Multiple Sclerosis (MS)

What is Multiple sclerosis?

In MS, the immune system attacks myelin, the insulating layer around nerve fibres, causing areas of inflammation and scarring (lesions or plaques) in the brain, optic nerves and spinal cord. Signals travelling along the affected nerves are slowed or blocked, producing symptoms that depend on the location of the lesions.

MS usually starts between the ages of 20 and 40 and is two to three times more common in women. Genetic predisposition, low vitamin D levels, smoking and previous Epstein–Barr virus infection are among the known risk factors. MS is not contagious, and it is not directly inherited.

Types of MS

• Relapsing-remitting MS: the most common form at onset; episodes of new or worsening symptoms (relapses) followed by partial or complete recovery
• Secondary progressive MS: after years of relapsing disease, gradual worsening with or without relapses
• Primary progressive MS: gradual worsening from the start, without distinct relapses
• Clinically isolated syndrome: a first episode suggestive of MS

Living with MS today

The treatment of MS has changed fundamentally over the past two decades. Many people diagnosed today continue to study, work, travel, have families and lead active lives. The goal of modern MS care is not only to prevent relapses but to achieve “no evidence of disease activity” — no relapses, no new MRI lesions and no worsening of disability — through early, individually tailored treatment and regular monitoring.

Symptoms of Multiple sclerosis

• Blurred or lost vision in one eye, often with pain on moving the eye (optic neuritis)
• Numbness, tingling or a band-like feeling in the body or limbs
• Weakness or heaviness of a limb
• Double vision
• Balance problems, dizziness and clumsiness
• An electric sensation down the spine when bending the neck (Lhermitte’s sign)
• Fatigue, often severe
• Bladder and bowel problems
• Difficulties with concentration and memory
• Symptoms worsening with heat (Uhthoff’s phenomenon)

When should you see a neurologist?

• A first episode of neurological symptoms lasting more than 24 hours
• Optic neuritis
• MRI showing “white matter lesions” or “demyelinating lesions”
• Known MS with new symptoms, suspected relapse or worsening
• For a second opinion on diagnosis or treatment
• When planning pregnancy with MS

How is Multiple sclerosis diagnosed?

MS is diagnosed by showing that lesions have occurred in different parts of the central nervous system and at different times, after excluding other conditions that can mimic it.

• MRI of the brain and spinal cord, with contrast, to show lesions and active inflammation
• Evoked potentials to detect silent damage in visual or sensory pathways
• Lumbar puncture to look for oligoclonal bands in the spinal fluid
• Blood tests to exclude conditions that mimic MS, such as vitamin B12 deficiency, autoimmune diseases, infections and neuromyelitis optica (NMOSD)
• Eye examination and optical coherence tomography (OCT) in some cases

Not every white spot is MS

Small white matter spots on MRI are common and can be caused by migraine, small vessel disease, high blood pressure or ageing. Overdiagnosis of MS based on MRI alone is a known problem. A careful expert review of the images together with the history and examination is essential before starting long-term treatment.

How is Multiple sclerosis treated?

Treatment of relapses

Significant relapses are usually treated with a short course of high-dose corticosteroids to speed up recovery. In severe relapses that do not respond, plasma exchange may be considered.

Disease-modifying therapy

Disease-modifying treatments reduce the frequency of relapses, slow the accumulation of new lesions and delay disability. They include injectable, oral and infusion therapies with different levels of efficacy and different safety profiles. The choice depends on disease activity, MRI findings, age, family planning, other health conditions and personal preferences. Starting effective treatment early is associated with better long-term outcomes.

Symptom management and rehabilitation

Fatigue, spasticity, bladder problems, pain, mood changes and cognitive difficulties are treated individually. Physiotherapy, exercise, a healthy lifestyle, stopping smoking and maintaining adequate vitamin D levels are part of comprehensive MS care. Botox can be used for spasticity and overactive bladder.

Treatment timeline and your stay in Istanbul

The first consultation takes 45–60 minutes. MRI and evoked potentials can usually be completed within one or two days. Follow-up visits and MRI monitoring are planned according to the treatment and disease activity, typically every three to twelve months.

For international patients, the diagnostic assessment can be completed in 1–2 days in Istanbul, and a written summary in English can be provided for continuation of care at home.

Follow-up after treatment

• Take disease-modifying treatment regularly and attend safety blood tests
• Have MRI scans as scheduled, ideally on the same machine type
• Report new symptoms lasting more than 24 hours
• Stay physically active and avoid smoking
• Discuss vaccinations and pregnancy plans with your neurologist
• Infections and heat can temporarily worsen symptoms (pseudo-relapse)

Risks and what to watch for

Untreated active MS can lead to accumulating disability over time. Disease-modifying treatments can have side effects such as flu-like symptoms, injection site reactions, changes in blood counts or liver function and, with some highly effective treatments, an increased risk of infections. These are monitored with regular blood tests and MRI. Corticosteroids can raise blood sugar and blood pressure and affect sleep and mood.

Frequently asked questions about Multiple sclerosis