Symptoms of multiple sclerosis appear in a variety of ways. Most patients first have a single attack of symptoms, a neurological episode called a clinical isolated syndrome, which typically occurs between the ages of 20 and 50. Initial symptoms may be mild enough that patients do not always seek medical care. Once a second attack occurs, the patient is considered to have relapsing-remitting multiple sclerosis. Much less commonly, the disease is progressive from the start, with the patient having more or less continuous symptoms.
Symptoms in multiple sclerosis depend on the location of the nerve lesion. Not all symptoms affect all patients.
Symptoms more likely to occur earlier in the disease include:
- Vision Problems. Optic neuritis, inflammation of the nerves in the eye, is a common early symptom in over half of patients. Patients may initially experience blurred or double vision, usually because of problems with one eye. As the condition progresses, vision loss increases, although total blindness is rare.
- Tingling and Numbness Sensations. Tingling, crawling or burning sensations, or loss of sensation can occur. Patients may feel sensations of intense heat or cold. Symptoms often begin at the end of the legs or arms and move up towards the beginning of the limb. L’Hermmitte’s sign, which is caused by lesions in the cervical spine in the neck, is an electrical buzzing sensation that runs down the back and into the legs. It occurs when bending the neck forward.
- Muscle Weakness and Spasms. Patients can feel weakness, clumsiness, or heaviness in the limbs. They may have difficulty with finger dexterity. Muscle spasms and stiffness (spasticity), particularly in the legs, occur in an initial attack of MS in about 40% of patients.
- Problems with Balance and Coordination. Patients have an unsteady gait and difficulty walking normally and keeping their balance. They may have trouble grasping small objects. These problems can be compounded by other common MS symptoms, such as dizziness and tremor. Ataxia (lack of muscle coordination) and tremors (shaking or trembling of limb) affect up to half of patients.
- Fatigue. Fatigue is the most common and debilitating symptom of MS and often occurs early in the disease. Fatigue is typically worse in the late afternoon and improves in the early evening, and may be accompanied by an increase in body temperature. At the onset, fatigue occurs in about 20% of patients, but as the disease progresses, this is a significant symptom in nearly all patients
Other Common Symptoms
Other common symptoms that progress over time include:
Bladder and Bowel Problems. Some patients have problems emptying their bladder (urinary retention) and bowels (constipation) or find they cannot control their bladder and bowels (incontinence). Patients with urge incontinence need to urinate frequently or are unable to reach the bathroom before leakage occurs. Bladder problems, and catheterization for urinary retention, can lead to urinary tract infections. [For more information, see In-Depth Reports #50: Urinary incontinence and #36: Urinary tract infections.]
Pain. About two-thirds of patients have pain at some point during the course of the disease, and 40% are never pain free. MS causes many pain syndromes; some occur for a short time while others continue for a long time. Some worsen with age and disease progression. Pain syndromes associated with MS include trigeminal (facial) pain, powerful spasms and cramps, pressure pain, stiffened joints, and a variety of sensations, including feelings of itching, burning, and shooting pain.
Sexual Dysfunction. Sexual dysfunction is a common problem, occurring in more than 70% of patients. Men are likely to have erectile dysfunction, and women often have problems with vaginal lubrication. Sexual dysfunction appears to be highly associated with urinary dysfunction. [For more information, see In-Depth Report #15: Erectile dysfunction.]
Speech and Swallowing Problems. Up to half of patients have trouble chewing or swallowing. Some patients have slurred speech and problems speaking clearly.
Thinking, Concentration, and Memory Problems. Cognitive problems, such as having trouble concentrating, reasoning, and solving problems, affect about half of patients. Up to 75% of patients have problems with memory. These disabilities can create difficulties in the workplace.
Mood Swings. Depression is very common and is sometimes very severe. Depression can be caused both by physical changes in the brain as well as emotional response to the stress of dealing with MS. About 10% of patients suffer from psychosis (manic depression and paranoia). About 5% of patients with severe MS have uncontrolled and extreme mood swings where they alternate between uncontrollable laughing and weeping (pseudobulbar affect). [For more information, see In-Depth Reports #8: Depression and #31: Stress.]
Possible Symptom Triggers
Some patients find that MS flares (relapses) are triggered by certain factors. Possible symptom triggers include.
Infections. Viral and bacterial infections, including urinary tract infections, may provoke MS symptoms.
Heat and Cold. Sudden changes in temperature or humidity can trigger symptoms. Many patients with MS have heat intolerance and find that heat worsens their symptoms.
Stress. Many patients report that stress worsens their symptoms.