From the Guidelines
Multiple sclerosis (MS) symptoms vary widely depending on which parts of the nervous system are affected, and early recognition of these symptoms is crucial for diagnosis and effective treatment, as stated in the 2019 study by Thompson et al. 1.
Common Symptoms of MS
- Fatigue
- Numbness or tingling in limbs
- Vision problems (blurred vision, double vision, or partial/complete vision loss)
- Muscle weakness
- Coordination and balance difficulties
- Problems with walking
- Cognitive issues like memory problems, difficulty concentrating, or slowed thinking
- Bladder and bowel dysfunction
- Sexual problems
- Dizziness
- Pain (including facial pain or electric-shock sensations)
- Speech difficulties
- Tremors
- Heat sensitivity that worsens symptoms
Importance of Early Recognition
Early recognition of MS symptoms is essential for diagnosis, as MS treatment is most effective when started early in the disease course, as highlighted in the 2015 study by the Magnims consensus guidelines 1. The 2010 McDonald criteria, as discussed in the 2015 study, have improved the diagnostic process in relapsing–remitting MS (RRMS), but exhibit limitations in primary progressive MS (PPMS) 1.
Diagnostic Criteria
The diagnosis of MS is based on the detection of lesions within the CNS that demonstrate dissemination in space (DIS) and dissemination in time (DIT), as well as the exclusion of alternative diagnoses, as stated in the 2001 study by McDonald et al. 1. MRI findings can replace certain clinical criteria in a substantial proportion of patients, and the concomitant presence of gadolinium-enhancing and gadolinium-nonenhancing lesions can be used as evidence for DIT, as discussed in the 2015 study 1. The most recent and highest quality study, published in 2019, provides practical guidelines for the correct interpretation and classification of lesions in MS patients, which is essential for accurate diagnosis 1.
From the Research
Symptoms of Multiple Sclerosis
The symptoms of multiple sclerosis (MS) can be difficult for patients to characterize and for clinicians to interpret 2. Typical symptoms of MS include:
- Discrete episodes ("attacks" or "relapses") of numbness, tingling, weakness, vision loss, gait impairment, incoordination, imbalance, and bladder dysfunction 3
- Fatigue and heat sensitivity between attacks 3
- Insidious worsening of neurologic function and accumulation of disability ("progression") that is not associated with discrete relapse activity 3
Diagnosis of Multiple Sclerosis
The diagnosis of MS is based on demonstrating evidence of inflammatory-demyelinating injury within the central nervous system that is disseminated in both time and space 3. Diagnosis is made through a combination of:
- Clinical history
- Neurologic examination
- Magnetic resonance imaging (MRI)
- Exclusion of other diagnostic possibilities 3 The diagnostic criteria for MS have evolved over the past several decades, with each revision impacting the apparent prevalence and prognosis of the disorder 3.
Differential Diagnosis of Multiple Sclerosis
Differential diagnosis in MS must be guided by clinical presentation and neurologic localization 3. Conditions that can mimic MS clinically or radiologically include:
- Infectious disorders
- Neoplastic disorders
- Genetic disorders
- Metabolic disorders
- Vascular disorders
- Other idiopathic inflammatory demyelinating disorders (IIDD) 4 It is essential to identify MS-related attacks and determine the final diagnosis to ensure correct treatment choice and long-term disability prevention 4.