What are the prevalence rates of common symptoms in multiple sclerosis?

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Prevalence Rates of Common Symptoms in Multiple Sclerosis

The most prevalent symptoms in MS are fatigue (affecting the majority of patients), spasticity, and voiding disorders, with dysphagia affecting 36% by subjective screening methods and up to 81% when assessed by objective instrumental testing. 1, 2

Core Symptom Prevalence

Most Common Symptoms (Nationwide Registry Data)

  • Fatigue: Most frequently reported symptom across all disease stages, particularly prominent even in patients with short disease duration 2
  • Spasticity: Second most common symptom, with treatment rates higher than other symptoms 2
  • Voiding disorders: Third most common symptom reported 2
  • Sensory disturbances: Ranges from 5% to 94% depending on disease stage and population studied 3, 4
  • Motor dysfunction: Ranges from 35.4% to 100% as initial presentation, particularly in late-onset MS 3

Dysphagia Prevalence (Critical for Morbidity/Mortality)

The prevalence of dysphagia varies dramatically based on assessment method, which is clinically crucial since dysphagia directly impacts aspiration pneumonia risk and mortality 1:

  • Subjective screening methods (questionnaires): 36% pooled prevalence (95% CI 31-42%) 1
  • Objective instrumental methods (FEES/VFS): 81% pooled prevalence 1
  • Specific screening tools:
    • DYMUS questionnaire: 31% abnormal results, with 92% reporting altered feeding habits 1
    • Water swallow test (150 ml): 43% positive screening 1
    • Northwestern Dysphagia Patient Check Sheet: 31.7% classified as having dysphagia 1
    • FEES in consecutive progressive MS patients: 34-90% depending on population severity 1

Specific Dysphagia-Related Symptoms

  • Altered feeding habits: 92% of patients with dysphagia 1
  • Coughing and choking during meals: 58% 1
  • Food sticking in throat: 32% 1
  • Difficulty managing secretions: 32% 1
  • History of pneumonia: 12% 1
  • Pharyngeal stage disorders: 28.7% (most common impairment) 1
  • Aspiration: 6.9% 1

Initial Presentation Symptoms

Relapsing-Remitting MS (Most Common Form)

  • Unilateral optic neuritis: Common initial presentation 5
  • Partial myelitis: Common initial presentation 5
  • Sensory disturbances: Common initial presentation 5, 4
  • Brainstem syndromes (e.g., internuclear ophthalmoplegia): Common initial presentation 5, 4
  • Lhermitte sign: Characteristic symptom 4

Late-Onset MS (>50 years)

  • Motor dysfunction: 35.4-100% as first presentation (most prevalent) 3
  • Sensory problems: 5-94% 3
  • Visual symptoms: 5-22.9% 3
  • Brainstem dysfunction: 12.3-25% 3
  • Spinal cord involvement: 65% (95% CI 44.71-81.02%) 3

Early-Onset MS (<20 years)

  • Visual loss: Most frequent initial symptom 6
  • Other functional systems: Variable frequency 6

Undertreated Symptoms (Quality of Life Impact)

Despite high prevalence, certain symptoms remain significantly undertreated 2:

  • Fatigue: Treated in only one-third of affected patients despite being the most common symptom 2
  • Sexual dysfunction: Treated to a far lesser extent than prevalence warrants 2
  • Cognitive dysfunction: Treated to a far lesser extent than prevalence warrants 2
  • Dysphagia: Undertreated relative to its 81% objective prevalence and mortality risk 1, 2

In contrast, spasticity and depression receive more consistent treatment 2.

Risk Factors for High-Prevalence Symptoms

Dysphagia Risk Factors

  • Severe brainstem impairment: OR 3.24 (95% CI 1.44-7.31) 1
  • Severity of illness: OR 2.99 (95% CI 1.36-6.59) 1
  • Cerebellar dysfunction: Significantly associated 1
  • Longer disease duration: Significantly associated 1
  • Higher EDSS scores: Significantly associated 1
  • Progressive MS forms: More frequent in secondary and primary progressive MS 1

Critical pitfall: Dysphagia can occur even in patients with EDSS <2.5 (low disability), so screening should not be delayed until severe disability develops 1.

Neuropsychological Impact

  • Neuropsychological symptoms: Nearly one-fifth of patients with EDSS ≤3.5 and neuropsychological symptoms had retired from work, demonstrating major quality of life impact even at low disability levels 2
  • Depression: Common enough to warrant routine symptomatic treatment 2

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Research

Multiple Sclerosis: A Primary Care Perspective.

American family physician, 2022

6
Research

Early onset multiple sclerosis.

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2000

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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