Demyelinating diseases damage myelin, the insulating layer around nerve fibres in the brain, optic nerves and spinal cord. Multiple sclerosis is by far the most common. Others include neuromyelitis optica spectrum disorder (NMOSD), MOG antibody disease and acute disseminated encephalomyelitis.
Telling them apart matters because some MS drugs can make NMOSD worse. None can currently be cured, but modern treatment prevents most relapses and slows disability.
Symptoms
- Blurred or painful loss of vision in one eye (optic neuritis)
- Numbness, tingling or a tight band around the trunk
- Weakness or stiffness in the legs
- Double vision or vertigo
- Bladder urgency
- Electric shock sensation on bending the neck
- Marked fatigue, often worse with heat
Causes and risk factors
These are immune-mediated conditions. In MS, genetic susceptibility combines with factors such as past Epstein-Barr virus infection, low vitamin D, smoking and adolescent obesity. NMOSD and MOG disease are caused by specific antibodies against aquaporin-4 or myelin oligodendrocyte glycoprotein. None are directly inherited, although relatives carry a slightly raised risk.
How it is diagnosed
- MRI of brain and spinal cord with contrast: Shows the number, position and age of lesions; the basis of MS diagnosis.
- Lumbar puncture: Oligoclonal bands in spinal fluid support MS.
- Aquaporin-4 and MOG antibodies: Blood tests that identify NMOSD and MOG disease.
- Visual evoked potentials and OCT: Detect previous optic nerve damage.
- Blood tests for mimics: Exclude B12 deficiency, infection, lupus and sarcoidosis.
Treatment options
- High-dose steroids: Shorten a relapse; plasma exchange is added for severe attacks.
- Disease-modifying therapy for MS: Ranges from injections and tablets to high-efficacy infusions such as ocrelizumab, natalizumab and ofatumumab.
- Targeted therapy for NMOSD: Eculizumab, inebilizumab, satralizumab or rituximab to prevent attacks.
- Symptom management: Treatment for spasticity, bladder problems, pain and fatigue.
- Rehabilitation: Physiotherapy and occupational therapy to preserve function.
- Stem cell transplantation (AHSCT): An intensive option for a small group with very active relapsing MS; it carries serious risks and is not a cure.
When it is urgent
Sudden loss of vision, rapidly rising numbness or weakness in both legs, or inability to pass urine needs urgent assessment locally, because early steroid or plasma exchange treatment protects function.
Travelling to Türkiye for treatment
Diagnosis review, a second opinion on the choice of therapy and a rehabilitation block fit a visit well. Long-term disease-modifying therapy needs regular blood tests and MRI monitoring close to home. Be wary of any offer of stem cell injections that is not formal AHSCT in a haematology unit.
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
Is every white spot on MRI multiple sclerosis?
No. Migraine, high blood pressure and ageing cause spots as well. Misdiagnosis is common, so review by an MS specialist is worthwhile.
Should I start strong treatment early?
Evidence increasingly favours high-efficacy therapy early in active MS, balanced against infection risks.
Can I travel between infusions?
Usually yes. Six-monthly infusions leave plenty of room, but have them where your monitoring is done.