What are the symptoms and treatment options for Multiple Sclerosis (MS)?

Symptoms of Multiple Sclerosis

Primary Neurological Symptoms

MS presents with diverse neurological symptoms that directly result from demyelination and axonal loss in the central nervous system, typically beginning in young adults aged 20-30 years. 1

Common Presenting Symptoms

• Unilateral optic neuritis (visual disturbances, eye pain) is a classic initial presentation, developing over several days 1
• Partial myelitis causing motor weakness and sensory disturbances in the limbs 1
• Brainstem syndromes including internuclear ophthalmoplegia (double vision, abnormal eye movements) 1
• Sensory loss affecting various body regions, often asymmetric 2, 1
• Ataxia and coordination problems resulting from cerebellar involvement 2

Frequently Occurring Symptoms

• Fatigue and weakness are among the most common and disabling symptoms 2
• Balance dysfunction and gait problems affect 50-80% of patients, even early in disease course 3
• Spasticity (muscle stiffness and spasms) 2, 3
• Bladder, bowel, and sexual dysfunction 2
• Cognitive impairment affecting memory, attention, and processing speed 2, 1
• Depression and other mood disturbances 2
• Neuropathic pain (burning, tingling, shooting pain) 2

Less Common Symptoms

• Dysarthria (speech difficulties) and dysphagia (swallowing problems) 2
• Vertigo (spinning sensation) 2
• Tremors 2

Rare Symptoms

• Seizures 2
• Hearing loss 2
• Complete paralysis 2

Secondary and Tertiary Symptoms

• Secondary symptoms develop as consequences of primary symptoms, such as urinary tract infections from bladder dysfunction 2
• Tertiary symptoms include social isolation, unemployment, and reactive depression resulting from disease impact 2

Falls and Mobility Impact

• Over 50% of MS patients fall at least once annually, with falls associated with injuries, reduced participation, and increased fear of falling 3
• Postural control problems manifest as decreased ability to maintain position, limited movement toward stability limits, and delayed responses to perturbations 3
• Walking changes include reduced gait speed, impaired walking balance, and decreased walking-related physical activity 3

Functional Impact

• Physical disability, cognitive impairment, and reduced quality of life are hallmark consequences of MS 1
• Life expectancy is reduced compared to the general population (75.9 vs 83.4 years) 1
• Symptoms can interact with each other, making management challenging 4

Important Clinical Pearls

• MS can affect any part of the central nervous system, leading to highly variable presentations 5
• Symptoms typically develop over several days rather than suddenly 1
• Women are affected nearly 3 times more often than men 1
• The disease typically presents between ages 20-30 years 1, 5