You will be offered regular appointments with members of your healthcare team to review the different parts of your care and check that your symptoms are being managed as well as possible. How often you need these checks will depend on the needs of you and your carers, and what drugs and other treatments you are having.
Many people with MS have fatigue. This is not ordinary tiredness, but a feeling of utter exhaustion that is not related to how much you have been doing. The fatigue can be brought on by heat, overexerting yourself or stress. Sometimes it can be related to the time of day. If you have problems with fatigue, your GP will first make sure that nothing else could be causing it, such as anxiety, depression, difficulty in sleeping or medical problems such as anaemia or thyroid disease. If you have any of these conditions you will be offered treatment for them first.
If your fatigue is caused by your MS, a drug called amantadine could help with this.
Training in mindfulness (paying attention to your present thoughts and feelings), cognitive behavioural therapy (a type of talking therapy that helps you change the way you think and behave) or special techniques to help you manage your fatigue may also help. Aerobic, balance and stretching exercises such as yoga may also help ease MS-related fatigue.
If you are having problems with mobility you will be fully assessed so that you and your healthcare professional (usually a rehabilitation specialist or a physiotherapist with expertise in MS) can set some goals and plan how you can achieve them.
Taking part in a supervised exercise class that combines some aerobic and strength training may help if you have problems with mobility or fatigue.
If you find it hard to balance because of dizziness, special exercises to improve your balance may also be helpful.
Spasticity is a condition that affects the muscles, making them more stiff and rigid than usual. Other conditions can make spasticity worse such as constipation or an infection and these should be assessed and treated.
You may need to try several different drugs for spasticity taken at various doses until the right one is found for you. The drugs could include baclofen, gabapentin, tizanidine, dantrolene, and benzodiazepines. You may even need to try a combination of drugs. Drugs that don't work for you should be stopped. Once the right drug and dose has been prescribed, your neurologist will set up an appointment to review your treatment at least once a year.
You will also be encouraged to manage your own spasticity by varying the drug dose you take within agreed limits.
If drugs do not help your spasticity you will be referred to a specialist spasticity service.
You may have a problem with your eyesight that makes it look as if objects are moving when they are not (you may hear this called 'oscillopsia'). Drugs called gabapentin or memantine could help. If neither of the drugs work or the side effects mean that you can't take them, your neurologist may refer you to an eye specialist called an ophthalmologist.
Emotional lability is a difficulty with emotions that means you may laugh or cry inappropriately without being able to control it. If this happens to you, talk to your neurologist about whether a drug called amitriptyline may help.
You may have neuropathic pain. This happens when the nerves don't work properly and send the wrong signals to the brain. It can feel like stabbing, an electric shock, burning, tingling, prickling, itching, or a sensation of pins and needles anywhere in the body. If you have this, you will be offered treatment in line with NICE's guideline on neuropathic pain.
You might also get pain in your muscles, joints and bone, and this is usually caused by problems with mobility or posture. If you have this type of pain your doctor will assess your symptoms and offer treatment or referral.
For most people with MS, the best diet is a healthy, varied one.
Some people with MS say that following a specific diet has made a difference to how they feel, but there’s no conclusive evidence to support excluding specific foods from your diet to treat MS.
Eating nutritionally balanced meals helps the body to work to its full potential – particularly useful when living with a long-term condition.
You can ask for a referral to a dietitian, who can help if you have any particular nutritional or energy needs – for example, if you have a constant tremor, you’re underweight, or if you have another health condition which might affect your diet. A dietitian can help you plan your meals so that you’re getting all the nutrients you need.
f you have problems with your memory or thinking, or if you have anxiety, depression or difficulty in sleeping, you may be referred to one of our neuro-psychiatrists to assess your symptoms and offer you treatment. They may suggest you see an occupational therapist or neuropsychologist (a psychologist who specialises conditions that affect the nervous system). You may also be referred to a memory clinic if your problems relate to memory or thinking.