What are the symptoms of Multiple Sclerosis (MS)?

Symptoms of Multiple Sclerosis (MS)

Multiple sclerosis presents with a wide variety of symptoms that can affect different parts of the nervous system, including vision problems, motor weakness, sensory disturbances, balance issues, fatigue, and cognitive difficulties. 1

Common Primary Symptoms

• Vision Problems:

  • Optic neuritis (inflammation of the optic nerve)
  • Blurred vision
  • Double vision (diplopia)
  • Internuclear ophthalmoplegia 1, 2

• Motor Symptoms:

  • Weakness in limbs
  • Spasticity (muscle stiffness)
  • Tremor or lack of coordination
  • Gait problems 1, 3

• Sensory Disturbances:

  • Numbness or tingling (paresthesia)
  • Electric-shock sensations (Lhermitte's sign)
  • Neuropathic pain
  • Sensory loss 1, 4

• Balance and Coordination Issues:

  • Ataxia (lack of muscle coordination)
  • Decreased ability to maintain position
  • Delayed responses to postural changes
  • Increased fall risk (50-80% of patients) 3

• Fatigue:

  • One of the most common and debilitating symptoms
  • Often worsens with heat exposure 1, 4

• Cognitive Dysfunction:

  • Memory problems
  • Difficulty concentrating
  • Slowed information processing 1, 4

• Bladder, Bowel, and Sexual Function:

  • Urinary urgency or retention
  • Constipation
  • Sexual dysfunction 1, 4

Less Common Symptoms

• Dysarthria (speech difficulties)
• Dysphagia (swallowing difficulties)
• Vertigo
• Hearing loss
• Seizures 4

Symptom Patterns by MS Type

1. Relapsing-Remitting MS (RRMS) - Affects approximately 85% of patients:

   • Discrete episodes of symptoms developing over days
   • Symptoms typically stabilize between attacks
   • Patients may experience complete or partial recovery between relapses 1, 5

2. Primary Progressive MS (PPMS) - Affects approximately 15% of patients:

   • Progressive deterioration from onset
   • No distinct relapses or remissions
   • Typically presents around age 40 1, 5

Factors Affecting Symptom Presentation

• Disease Duration: Symptoms often accumulate and worsen over time 2
• Lesion Location: Symptoms depend on which areas of the CNS are affected 5
• Temperature: Many symptoms worsen with increased body temperature (Uhthoff's phenomenon) 4
• Fatigue: Can exacerbate other symptoms 4

Diagnostic Considerations

MS diagnosis requires evidence of damage in different parts of the nervous system (dissemination in space) occurring at different times (dissemination in time), according to the McDonald criteria. MRI of the brain and spinal cord is essential for diagnosis, looking for characteristic T2-hyperintense and gadolinium-enhancing lesions 1, 6.

Clinical Implications

Early recognition of MS symptoms is crucial for timely diagnosis and treatment. Disease-modifying therapies can reduce relapse rates by 29-68% compared to placebo or active comparators 5. Symptom management includes both pharmacological and non-pharmacological approaches to improve quality of life 4.

The presence of dysphagia (swallowing difficulties) in MS patients should be screened for regularly, as it can lead to serious complications including aspiration pneumonia, dehydration, and malnutrition 6.