The science behind MS

And making sense of it.

On this page, you’ll find an easy-to-follow summary of what MS is, what the treatments are and an explanation of clinical trials and how they work.

What Is Multiple Sclerosis (MS)?

Multiple sclerosis (MS) is a lifelong condition that affects the brain and spinal cord. It happens when the immune system, which normally fights infections, mistakenly attacks a protective layer called myelin that surrounds nerves. This disrupts the way messages travel through the nervous system.

MS usually starts between ages 20 and 40, and it affects three times more women than men. While MS can cause a wide range of symptoms, most people with MS have a normal life expectancy, and many live active, fulfilling lives with the help of treatments and support.

Common MS symptoms

Symptoms vary from person to person. They can include:

  • Blurred or double vision, or pain when moving the eyes

  • Tingling or numbness in the arms, legs, or face

  • Muscle stiffness or weakness, which can affect walking or balance

  • Fatigue, often severe

  • Bladder problems

  • Dizziness

  • Memory or thinking difficulties (in some people)

Symptoms often come and go in phases, with periods of relapse (when symptoms get worse) and remission (when they improve or disappear).

What causes MS?

The exact cause of MS is unknown, but it's likely due to a mix of genetic, immune, and environmental factors. MS is not inherited, but having a close relative with MS slightly increases the risk.

Certain factors linked to MS risk include:

  • Epstein-Barr virus (a common virus linked to glandular fever)

  • Low vitamin D levels and less sunlight exposure

  • Smoking, which raises both the risk of getting MS and how severe it becomes

Types of MS

There are a few different ways MS can progress:

  • Relapsing-remitting MS (RRMS) – the most common form. Symptoms come and go.

  • Secondary-progressive MS (SPMS) – symptoms gradually worsen over time after an initial relapsing phase.

  • Primary-progressive MS (PPMS) – steady worsening from the start, without clear relapses.

  • Clinically isolated syndrome (CIS) – a first episode of symptoms that may or may not lead to MS.

  • Radiologically isolated syndrome (RIS) – signs of MS on a brain scan, but no symptoms (very rare).

How is MS diagnosed?

There’s no single test for MS. Doctors use a combination of:

  • MRI scans to look for lesions in the brain or spinal cord

  • Lumbar puncture (spinal tap) to check spinal fluid

  • Nerve signal tests (evoked potentials)

  • Medical history and neurological exam

Diagnosis can take time, especially early on.

Is there a cure?

There’s no cure yet, but many effective treatments are available. These can:

  • Reduce relapses

  • Slow down disability progression

  • Manage symptoms like pain, fatigue, or muscle stiffness

Some medicines are taken daily or weekly (pills or injections), while others are given by infusion every few months.

Living with MS

While MS is unpredictable, many people live independently for decades. With early diagnosis, good care, and the right treatment, people with MS can work, travel, raise families, and enjoy full lives.

Support may include:

  • Medications to manage symptoms

  • Physical and occupational therapy

  • Emotional support for mood changes or depression

  • Lifestyle tools, like exercise, rest, and stress management

The role of research

MS research is moving fast. Scientists are working on:

  • Better ways to diagnose MS early

  • Treatments for progressive MS

  • Tools to repair myelin

  • Understanding the role of gut health, infections, and genetics

Clinical trials are always looking for volunteers — both people with MS and without — to help discover the next breakthroughs.

How Is MS Treated?

There’s currently no cure for multiple sclerosis (MS), but there are effective treatments that can:

  • Reduce the number of relapses (flare-ups)

  • Slow the progression of disability

  • Help manage day-to-day symptoms

The right treatment depends on the type of MS, your symptoms, and your individual health needs. Most people with MS benefit from a combination of medications, rehabilitation, and lifestyle support.

Treatments to Reduce Relapses and Slow Progression

(Disease-modifying therapies – DMTs)

These medications aim to reduce inflammation, prevent new damage, and slow the disease over time. They work best when started early, especially for people with relapsing forms of MS.

Types of DMTs:

Injectables (under the skin or into muscle)

  • Interferon beta and glatiramer acetate were among the first MS drugs. They reduce relapse rates but are used less now due to newer options.

Oral tablets (easier to take, but with some risks)

  • Fingolimod, dimethyl fumarate, teriflunomide, and others help reduce relapses.

  • Side effects vary, and some require regular blood tests.

Infusions (IV drips at a clinic or hospital)

  • Ocrelizumab (Ocrevus®): the only DMT approved for primary progressive MS and also used in relapsing MS.

