Symptoms of Multiple Sclerosis (MS)
Multiple sclerosis presents with a wide variety of neurological symptoms that reflect damage to the central nervous system, with the most common symptoms including fatigue, sensory changes, motor impairments, visual disturbances, cognitive dysfunction, and bladder/bowel problems. 1, 2, 3
Common Primary Symptoms
Sensory Symptoms
- Numbness or tingling (paresthesia) in face, body, or extremities
- Pain (neuropathic)
- Sensory loss
- Vibration sensation changes 2, 3
Motor Symptoms
- Muscle weakness
- Spasticity (muscle stiffness)
- Balance problems and poor coordination
- Gait difficulties
- Tremor 2, 4
Visual Disturbances
- Optic neuritis (presenting as unilateral vision loss with pain on eye movement)
- Blurred vision
- Double vision (diplopia)
- Visual field defects 1, 3
Cognitive and Psychological Symptoms
- Fatigue (one of the most common and debilitating symptoms)
- Cognitive changes (memory problems, difficulty concentrating)
- Depression and mood disorders
- Emotional lability 2, 4
Bladder and Bowel Dysfunction
- Urinary urgency or retention
- Frequent urination
- Bowel constipation or incontinence
- Sexual dysfunction 2, 4
Less Common Symptoms
- Dysarthria (speech difficulties)
- Dysphagia (swallowing problems)
- Vertigo and dizziness
- Hearing loss (rare)
- Seizures (rare)
- Paralysis (in advanced cases) 4
Symptom Patterns and Disease Course
MS symptoms typically manifest in one of several patterns:
Relapsing-remitting pattern: Discrete episodes ("attacks" or "relapses") of neurological dysfunction followed by periods of partial or complete recovery (remission) 3
Progressive pattern: Gradual, continuous worsening of neurological function without distinct relapses, accounting for most long-term disability in MS 3
Primary progressive MS: Occurs in approximately 15% of cases, characterized by progressive deterioration from onset without relapses or remissions, typically presenting around age 40 1
Clinical Considerations
- Symptoms vary widely between individuals and can fluctuate in severity
- Heat sensitivity often exacerbates symptoms temporarily
- Symptoms may worsen during periods of stress, fatigue, or infection
- The combination and severity of symptoms reflect the location and extent of demyelination and axonal damage in the central nervous system 2, 3
Diagnostic Implications
The diagnosis of MS requires evidence of inflammatory-demyelinating injury within the central nervous system that is disseminated in both time and space, as outlined in the McDonald criteria 1, 3. MRI of the brain and orbits with and without contrast is recommended as the primary imaging study for initial assessment, particularly when optic neuritis is present 1.
It's important to note that many of these symptoms can occur in other neurological conditions, making a thorough diagnostic evaluation essential to confirm MS and rule out other conditions that may mimic its presentation.