Multiple sclerosis

What it is

MS is an autoimmune, demyelinating disease of the central nervous system. Most patients present with relapsing-remitting disease; a minority have primary progressive MS. Diagnosis follows the 2024 McDonald criteria (clinical episodes plus MRI dissemination in time and space, with CSF oligoclonal bands where needed). The treatment landscape has expanded dramatically over the last decade.

Symptoms and signs

• New visual blurring or pain on eye movement in one eye (optic neuritis).
• New numbness, tingling, weakness or "Lhermitte's sign" (electric shock down the spine on neck flexion).
• New balance problems, vertigo, or double vision lasting more than 24 hours.
• Established MS with new symptoms (relapse) or change in baseline function (progression).
• Fatigue, bladder symptoms, cognitive slowing — often the most disabling features long-term.

How we investigate

Neurological examination, MRI brain and whole-spine (3-Tesla with gadolinium), CSF analysis for oligoclonal bands, blood-based mimics screen (vitamin B12, thyroid, ANA, aquaporin-4 and MOG antibodies, HIV / syphilis serology, lyme where exposure history). Evoked potentials and optical coherence tomography where indicated.

Treatment options at The Vesey

• Acute relapse management — high-dose oral or IV methylprednisolone for confirmed disabling relapse.
• Disease-modifying therapy — moderate-efficacy DMT (teriflunomide, dimethyl fumarate, interferon, glatiramer) or high-efficacy DMT (ocrelizumab, ofatumumab, natalizumab, cladribine) selected by phenotype and prognostic markers. We coordinate with your NHS neurology team where infusion-based therapies are already in place.
• Symptom management — fatigue, spasticity, neuropathic pain, bladder, mood and cognitive support pathways.
• Monitoring — annual MRI, EDSS, OCT and JC virus serology as per current standards.
• Patient choice clinics — independent second opinion on DMT switching, escalation or de-escalation.