  • Natalizumab (Tysabri®): highly effective but requires close monitoring for rare brain infections.

  • Alemtuzumab (Lemtrada®) and cladribine (Mavenclad®): powerful treatments used when other options haven’t worked.

💡 Most DMTs are used for relapsing MS. Some can delay progression into more advanced stages.

Treatments for MS attacks (relapses)

If you have a sudden flare-up of symptoms, your doctor may offer:

  • Corticosteroids (e.g. methylprednisolone): Short courses of strong anti-inflammatory medicine to speed up recovery.

  • Plasma exchange (plasmapheresis): Used in severe relapses that don’t respond to steroids. It filters antibodies out of the blood.

These treatments don’t change long-term outcomes but can help with short-term recovery.

Treatments to Manage MS Symptoms

MS can cause a wide range of symptoms — but many can be treated.

Physical symptoms

  • Muscle stiffness/spasms: treated with muscle relaxants like baclofen or tizanidine.

  • Fatigue: managed with energy-conservation techniques, exercise, and sometimes medications.

  • Walking difficulties: Dalfampridine (Ampyra®) may improve walking speed in some people.

Cognitive and emotional symptoms

  • Depression or mood swings: treated with therapy and medications (often SSRIs).

  • Cognitive issues: strategies from occupational therapists and medications may help in some cases.

Bladder and bowel issues

  • Managed with diet, fluid adjustments, and medications. Urologists can offer tailored help.

Pain

  • Nerve pain, muscle spasms, or facial pain (like trigeminal neuralgia) can be treated with specific drugs (e.g. gabapentin, carbamazepine).

Rehabilitation and Supportive Therapies

Living well with MS often means combining medication with non-drug support:

  • Physiotherapy: to maintain strength, mobility, and balance.

  • Occupational therapy: to adapt daily activities and conserve energy.

  • Speech and language therapy: for voice or swallowing difficulties.

  • Cognitive rehab: for memory and concentration problems.

Emerging and Experimental Therapies

Researchers are exploring:

  • Stem cell transplants: in carefully selected cases, this may "reset" the immune system.

  • BTK inhibitors: new oral drugs that may slow progression in progressive MS.

  • Remyelination therapies: aiming to repair damaged nerve insulation (myelin).

  • Better biomarkers: for earlier diagnosis and personalised treatment.

These are mostly in clinical trials – and not yet widely available.

Finding the Right Treatment

Choosing a treatment depends on:

  • The type of MS you have

  • How active your MS is (relapses, MRI changes)

  • Other health conditions

  • Pregnancy plans or age

  • Side effects and lifestyle factors

Your MS team will work with you to weigh benefits vs. risks, monitor how you’re doing, and adjust treatment as needed.

Takeaway

Although MS can be unpredictable, there are more treatment options than ever before. Many people live long, active lives thanks to early diagnosis, effective therapies, and supportive care.

Talk to your neurologist or MS nurse about which treatments are right for you.

Clinical trials: A quick introduction

Befiore we dive into new research, we wanted to give you a quick primer on clinical research. I think most of us have probably lots of different “breakthroughs” on the news at some point. You know the type, “New drug CURES everything in Phase 1 trial.” Cue excitement – but hold your horses, it’s important to understand what’s promising research and what’s a click-bait headline. So, let’s break down what clinical trials actually involve.

What’s the deal with clinical trials?

Clinical trials are research studies that test how well new treatments (drugs, therapies or lifestyle changes) actually work. They’re also there to check if these treatments are safe. But, and it’s a big but, the road from lab research to you actually taking that drug is long and full of challeneges.

There are four main phases of clinical trials, and they each serve different purposes. Let’s go through them one at at time.

Phase 1: The safety check

This is the first time the drug leaves the lab and is tested on people – usually a small group of volunteers. These people may be healthy or they could have MS. But the thing is, Phase 1 is usually just making sure the drug doesn’t come with any serious side effects. It’s all about safety, not effectiveness. About 70% of drugs pass this stage.

Phase 2: Does it actually work?

With safety established, we can move on to Phase 2. Now the drug is tested on a larger group to see if it actually works. This is the phase where we start seeing if it has any positive effect on MS symptoms. But keep in mind, this is still early days. About 67% of drugs fail to make it out of Phase 2.

