What are the symptoms of Multiple Sclerosis (MS)?

From the Guidelines

Multiple sclerosis symptoms can be effectively diagnosed and managed using the 2010 McDonald criteria, which prioritize MRI findings and clinical presentation to support the diagnosis and rule out other disorders. The diagnosis of multiple sclerosis (MS) is based on the detection of lesions within the central nervous system (CNS) that demonstrate dissemination in space (DIS) and dissemination in time (DIT) 1. Common symptoms of MS include fatigue, numbness or tingling in limbs, vision problems, muscle weakness or spasms, and difficulty with coordination and balance.

Key Symptoms

• Fatigue
• Numbness or tingling in limbs
• Vision problems like blurred vision or double vision
• Muscle weakness or spasms
• Difficulty with coordination and balance
• Cognitive changes such as memory problems, difficulty concentrating, or slowed thinking
• Bladder and bowel dysfunction
• Pain, either directly from nerve damage or secondary to muscle stiffness
• Speech problems, tremors, and dizziness

The 2010 McDonald criteria have substantially improved the diagnostic process in relapsing–remitting MS (RRMS), but they exhibit limitations in primary progressive MS (PPMS) 1. The use of MRI findings, in combination with clinical presentation, is crucial for supporting the diagnosis of MS and ruling out other disorders. Cerebrospinal fluid (CSF) testing may be relevant in certain patients, particularly those for whom MRI is not entirely diagnostic or reveals features that are unusual in MS 1.

Diagnostic Approach

• MRI findings to support the diagnosis of MS
• Clinical presentation to support the diagnosis of MS
• CSF testing to support the diagnosis of relapsing MS in certain patients
• Exclusion of alternative diagnoses that can mimic MS either clinically or radiologically

The variability of MS symptoms makes early diagnosis challenging, and symptoms can mimic other neurological conditions, so proper medical evaluation is essential for accurate diagnosis and treatment 1. A prompt and accurate diagnosis of MS is crucial, as disease-modifying treatments are thought to be particularly effective in the early phases of the disease.

From the Research

Multiple Sclerosis Symptoms

• Multiple sclerosis (MS) is an autoimmune-mediated neurodegenerative disease of the central nervous system characterized by inflammatory demyelination with axonal transection 2.
• MS typically presents in young adults aged 20 to 30 years with unilateral optic neuritis, partial myelitis, sensory disturbances, or brainstem syndromes such as internuclear ophthalmoplegia developing over several days 2.
• The prevalence of MS worldwide ranges from 5 to 300 per 100 000 people and increases at higher latitudes 2.
• Overall life expectancy is less than in the general population (75.9 vs 83.4 years), and MS more commonly affects women (female to male sex distribution of nearly 3:1) 2.

Disease-Modifying Therapies

• Nine classes of disease-modifying therapies (DMTs) are available for relapsing-remitting MS and secondary progressive MS with activity 2.
• These drugs include interferons, glatiramer acetate, teriflunomide, sphingosine 1-phosphate receptor modulators, fumarates, cladribine, and 3 types of monoclonal antibodies 2.
• One additional DMT, ocrelizumab, is approved for primary progressive MS 2.
• Treatment with DMT can reduce the annual relapse rate by 29% to 68% compared with placebo or active comparator 2.

Comparison of Therapies

• Interferons-beta (IFNs-beta) and glatiramer acetate (GA) have similar clinical efficacy at 24 months, but IFNs-beta may be more effective in reducing MRI lesion load 3.
• GA may be a suitable alternative for patients who discontinue IFN-beta therapy, with no negative influence on efficacy, safety, or tolerability 4.
• The choice of DMT should reflect the risk/benefit profile, as well as the impact on quality of life, and may involve patient engagement strategies and individualization of treatment 5.

Treatment Recommendations

• The American Academy of Neurology has developed recommendations for DMT in MS, including starting, switching, and stopping therapies, with a focus on patient engagement and individualization of treatment 5.
• The use of interferon beta and glatiramer acetate in MS is still relevant, despite the introduction of newer therapies, due to their efficacy and safety profile 6.