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

Symptoms of Multiple Sclerosis

Primary Neurological Symptoms

Multiple sclerosis presents with a wide range of neurological symptoms that result directly from demyelination and axonal loss in the central nervous system. 1, 2

Common Presenting Symptoms

• Sensory disturbances including numbness, tingling, and Lhermitte sign (electric shock sensation down the spine with neck flexion) are among the most frequent initial presentations 2, 3, 4
• Visual problems, particularly unilateral optic neuritis causing vision loss, pain with eye movement, and decreased visual acuity 2, 3
• Motor weakness affecting limbs, often asymmetric and developing over several days 2, 3, 4
• Brainstem syndromes such as internuclear ophthalmoplegia (impaired eye coordination), diplopia (double vision), and dysarthria (slurred speech) 2, 3, 4
• Coordination and balance problems including ataxia, impaired gait, and postural instability 5, 6
• Fatigue, which is one of the most disabling symptoms affecting the majority of patients 5, 4

Additional Common Symptoms

• Spasticity causing muscle stiffness and involuntary muscle contractions 5, 4, 6
• Bladder dysfunction including urgency, frequency, hesitancy, and urinary retention 5, 4
• Bowel dysfunction with constipation being particularly common 5, 4
• Sexual dysfunction affecting both men and women 5, 4
• Cognitive impairment involving memory, attention, processing speed, and executive function 5, 3
• Depression and mood changes as both primary and reactive symptoms 5, 4
• Neuropathic pain including burning sensations, dysesthesias, and trigeminal neuralgia 5, 4

Less Common Symptoms

• Vertigo and dizziness 5
• Tremors, particularly intention tremor affecting coordinated movements 5
• Dysphagia (swallowing difficulties) 5
• Heat sensitivity (Uhthoff's phenomenon) causing temporary worsening of symptoms with elevated body temperature 5

Rare Symptoms

• Seizures occur in less than 5% of MS patients 5
• Hearing loss, though bilateral sudden hearing loss should prompt evaluation for alternative diagnoses 2, 5
• Complete paralysis is uncommon 5

Clinical Presentation Patterns

MS typically presents in young adults between ages 20-30 years, with symptoms developing over several days and affecting women nearly three times more often than men. 2, 3

Diagnostic Red Flags

• Sudden onset of focal neurologic symptoms such as headache, confusion, focal weakness, or numbness occurring acutely (within minutes to hours) may indicate stroke rather than MS and requires immediate evaluation 2
• Bilateral sudden hearing loss suggests an alternative diagnosis and warrants prompt otolaryngologic assessment 2
• Symptoms in patients under age 10 or over age 59 require more stringent diagnostic criteria and careful consideration of alternative diagnoses 2

Secondary and Tertiary Symptoms

Secondary symptoms arise as consequences of primary neurological deficits, while tertiary symptoms reflect the psychosocial impact of the disease. 5

Secondary Symptoms

• Urinary tract infections resulting from neurogenic bladder and urinary retention 5
• Pressure ulcers from immobility 5
• Contractures from chronic spasticity 5
• Deconditioning from reduced physical activity 5

Tertiary Symptoms

• Social isolation due to disability and symptom burden 5
• Unemployment and vocational disability 5
• Relationship difficulties 5
• Reactive depression beyond primary mood changes 5

Balance, Gait, and Falls

The overwhelming majority of MS patients have abnormalities of postural control and gait even early in the disease course, with 50-80% experiencing balance and gait dysfunction and over 50% falling at least once yearly. 6

Balance Dysfunction Components

• Decreased ability to maintain position during static standing 6
• Limited and slowed movement towards limits of stability 6
• Delayed responses to postural displacements and perturbations 6
• Impaired dual-task integration affecting functional balance performance 6

Gait Changes

• Reduced gait speed is nearly universal in symptomatic patients 6
• Impaired walking balance with increased fall risk 6
• Reduced walking-related physical activity contributing to deconditioning 6

Weight Loss and Nutritional Issues

Weight loss, malnutrition, and even cachexia are well-recognized features of MS patients. 1

Contributing Factors

• Reduced mobility and fatigue limiting food preparation and eating 1
• Inappropriate diet due to cognitive impairment or lack of knowledge 1
• Physical difficulty with eating or drinking from motor impairment 1
• Poor appetite as a primary symptom 1
• Visual impairment affecting meal preparation 1
• Dysphagia causing difficulty swallowing 1
• Reduced cognition impairing meal planning and execution 1

Clinical Course Variability

The course of MS is highly variable, with at least two main clinical forms: relapsing-remitting MS (affecting approximately 85% of patients) and primary-progressive MS (affecting approximately 15%). 1, 3, 4

• Relapsing-remitting MS involves acute symptom exacerbations (relapses) followed by periods of remission, with 85% of patients experiencing exacerbations that may require corticosteroid treatment 1, 4
• Secondary progressive MS develops in many patients initially diagnosed with relapsing-remitting disease, characterized by steadily increasing neurological disability 1, 3
• Primary progressive MS presents with progressive neurological deterioration from onset without distinct relapses 1, 3