Living with multiple sclerosis amid stress: Insights from UAE doctors

Living with multiple sclerosis is about playing the long game, as Dubai-based Marie Meillaud says. While the diagnosis undoubtedly hit like a 'tsunami,' she, like many others with the condition, adopts a “moving forward” approach rather than a fighting mindset.

Despite the challenges MS can bring, Meillaud, a member of the National Multiple Sclerosis Society, UAE, focuses on maintaining normalcy in her life. “I want to live as normally as possible. I have a demanding job in operations, where I lead a team, maintain a busy social life, and raise 10-year-old twins as a normal family. I constantly set new personal goals for myself,” she says.

MS can affect each person differently, which is why understanding the condition, its causes, symptoms, and forms, is crucial for patients and caregivers alike.

Understanding multiple sclerosis

Dr. Rajit Pillai, Specialist Neurology at Aster Clinic in Sharjah, explains what MS really is: A chronic neurological condition where the immune system attacks the protective covering of nerve fibres in the central nervous system, disrupting communication between the brain and the body, resulting in a variety of symptoms.”

In essence, myelin, the protective sheath that insulates nerve fibres, serves a role similar to electrical insulation, ensuring that nerve signals are transmitted efficiently. The immune system’s attack on myelin is thought to result from a process known as molecular mimicry. Researchers suggest that prior exposure to a foreign agent, such as a virus, may prime the immune system against a protein structure that closely resembles proteins in human myelin. As a result, when T cells generate can mistakenly target myelin, leading the immune system to attack healthy nerve tissue.

When it is damaged, nerve signals can be slowed or misdirected, causing symptoms that vary widely from person to person. These may include fatigue, vision changes, numbness, difficulty with balance, and muscle weakness. Symptoms can come and go or gradually worsen over time, making daily life unpredictable.

MS can present in several forms:

• Relapsing-remitting MS (RRMS): Flare-ups followed by periods of recovery, which may eventually evolve into secondary progressive MS (SPMS)

• Primary progressive MS (PPMS): Symptoms steadily worsen from the onset

• Clinically isolated syndrome (CIS): A first episode that may or may not develop into MS

The current therapies focus on managing symptoms, reducing relapses, and slowing disease progression, allowing people to continue their daily routines with confidence.

Stress and MS: Why it matters

For people living with MS, stress can have a disruptive impact. Dr. Ruqqia Mir, Consultant Neurologist at Yas Clinic Khalifa City and member of the National MS Society’s Medical Advisory Committee, explains: Stress activates the body’s fight-or-flight response, leading to the release of cortisol. This increases heart rate, raises blood pressure, and causes muscle tension while heightening alertness.

Dr Mir emphasises: "Stress does not cause MS and is not considered a direct driver of disease progression. However, it plays a significant role in symptom fluctuation." The prolonged stress can lead to a temporary worsening of existing symptoms such as fatigue, brain fog, or mobility issues. These changes can feel severe but are usually not linked to new neurological damage. In many cases, stress acts as an amplifier rather than a cause of new disease activity.

Moreover, people with MS are particularly sensitive to stress because their central nervous system is already affected by inflammation and damage. “It can intensify existing symptoms, which in turn increases anxiety and creates a cycle of worsening symptoms and emotional distress,” Dr. Mir adds.

And so, breaking this cycle is essential for maintaining stability.

Signs of stress-induced symptom worsening

Dr. Mir explains how to distinguish temporary flare-ups from true disease progression. "Pseudo flare ups are temporary episodes where existing MS symptoms worsen due to external triggers such as stress, heat, infection, or lack of sleep. These episodes usually last less than 24 hours and improve with rest, hydration, or cooling. They are not caused by new disease activity, but by external stressors affecting the body," she says.

However, a true relapse is different because it reflects new neurological inflammation. It involves new symptoms, such as vision loss or new weakness, and typically lasts longer than 24 to 48 hours with gradual worsening over time.

Common triggers include:

• Emotional stress: anxiety, uncertainty, family pressures

• Physical stress: lack of sleep, overexertion, dehydration, illness

• Environmental stress: heat, excessive negative news exposure

• Additional triggers: infections, such as fever, urinary infections, or poorly controlled conditions such as diabetes

Practical strategies for managing stress

Dr. Mir offers actionable day-to-day strategies for people living with MS:

• Manage information intake and limit exposure to distressing news

• Use breathing techniques, such as the 4-7-8 method, to regulate the nervous system and reduce anxiety

• Prioritise tasks, break activities into smaller steps, and take breaks before exhaustion for effective energy management

• Engage in gentle physical movement, such as stretching or short walks, to support circulation and balance

• Maintain good sleep habits with a consistent routine, reduced screen time before bed, and a comfortable sleep environment to support recovery and regulate the immune system

• Follow a healthy diet, such as a Mediterranean-style approach, and consider supplements like vitamins C and D under medical guidance

While living with MS can be unpredictable, understanding the condition and how stress impacts symptoms empowers patients to take control of their health. With medical guidance, community support, and practical coping strategies, people with MS in the UAE can navigate even stressful periods without letting the disease define their lives.