Phase 3: The big one

By this point, a new treatment starts to look really promising. Hundreds, maybe thousands, of people are involved at this stage. The goal here is to figure out if this new drug is better than what’s already out there. It’s also where any side effects that have remained hidden so far can be picked up. You might think, “Surely if it’s got this far, we’re good to go!” But that’s not always true. In fact, up to 50% of drugs fail here, too. Drug development is a costly and risky process.

Phase 4: Post-launch surveillance

Phase 4 is after a drug has passed all its previous trial and it’s finally approved. But the research doesn’t stop there. Phase 4 kicks in to keep an eye on the long-term safety and effectiveness now that it’s out in the public domain (i.e., you and thousands of others are using it). Rare side effects? Unforeseen problems? That’s what they’re watching for here. It’s very rare for anything to go wrong at this point, but it’s not impossible. Around 4% of drugs that get through Phase 3 trials and enter the market are later recalled or heavily restricted. This is why ongoing surveillance even after a drug is approved is so important.

In vitro, in vivo – what does it mean?

You’ll often see the terms in vitro and in vivo when looking at any reseach. Simply put, in vitro means testing stuff in a lab dish (outside a living body), and in vivo means testing it in animals or humans (inside a living body). Just because something works in vitro doesn’t mean it’ll work in vivo, and that’s why you shouldn’t get too excited about in vitro results. They’re just the first baby steps of a long journey. Similarly, if a study is in vivo but it’s in mice or something else, that doesn’t mean it’ll have the same effect in humans.

Why does all this matter?

Well, next time you see a headline about a miracle MS drug, you’ll have a better idea of how far it’s got to go. Clinical trials take years – sometimes decades – and most drugs fail at some point along the way. Only about 1 in 5,000 compounds tested in a lab will actually end up available on prescription. So those Phase 1 results might be exciting, but they’re really just the earliest steps.

We’re not saying don’t get hopeful. But we are saying keep your expectations in check. Understanding clinical trials means you’ll know when to take those “breakthrough” headlines with a big pinch of salt. And, more importantly, you won’t be left disappointed when the latest wonder drug doesn’t pan out after all.

New MS research

  • Two people working with a medical testing device on a table, one is wearing a pink wristband and the other is taking notes on a clipboard.

    HERCULES Phase 3 trial

    There’s been a some new informations anou the HERCULES Phas 3 trial, which is testing a drug called tolebrutinib in people with non-relapsing secondary progressive multiple sclerosis (nrSPMS).

    The main news from this is that tolebrutinib managed to delay disability progression by 31% compared to a placebo. That means it took longer for people on the drug to experience a confirmed worsening of their condition over six months. Plus, twice as many people (10%) showed improvement in their disability compared to those on placebo (5%).

    The drug works by targeting brain cells that drive the disease's progression. So instead of just tackling relapses, it seems to help slow down the damage that’s happening behind the scenes, which is a huge deal for people with this form of MS.

    There are some side effects though. A few patients (about 4%) had increased liver enzymes, which can be a sign of liver stress. One person even needed a liver transplant, but Sanofi, the company behind the drug, has since tightened their monitoring and reduced serious risks.

    As for what’s next, Tolebrutinib is under review for regulatory approval, and they’re also looking into how it works in people with primary progressive MS with results expected next year.

    This is good news overall since there aren’t many treatment options out there right now.

    More info
  • A microscopic view of brain neurons stained in purple with many small dark purple cell bodies and thin neural connections.

    PIPE-307: May help repair myelin

    PIPE-307, an experimental oral treatment currently in Phase 2 trials for relapsing-remitting multiple sclerosis (RRMS), may help repair damaged myelin, according to early research. The findings, published in PNAS, show that PIPE-307 promoted myelin repair in a mouse model of MS.

    Developed by Contineum Therapeutics, PIPE-307 works by blocking a receptor in the brain, M1R, which stops myelin-producing cells (oligodendrocytes) from maturing. By inhibiting M1R, the drug allows these cells to mature and repair damaged myelin.

    In preclinical studies, PIPE-307 reduced disability and increased myelin repair in mice with MS-like symptoms. The drug also showed potential in promoting myelin repair in human brain tissue samples. However, it’s important to note that these findings are still early, and the drug is undergoing further testing in people.

    Currently, PIPE-307 is being studied in a Phase 2 trial called VISTA, which is recruiting people with RRMS across the U.S. The trial aims to evaluate its safety and impact on symptoms like vision and walking. While the results so far are promising, more research is needed before PIPE-307 can be confirmed as a treatment for MS.

    So, while it’s encouraging, it’s still early days!

    Find out more