Multiple Sclerosis: Symptoms, Causes, and Related Conditions
What is Multiple Sclerosis?
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. The immune system mistakenly attacks the protective myelin sheath surrounding nerve fibres in the brain and spinal cord. This leads to demyelination, inflammation, and eventual axonal damage.
Over time, these processes disrupt the transmission of electrical signals in the nervous system, producing a wide range of neurological symptoms. MS is highly variable — no two people experience it in the same way.
MS affects around 2.8 million people worldwide. It is most commonly diagnosed between ages 20 and 40 and affects women more often than men.
Physiological Processes and Current Theories
Immune-mediated demyelination: T-cells and B-cells cross the blood–brain barrier, attacking myelin and oligodendrocytes.
Axonal injury and neurodegeneration: Damage to axons contributes to long-term disability, independent of demyelination.
Neuroinflammation: Cytokines such as IL-17, IFN-γ, and TNF-α drive inflammation in the CNS.
Failure of remyelination: The body attempts to repair damage, but remyelination is often incomplete, leading to progressive deficits.
Gut–brain axis: Emerging evidence shows that alterations in the gut microbiome may influence immune regulation in MS.
Genetic and environmental factors: HLA-DRB1*15:01 is strongly linked, and risk is increased by low vitamin D, smoking, and prior Epstein–Barr virus infection.
Types of MS
Relapsing–remitting MS (RRMS): the most common form, with episodes of symptoms followed by partial or full recovery.
Secondary progressive MS (SPMS): begins as RRMS but transitions into steady progression of disability.
Primary progressive MS (PPMS): gradual worsening from onset, without relapses.
Common Symptoms
Fatigue and reduced endurance
Vision problems (optic neuritis, blurred or double vision)
Muscle weakness and spasticity
Numbness, tingling, or altered sensation
Difficulty with balance and coordination
Bladder and bowel dysfunction
Less Common Symptoms
Slurred speech (dysarthria)
Tremor or involuntary movements
Swallowing difficulties (dysphagia)
Sexual dysfunction
Seizures (rare but possible)
Comorbidities and Overlapping Conditions
MS often coexists with or leads to additional health challenges, including:
Depression and anxiety, which affect up to 50% of patients
Chronic pain syndromes, such as neuropathic pain or musculoskeletal pain from altered movement patterns
Sleep disorders, including insomnia and restless legs syndrome
Autoimmune comorbidities such as thyroid disease, type 1 diabetes, and inflammatory bowel disease
Osteoporosis, often linked to reduced mobility and steroid use
Cognitive impairment, affecting memory, attention, and executive function
Diagnosis in 2025
Diagnosis is made by a neurologist, based on the 2017 McDonald criteria, which require evidence of demyelinating lesions in space (different parts of the CNS) and time (occurring on separate occasions).
Key tools include:
MRI of brain and spinal cord showing lesions
Lumbar puncture to detect oligoclonal bands in cerebrospinal fluid
Evoked potentials to measure slowed electrical conduction
Earlier diagnosis is now possible thanks to improved imaging and biomarker studies, which means treatment can begin sooner.
Current State of Knowledge
MS is recognised as a complex autoimmune neuroinflammatory and neurodegenerative disease. Modern therapies have transformed the outlook, especially for relapsing–remitting MS, where early initiation of disease-modifying therapy can delay disability progression.
Research is now focused on:
Neuroprotection: slowing or preventing axonal degeneration
Remyelination strategies: therapies to promote repair of damaged myelin
Lifestyle interventions: the role of exercise, diet, stress reduction, and sleep optimisation in disease course
Biomarkers: advanced imaging and serum markers to personalise treatment choices
If you are living with multiple sclerosis in Cork and want to explore evidence-based treatment and rehabilitation options, read more about multiple sclerosis treatment here.
