From the Guidelines
Multiple sclerosis (MS) typically presents with a wide range of signs and symptoms, including fatigue, numbness or tingling in limbs, vision problems, muscle weakness, coordination and balance difficulties, and problems with walking, which can vary greatly between individuals. Common symptoms of MS also include sensory disturbances like pins and needles sensations or pain, cognitive issues such as problems with memory, attention, and information processing, bladder and bowel dysfunction, sexual problems, and emotional changes like depression 1. According to the most recent guidelines, the diagnosis of MS is based on the detection of lesions within the CNS that demonstrate dissemination in space (DIS) and dissemination in time (DIT), and the exclusion of alternative diagnoses that can mimic MS either clinically or radiologically 1.
Key Symptoms
- Fatigue
- Numbness or tingling in limbs
- Vision problems (such as blurred vision, double vision, or partial vision loss)
- Muscle weakness
- Coordination and balance difficulties
- Problems with walking
- Sensory disturbances like pins and needles sensations or pain
- Cognitive issues, including problems with memory, attention, and information processing
- Bladder and bowel dysfunction
- Sexual problems
- Emotional changes like depression
The variability in symptoms occurs because MS damages the protective myelin sheath around nerve fibers in the central nervous system, disrupting nerve signal transmission to different parts of the body 1. Early recognition of these symptoms is crucial for prompt diagnosis and treatment, as modern disease-modifying therapies can help slow disease progression when started early. It is essential to note that the symptoms of MS can appear in episodes called relapses or exacerbations that last days to weeks, followed by periods of remission, though some forms of MS progress steadily without distinct relapses.
Importance of Early Diagnosis
Early diagnosis and treatment of MS can significantly improve the quality of life for patients, as it allows for the initiation of disease-modifying therapies that can slow disease progression. The 2010 McDonald criteria have substantially improved the diagnostic process in relapsing–remitting MS (RRMS), but they exhibit a number of limitations in primary progressive MS (PPMS) 1. The use of MRI is essential in the diagnosis of MS, as it can detect white matter abnormalities and help identify typical MS lesions. However, careful determination of which imaging features and patterns constitute ‘typical’ MS lesions and which are atypical is crucial to avoid misdiagnosis 1.
From the Research
Signs and Symptoms of Multiple Sclerosis
The signs and symptoms of multiple sclerosis (MS) can vary widely from person to person, but common presentations include:
- Unilateral optic neuritis
- Partial myelitis
- Sensory disturbances
- Brainstem syndromes, such as internuclear ophthalmoplegia These symptoms typically develop over several days and can lead to physical disability, cognitive impairment, and decreased quality of life 2.
Physical Disability and Cognitive Impairment
MS can cause a range of physical disabilities, including:
- Weakness or numbness in one or more limbs
- Vision problems, such as blurred vision or loss of vision
- Tremors or lack of coordination
- Balance and walking problems Cognitive impairment is also common in MS, and can include:
- Memory problems
- Difficulty with concentration and attention
- Decreased processing speed
- Difficulty with problem-solving and decision-making 2, 3.
Diagnosis and Treatment
Diagnosis of MS is made based on a combination of signs and symptoms, radiographic findings (such as MRI T2 lesions), and laboratory findings (such as cerebrospinal fluid-specific oligoclonal bands) 2. Treatment for MS typically involves disease-modifying therapies (DMTs), which can reduce the frequency and severity of relapses and slow the progression of disability. Common DMTs include interferons, glatiramer acetate, and monoclonal antibodies 2, 4, 5, 6.
Disease-Modifying Therapies
DMTs can be effective in reducing the annual relapse rate and slowing the progression of disability in MS. For example:
- Interferon-beta-1b has been shown to reduce the annual relapse rate and increase the proportion of relapse-free patients compared with placebo 4, 5.
- Peginterferon beta-1a has an extended half-life and requires less frequent administration than other available treatments, which may improve adherence and reduce adverse events 6.
- Other DMTs, such as glatiramer acetate and monoclonal antibodies, may also be effective in reducing relapse rates and slowing disease progression 2, 6.