What are the common presenting symptoms of multiple sclerosis?

Common Presenting Symptoms of Multiple Sclerosis

The most common presenting symptoms of multiple sclerosis include unilateral optic neuritis, partial myelitis, sensory disturbances, and brainstem syndromes such as internuclear ophthalmoplegia, typically developing over several days. 1

Initial Presentation Patterns

Multiple sclerosis (MS) typically presents in young adults between 20-30 years of age with a variety of neurological symptoms that reflect damage to different parts of the central nervous system. The presentation patterns include:

Visual Symptoms

• Optic neuritis: Unilateral vision loss with pain on eye movement 1, 2
• Visual disturbances: Blurred vision, double vision (diplopia), or complete loss of vision 3, 2
• Internuclear ophthalmoplegia: Failure of ipsilateral eye adduction with contralateral eye abduction nystagmus 2

Sensory Symptoms

• Sensory disturbances: Numbness, tingling, or paresthesias 3
• Neuropathic pain: Can occur in various body regions 4
• Sensory loss: Decreased sensation in limbs or trunk 4

Motor Symptoms

• Weakness: Often asymmetric, affecting one or more limbs 3, 4
• Spasticity: Increased muscle tone and stiffness 3
• Balance problems: Difficulty maintaining equilibrium 3
• Gait abnormalities: Unsteady walking or coordination difficulties 4
• Ataxia: Lack of muscle coordination 3, 5

Brainstem and Cerebellar Symptoms

• Brainstem syndromes: Including vertigo, facial numbness or weakness 1, 2
• Dysarthria: Slurred speech 4
• Dysphagia: Difficulty swallowing 4
• Tremors: Involuntary rhythmic movements 4

Bladder, Bowel, and Sexual Symptoms

• Bladder dysfunction: Urgency, frequency, or retention 3, 4
• Bowel issues: Constipation or incontinence 3, 4
• Sexual dysfunction: Decreased libido or performance issues 4

Cognitive and Psychological Symptoms

• Cognitive changes: Memory problems, difficulty concentrating 3
• Mood disorders: Depression, anxiety 3, 5

Other Common Symptoms

• Fatigue: One of the most common and debilitating symptoms 3, 4
• Lhermitte's sign: Electric-like sensation running down the spine upon neck flexion 6

Key Diagnostic Features

The diagnosis of MS is based on demonstrating:

1. Dissemination in space: Evidence of damage in different parts of the nervous system
2. Dissemination in time: Evidence of damage occurring at different times
3. No better explanation for the clinical presentation 6

Important Clinical Considerations

• MS symptoms typically develop over days (subacute onset) rather than minutes or hours 1
• Symptoms often resolve partially or completely during early stages of the disease 6
• The presence of bilateral simultaneous symptoms should raise suspicion for alternative diagnoses 6
• MS more commonly affects women, with a female to male ratio of nearly 3:1 1

Diagnostic Approach

MRI imaging is essential for diagnosis, including:

• Brain MRI with and without contrast to detect T2-hyperintense and gadolinium-enhancing lesions
• Spinal cord MRI, particularly important when brain findings are minimal 6

Lumbar puncture may reveal:

• Oligoclonal bands
• Elevated IgG index
• Normal cell count and protein levels 6

Understanding these common presenting symptoms is crucial for early recognition and prompt diagnosis of MS, which can lead to earlier treatment initiation and potentially better long-term outcomes for patients.