Multiple sclerosis: an animated, cited guide

This page needs JavaScript for its animations. The outline and key answers are below, and every claim in the full version carries a numbered citation.

Not medical advice. MS Companion is an educational synthesis of published literature. It does not replace a clinician.

What is in it

What MS is Who gets it, the numbers, and where in the nervous system it strikes.
Myelin and demyelination How signals jump along a myelinated nerve fibre, and what a lesion does to them.
The immune attack T cells, B cells and the blood-brain barrier, step by step.
Genes and risk factors HLA-DRB1*15:01, Epstein-Barr virus, vitamin D, smoking and teenage obesity.
Relapse and remission over time Relapsing, secondary progressive and primary progressive MS on one timeline.
A relapse, week by week Onset, steroids and recovery, and how a pseudo-relapse differs.
Measuring disability: EDSS The 0 to 10 scale and what confirmed worsening means.
McDonald criteria calculator Dissemination in space and time, CSF, and the 2017 and 2024 rules.
The differential NMOSD, MOGAD and other conditions that look like MS.
How the drugs work Where each disease-modifying therapy acts.
The DMT ladder Escalation, early high-efficacy treatment and stopping in later life.
Safety and monitoring PML and the JCV index, infections, vaccines and rebound.
Toward a cure Remyelination, BTK inhibitors, stem-cell transplantation and EBV.
Symptoms and rehabilitation Fatigue, spasticity, bladder, walking, mood and cognition.
Living with MS Pregnancy, work, heat, exercise and planning.
Nursing care Assessment, giving the medicines, monitoring and teaching.
History and people From Carswell and Charcot to the 2024 criteria.
Flashcards, quiz and glossary Revision for students.
Sources Every reference behind the app.

Part 5 · Living with MS

Living with MS

Pregnancy, smoking, life expectancy, work, heat, diet and planning ahead in MS, as published studies report them. Press play to walk through a pregnancy and see relapse rates fall, then rise after birth.

Compare PRIMS with

Through pregnancy

Annualised relapse rate = relapses per person per year. Bars are the published values; the drawn figure is schematic. PRIMS (published 1998) predates most of today's treatments; Kaiser and MSBase are more recent cohorts with lower rates throughout. ^89,215,269

Medicines before and during pregnancy are not covered here: which disease-modifying therapies need stopping, and how long before conception, is a drug-label question. See Safety & monitoring. The UK consensus from the Association of British Neurologists covers pre-pregnancy counselling, delivery, anaesthesia and the postpartum period. ¹¹⁹

Smoking after diagnosis

In the Swedish GEMS study of 728 people who smoked when they were diagnosed, each additional year of smoking after diagnosis brought conversion to secondary progressive MS (SPMS) forward by 4.7%. Press play to run both groups through the same ages.

Age

The ages are the published approximate ages at conversion; the 40–60 window and the walking figures are for display. ³⁹⁵

Life expectancy

Timeline

Median ages from two population cohorts. A standardised mortality ratio (SMR) of 1 means the same death rate as the general population. ^290,296

Everyday life

Exam hookPRIMS (1998): relapse rate 0.7 a year before pregnancy, 0.5, 0.6 and 0.2 by trimester, 1.2 in the first 3 months after birth, then back to baseline. The Kaiser cohort (2020) found no rebound above the pre-pregnancy rate. Pregnancy does not increase the risk of progression. ^89,269,352

In plain wordsMS touches work, family plans, holidays and later life, but it does not decide them on its own. Relapses usually quieten during pregnancy, smoking is linked with faster progression, and planning ahead, for medicines and for later life, helps.