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Multiple sclerosis is a chronic progressive condition of the central nervous system. So, it affects the brain and the spinal cord and it is the most common neurological condition affecting young adults. Multiple sclerosis can be diagnosed at any age, generally between 20 and 40, but we do diagnose people into their late 60s, 70s. 17, 18 year-olds can be diagnosed as well. There is currently no cure for MS, but it does not affect life expectancy particularly. In multiple sclerosis, symptoms will often come and go, sometimes the damage is permanent, but after some attacks, there will be a partial recovery and symptoms will reduce in severity.

Symptoms of MS will vary in severity and frequency in each person and any person can have a combination of any of the symptoms of MS. Common symptoms of MS can include problems with balance, some people may find that they are quite in-coordinated, they worry that, for example, when they are walking down the road they may appear drunk or trip over things. They can bump into things like doorways or just veer to one side, which can be quite distressing for them and also can cause them to fall at times. Bladder problems are very common with MS patients, around 80% of people who have MS will experience some problems with their bladder. This can include frequency of passing urine, urgency, stress incontinence. Not everybody experiences all of these, but the best person to deal with these problems are continence advisors and we would refer only if these patients had problems with, for example, their bladders. A lot of the problems tend to be with word finding or short-term memory. Some people might find it useful, for example, to use Post-It notes to put messages up, for example, if they get an urgent message from a family member, they write it down and put on the fridge, others might use a notebook. I think the important thing for someone with memory problems with MS is actually to make sure they write things down immediately, they have had the message so they can recall it later.

Some patients with MS have problems with planning. For example, if they want to put a meal on the table for 5 o'clock, they might have a difficulty planning a shopping list, going out shopping, retrieving the items, bringing them back and then getting them all cooked on time to be put on the table at 5 o'clock. Fatigue is what we call an invisible symptom of MS, it is not the same as normal fatigue, it is actually overwhelming fatigue associated with nerve tiredness. So, somebody may do even a small task and they might become overwhelmingly tired and need to rest, this may be for 10-15 minutes and then they can get up and get going again. Some people experience foot drops, so they might catch their foot when they are mobilizing, this may cause them to trip up. One of the common signs of foot drop is if you look at the bottom of somebody's shoe, then you might see some wearing out in the front of the sole, which means they are dragging their feet along, which is quite a good indicator of foot drop.

Some people find that they are heat sensitive. For example, when they have a hot bath, they may find that they become extremely tired and it might give them difficulty getting out of a hot bath. Others might experience heat sensitivity when they go abroad, for example, or they sit in the hot sunshine in this country, but that only affects some people, not everybody is heat affected. And the other thing is that some people are affected from the other extremity, from coldness, so they might find that makes their spasms worse or they might find that affects their ability. So it is really extremes of temperature, heat and cold. Mobility issues vary, not everyone will have problems with their mobility. With regards to mobility aid, some people might use just one stick or a crutch, some people may need to use bi-lateral support, for example, two crutches or a frame. Other people may need to use a scooter or a wheelchair intermittently, some people for long-term use. It really depends on their level of mobility problems. Depending on whether people have a good or a bad day, depends on what level of mobility aids they may or may not need to use.

Pain can be experienced and that can be neuropathic in nature, that may be anything from pins and needles to insects crawling under the skin, to burning, to socks feeling wrapped up underneath your feet. Some people experience, for example, a tightness around their middle, they call it banding or the MS hug, which they may see on some social media sites as a description. The other type of pain that somebody may experience is musculoskeletal pain, this may be secondary to problems with walking. Some people experience, for example, a frozen shoulder where they get a lot of stiffness and immobility in the arm. Problems with speech and swallowing are quite uncommon in MS. Some patients may have problems just with their swallow, they may cough or choke on food or fluids, even on saliva at times. The best solution is to refer them to speech and language therapy so they can have specialist intervention and they will teach them how to improve their swallowing technique and, if necessary, they will refer them on for further investigations.

With the speech, again, that is fairly uncommon in MS patients. Some people do have slightly slurred speech or they may have hesitant speech, some people may lose the ability to communicate all together, but again, that's very rare. Spasms can be described as simple stiffness or they can be a cramp-like experience, they may cause the leg to shoot out and kick out straight, or sometimes they get weak or flexor spasms, which cause the legs to bend up and they can flex in both of which can be quite uncomfortable for some patients. If patients do have a tremor, it's best to be assessed by the neurologist as they can also be a symptom of other diseases as well.

Some patients have problems with their eyes affecting their vision. This can either be pain behind the eyes, some people may have double vision or loss of colour perception, vision may be blurred or they may describe a black dot in the centre division obscuring their vision and affecting their sight. There are many other symptoms of MS that may or may not occur rarely or more frequently and many symptoms that we have described are hidden. If there is concern about a symptom, the best thing for the person to do would be to phone their MS nurse or discuss again with their neurologist to clarify whether the symptoms relate to their MS or not, as some symptoms may be related to something completely different. And just because somebody is diagnosed with MS, we do not always want to presume that the symptom they are describing is related to MS.