Multiple sclerosis (MS) is a chronic, debilitating, neurodegenerative disease that has

a high impact on patients’ quality of life. Individuals are often diagnosed in early adulthood and

are faced with the difficulty of managing their lifestyle within the context of this chronic illness.

Here we review factors that influence the disease course and the challenges that might be

encountered when managing patients with MS.

The majority of diagnosed patients are women of childbearing age, making pregnancy-related

issues a key concern. MS typically stabilizes during pregnancy and evidence suggests that

the disease has no impact on the risk of complications or outcomes. However, the effect of

disease-modifying therapies on outcomes is less clear, and discontinuation of treatment prior

to pregnancy or when breastfeeding is recommended. Awareness of genetic risk factors is

important for patients planning a family, as several genes increase the risk of MS.

Further aspects that require consideration include infections, vaccinations, environmental

factors, surgery and the emergence of osteoporosis. Vaccinations are generally not a risk

factor for MS and may be beneficial in terms of protection against infection and reducing the

number of relapses. Environmental factors such as vitamin D deficiency, low exposure to

sunlight, smoking and Epstein−Barr virus infection can all negatively influence the disease

course. Furthermore, osteoporosis is generally higher in patients with MS than the general

population, and the risk is increased by the environmental and genetic factors associated with

the disease; bone mineral density should be assessed and smoking cessation and correction

of serum vitamin D levels are recommended. Finally, as patients with MS are typically young,

they are at low risk of surgery-related complications, although they should be carefully

monitored postoperatively. Awareness of, and planning around, these factors may minimize

the impact of the disease on patients’ lifestyle.