the rest of Europe nevertheless seek a second opinion on their diagnosis or treatment choice, particularly when findings are uncertain or the disease is very active. Some turn to neurology departments in large accredited hospital groups in Istanbul.

If you consider this, bring all MRI scans on disc (not just the reports), lumbar puncture results and a list of previous medicines. Make sure you will receive a written opinion that your own neurologist can review, and that any treatment can be continued and monitored at home. Organisers such as New City Clinic in Istanbul coordinate hospital, doctor, hotel, transfers and interpreter, while medical decisions remain with the treating neurologists.