Multiple Sclerosis Treatment and Rehabilitation in Cork
International Standards of Care
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. While there is no cure, international guidelines (ECTRIMS/EAN 2023, AAN, NICE) emphasise a comprehensive approach:
Disease-modifying therapies prescribed by neurologists
Physiotherapy and structured exercise to preserve mobility and independence
Symptom management, including pain, fatigue, and spasticity
Psychological and lifestyle strategies to support long-term quality of life
Mind–body practices that regulate stress and improve nervous system resilience
Medical Management
Neurologists oversee MS treatment. The main medical strategy is the use of disease-modifying therapies (DMTs), which reduce relapse frequency and delay progression. Options include:
Injectable therapies (interferons, glatiramer acetate)
Oral therapies (fingolimod, dimethyl fumarate, cladribine, siponimod)
Monoclonal antibodies (ocrelizumab, natalizumab, alemtuzumab, ofatumumab)
Alongside DMTs, symptomatic treatments are often required:
Muscle relaxants for spasticity
Neuropathic pain medications
Bladder and bowel management strategies
Fatigue management support
Medication slows disease progression, but it cannot by itself preserve strength, coordination, or independence. That requires targeted rehabilitation.
Exercise and Physiotherapy in MS
Exercise in MS has a dual role. It preserves physical function and directly improves neuroplasticity, supporting the brain’s ability to reorganise and adapt. Research consistently shows that regular, tailored exercise:
Improves walking speed, balance, and coordination
Reduces spasticity and secondary musculoskeletal pain
Lowers fatigue levels when dosed correctly
Enhances mood and cognitive function
Supports cardiovascular health, which is vital given reduced mobility in many patients
A key challenge is variability: symptoms fluctuate day to day, and fatigue can limit activity. Many people with MS either avoid exercise altogether or overexert themselves and crash. Both patterns lead to further decline.
Specialised physiotherapy helps you:
Identify a safe baseline for strength and endurance training
Use interval and pacing strategies to build activity tolerance without worsening fatigue
Improve gait mechanics, posture, and balance with tailored mobility work
Strengthen core and limb muscles to protect against falls and secondary pain
Develop a sustainable programme you can adapt as your needs change
Exercise is not only safe in MS — it is now recognised as a disease-modifying behaviour that helps protect mobility and slow decline.
Somatic and Mind–Body Approaches
MS affects not just muscles and nerves, but also stress regulation, energy, and body awareness. Somatic and mind–body practices help address these dimensions.
Yoga therapy improves flexibility, reduces spasticity, and supports balance and core stability. It also improves fatigue and mood.
Breathwork helps regulate autonomic imbalance and improves lung function, particularly valuable when mobility is reduced.
Guided relaxation reduces background stress, which can worsen fatigue and flare-ups.
Mindfulness and meditation improve coping with unpredictable symptoms, reduce anxiety and depression, and help patients reconnect with a sense of agency.
These practices complement physiotherapy by addressing the nervous system directly, helping the body respond more effectively to physical training.
Psychological and Lifestyle Support
Cognitive behavioural therapy (CBT) and Acceptance and Commitment Therapy (ACT) improve coping, reduce fatigue-related distress, and support behaviour change.
Nutrition: An anti-inflammatory dietary pattern rich in omega-3 fatty acids, plant-based foods, and vitamin D is increasingly supported as beneficial for MS.
Sleep optimisation: Good sleep is critical for recovery and fatigue reduction.
Stress management: Chronic stress worsens MS outcomes; structured relaxation and pacing strategies are essential.
Rehabilitation at Neurokinetica
At Neurokinetica, we know MS is not just about lesions on an MRI. It is about fatigue that can derail your day, balance issues that make you hesitant to walk across a busy street, and the uncertainty of not knowing when symptoms will flare. Many patients feel caught between pushing themselves too far and doing too little out of fear.
We help you find the middle ground. Our programmes are designed to:
Build strength and mobility through targeted physiotherapy
Improve gait, posture, and balance with tailored exercise strategies
Use pacing and interval methods to reduce fatigue crashes
Integrate yoga-based movement, breathwork, and guided relaxation to regulate stress and restore nervous system balance
Provide step-by-step guidance until you feel confident managing your own rehabilitation independently
Patients often tell us they don’t just move better after working with us — they feel calmer, clearer, and more capable of handling the unpredictability of MS.
Our goal is not only to reduce symptoms but to give you the tools and confidence to live more fully with multiple sclerosis.
If you are seeking multiple sclerosis treatment in Cork and want a rehabilitation approach that combines exercise, nervous system regulation, and long-term support, book a session to get an assessment and learn more about our rehabilitation.