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Symptoms of Multiple Sclerosis

Patients with MS have a wide range of symptoms. Some problems occur often, and some are rarely seen. Symptoms will depend on where the inflammation and demyelination occur in a person’s CNS.

As with symptoms, the course of illness will be different for each person with MS. But even if there are no symptoms, progressive damage to the CNS and the development of disabilities will eventually occur over time, although this is not consistent. However, it is a possibility and this is one reason why it is so important for people with MS to continue with treatments that can slow the progression of the disease.

Some of the symptoms that may occur with MS are described in this section:

Optic Neuritis

This is an inflammation of the optic nerve, the nerve that mainly controls vision. Over a period of days, blurred vision may develop. Sometimes there may be pain behind the eye, which increases on movements of the head.

After the initial symptoms, there is a gradual improvement, sometimes after several weeks. But recovery is not always complete. During periods of stress, fatigue or fever, the blurred vision in the eye may return. This does not necessarily mean that the MS is active again. Rather, it may be the result of permanent disability that has accumulated over time.

Loss of Muscle Strength in Arms and Legs

The nervous system contains large numbers of nerve fibres (axons) that control movement - what doctors call ‘motor function’. MS often affects the axons that control muscle movement, and some people with MS lose muscular strength in the arms and legs as the disease progresses. Some people may eventually need to use a cane or crutches and a minority may require a wheelchair to get around. But please remember that MS usually progresses only slowly, and that the symptoms and course of the disease are very different from person to person.

Symptoms Affecting the Sense of Touch

The vast CNS includes many sensory axons that help people be aware of the world around them. These axons provide the sense of touch in all skin, and the ability to feel cold or heat on all parts of the body. When axons are damaged through MS, the sense of touch may be replaced by feelings of numbness or tingling. Parts of the body may feel burning hot or cold, even though there is no heat or chill present.

Symptoms can be temporary (relapses) or more progressive, and can occur in various parts of the body. This could be just one part of an arm or leg, in the whole lower half of the body - say below the navel - or a collection of numb patches occurring randomly all over the body.

Pain

MS can be accompanied by various kinds of pain:

• Damage to the sensory tracts in the spinal cord can result in burning pain in the arms and legs.
• MS can often result in damage to the nerves of the face, a painful condition known as 'trigeminal neuralgia’.
• If MS has impaired the ability to walk, the extra strain in the muscles of a person’s back and legs can become painful.
• MS can also cause extra tension in arm and leg muscles: this is known as ‘spasticity’ and can be painful.

Muscles Controlling Bladder and Bowels

Some people with MS may develop trouble controlling the urge to urinate or may be unable to completely empty the bladder. Less frequently, they may experience problems with bowel control. If MS progresses and a person develops a more sedentary lifestyle, they may also be troubled with constipation.

Sexual Problems

Having MS can lead to problems related to sexual activity, especially if the bladder or bowels are already affected. Men with MS can find it difficult to achieve or maintain an erection. In women, MS often causes a loss of sexual sensitivity, pain during intercourse, an inability to achieve an orgasm or a reduction in naturally produced lubrication.

Balance/Coordination

Damage from MS can result in poor balance or coordination. A person may, for instance, have difficulty grasping small objects, writing clearly or keeping a steady hand. When walking across a room, they may find themselves losing their balance, as if they were drunk. Like most other MS symptoms, these problems can be temporary (during a relapse), or they can be a permanent result of the progression of MS.

Fatigue

Many persons with MS experience fatigue or extreme tiredness. But since fatigue can be a sign of so many other diseases, too, it is not often immediately identified as being caused by MS. Fatigue occurs in both relapsing MS and in the more progressive types of the disease. It can often last for a few months, during which time a person’s energy is used up every day with just a little exertion.

Cognitive Function

At some point in the course of MS, you may notice changes in cognitive function, such as loss of memory or a slower speed of thinking. You may also have difficulty concentrating, making it hard for you to focus your attention. In some patients these symptoms can occur early in the disease; in others, they can come later.

Mood Changes/Depression

Many people with MS experience periods of depression. Sometimes these periods are linked directly to physical changes in the brain caused by MS. Understandably, they may also be an emotional reaction to having the illness and learning to cope with the symptoms and the challenges they represent. Depression may also be linked to some treatments for MS that are prescribed to help to slow the progression of symptoms and/or disability.

If feelings or symptoms of depression or hopelessness are a problem, it is important to talk to a doctor or specialist nurse. Effective treatments for depression are available. It is very important that persons with MS do not stop any treatments that they may be taking for MS without discussing things first with a doctor or specialist nurse.

 

Relapses and the Progression of Disability

The course of MS in any individual varies greatly in its severity and rate of progression and cannot be predicted (refM2). However, progression of disability can be measured with a suitable scale.

One such scale is the Expanded Disability Status Scale, or EDSS. This is based on a neurological examination and the person’s ability to walk. The scale ranges from 0-10, in steps of 0.5 units. For example: 1 is no disability; 4 is fully able to walk up to 500 metres without help or rest, despite some relatively severe disability; and 7 means that the person is fully reliant on a wheelchair (refM2).

The EDSS may be used to assess the effect of relapses on disability as well as the progression over time of the disability. A change in an EDSS score that subsequently stays at the same value for 6 months (excluding any short-term worsening due to relapses) indicates that the disability is irreversible (refM1).