Multiple sclerosis symptoms: What you need to know

Multiple sclerosis (MS) is a disease that impacts the central nervous system, a portion of your body that controls everything you do. In MS, inflammation damages both the neurons and their protective sheath, called myelin.

The damage disrupts or slows nerve signals, and causes a variety of symptoms depending on where the damage is. MS can affect a person's vision, ability to move parts of the body, and ability to feel sensations (such as pain and touch).

When do symptoms appear?

The symptoms of MS usually begin before age 40, but can first appear at an older age.

What are common symptoms of MS?

MS causes a variety of symptoms depending on which areas of the brain and spinal cord are affected. While many of these symptoms can interfere with daily activities, they can be treated or managed with the help of your health care team.

Common symptoms of MS can include:

Fatigue

Fatigue is one of the most common symptoms of multiple sclerosis, occurring in about 80% of people with the condition. In MS, fatigue may affect an individual as both physical fatigue (tiredness in the arms or legs) and cognitive fatigue (slowed processing speed or mental exhaustion). This symptom can interfere with the ability to function, and may be the most prominent symptom in a person who otherwise has minimal activity limitations.

Numbness or tingling

Numbness refers to absent, diminished, or altered sensation in parts of the body. It may be the sensation of a limb being "asleep" with a pins-and-needles feeling. Numbness of the face, body, or arms and legs is often the first symptom experienced by those eventually diagnosed as having MS.

Muscle weakness and spasticity

Muscle weakness is common in MS and can occur in any part of the body. Muscle weakness usually results from damage to nerves that stimulate muscles. Weakness in the legs, ankles, and feet can interfere with walking.

Spasticity is a feeling of stiffness and a wide range of involuntary muscle spasms. It can occur in any limb, but it is much more common in the legs.

It is very important that people with MS stay physically active because physical inactivity can contribute to deconditioning, stiffness, weakness, pain, fatigue, and other symptoms.

Rehabilitation strategies and the use of mobility aids and other assistive devices can help alleviate muscle weakness.

Walking and balance problems

Walking and balance problems can occur in many people with MS. Unsteady, uncoordinated movements are the most common cause of walking problem related to MS. Physical therapy or the use of assistive devices such as a cane or a walker can be beneficial.

Pain

Pain from MS can be felt in different parts of the body. Types of pain include facial pain, chronic back pain, or other musculoskeletal pain.

Pain is common in MS. In one study, 55% of people with MS had "clinically significant pain" at some time, and almost half had chronic pain.

Bladder problems

Bladder problems occur in at least 80% of people with MS. Problems with bladder control may include urinary frequency, urgency, or incontinence.

Constipation

Constipation is also common in MS. It can typically be treated with a high-fiber diet, laxatives, and stool softeners.

Eye and vision problems

Eye and vision problems are common in people with MS. MS rarely results in permanent blindness, but may result in symptoms such as:

• blurred or grayed vision
• temporary blindness in one eye
• loss of normal color vision, depth perception, or vision in parts of the visual field
• uncontrolled horizontal or vertical eye movements
• jumping vision
• double vision.

Vertigo and dizziness

Vertigo is the sensation that the individual or their surroundings is spinning. People with MS may have this feeling of vertigo, or may feel dizzy or lightheaded.

Sexual dysfunction

Sexual problems, including loss of libido, vaginal dryness, and erectile dysfunction, are commonly experienced by people with MS and can result from damage to nerves running through the spinal cord. Sexual problems may also stem from other MS symptoms such as fatigue, muscle weakness or spasms, and mental health issues.

Depression

Depression is a common symptom in individuals with MS. It can arise due to injury to the brain and struggling with other symptoms of MS. Depression can also intensify symptoms such as fatigue, pain, and sexual dysfunction.

Emotional changes

Anxiety, mood swings, irritability, and episodes of uncontrollable laughing and crying can also be experienced by individuals living with MS. These changes can be a reaction to the stresses of living with MS, or the result of neurologic and immune changes.

Cognitive impairment

Changes in cognitive function are common in MS. In particular, a decline in the ability to think quickly and clearly and to remember easily is common. These changes in cognitive function may appear at the same time as the physical symptoms, or they may develop gradually over time.

Tremor

Tremor refers to involuntary shaking and can occur in various parts of the body because of damaged areas along nerve pathways that coordinate movements. Tremor is a less common symptom of MS.

What are early symptoms of MS?

Early symptoms of MS can include:

• vision problems
• muscle weakness, muscle stiffness, painful muscle spasms
• tingling, numbness, or pain in the arms, legs, trunk, or face
• clumsiness, balance problems
• bladder control problems
• dizziness.

Do MS symptoms worsen over time?

MS can follow one of several different patterns reflecting different progressions. The three most common patterns seen in MS patients are:

• Relapsing-remitting MS. This is the most common type of MS. Most people with MS are initially diagnosed with this form of the disease, in which relapses are followed by remissions. Weeks, months, or even years may pass before another attack occurs, followed again by a period of inactivity. Between relapses, the patient's condition usually is stable, without deterioration.
• Primary progressive MS. In this less common pattern, symptoms of MS worsen gradually and continuously. There are no episodes of relapses and remissions.
• Secondary progressive MS. This phase occurs when someone who originally had relapsing-remitting MS begins to have gradual deterioration in nerve function. This may occur with or without relapses. If relapses occur, it is called progressive relapsing MS.

Most people with MS do quite well for a long time. Many medications are available that can help modify disease progression. Other medications can help manage relapses and symptoms.