Multiple Sclerosis

Multiple sclerosis is a condition in which the immune system attacks myelin, the insulating layer around nerve fibres in the brain, optic nerves and spinal cord. Patches of inflammation disrupt signals and leave scars.

Most people start with a relapsing-remitting course: episodes of new symptoms over days, followed by partial or full recovery. Some later develop gradual progression, and about one in ten has a progressive course from the start. It is lifelong and not curable, but disease-modifying treatments started early substantially reduce relapses and slow disability.

Symptoms

• Blurred or painful vision in one eye (optic neuritis)
• Numbness or tingling in limbs or across the trunk
• Weakness or heaviness in a leg
• Unsteadiness and dizziness
• Overwhelming fatigue
• Bladder urgency and frequency
• An electric-shock sensation down the spine on bending the neck
• Stiffness and muscle spasms
• Problems with memory and concentration

Causes and risk factors

The cause is not fully known. It arises in people with a genetic susceptibility who meet environmental triggers. The strongest known is previous Epstein-Barr virus infection. Others are low vitamin D and little sunlight, smoking, and obesity in adolescence. It is two to three times more common in women, typically begins between 20 and 40, and is more frequent further from the equator. It is not directly inherited, though relatives have a slightly raised risk.

How it is diagnosed

• Neurological examination and history: Looks for evidence of episodes separated in time and in different parts of the nervous system.
• MRI of brain and spinal cord with contrast: Shows characteristic lesions and whether any are currently active. It is central to the McDonald diagnostic criteria.
• Lumbar puncture: Oligoclonal bands in the spinal fluid support the diagnosis.
• Visual evoked potentials and OCT: Detect previous optic nerve involvement.
• Blood tests: Exclude mimics such as neuromyelitis optica (aquaporin-4 and MOG antibodies), B12 deficiency and lupus.

Treatment options

• Relapse treatment: High-dose methylprednisolone for 3 to 5 days speeds recovery from a disabling relapse. It does not change the long-term course.
• High-efficacy disease-modifying therapy: Ocrelizumab, ofatumumab, natalizumab and cladribine greatly reduce relapses and new lesions. Increasingly offered early.
• Moderate-efficacy therapy: Dimethyl fumarate, teriflunomide, fingolimod-type tablets, interferon beta and glatiramer.
• Treatment for progressive MS: Ocrelizumab for primary progressive and siponimod for active secondary progressive disease, with modest benefit.
• Symptom management: Medicines and physiotherapy for spasticity, bladder treatment, fatigue management and neuropathic pain relief.
• Rehabilitation: Physiotherapy, occupational therapy and exercise preserve function.
• Autologous stem cell transplantation (aHSCT): An intensive chemotherapy-based treatment for highly active relapsing MS that has failed strong drugs, in experienced centres only. It has serious risks. Other so-called stem cell injections have no proven benefit.

When it is urgent

Seek urgent local care for sudden loss of vision, rapidly worsening weakness, inability to pass urine, or severe new symptoms with fever, since infection can mimic or worsen a relapse. If you take an immune-suppressing therapy, fever or new confusion needs same-day review.

Travelling to Türkiye for treatment

MS care means years of monitoring, blood tests and repeat MRI, and must be anchored with a neurologist at home. A visit can offer a second opinion on diagnosis or treatment choice, a full MRI and spinal fluid work-up, or an intensive rehabilitation block. Be wary of any clinic advertising stem cell cures. Heat worsens symptoms temporarily, so Istanbul's summer may be uncomfortable.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions