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Multiple sclerosis

• Overview
• Symptoms
• Treatment

Alternative Names:

MS

Symptoms:

• weakness of one or more extremities
• paralysis of one or more extremities
• tremor of one or more extremities
• muscle spasticity (uncontrollable spasm of muscle groups)
• muscle atrophy
• movement, dysfunctional - slowly progressive; beginning in the legs
• numbness or abnormal sensation in any area
• tingling
• facial pain
• extremity pain
• loss of vision -- usually affects one eye at a time
• double vision
• eye discomfort
• uncontrollable rapid eye movements
• eye symptoms worsen on movement of the eyes
• decreased coordination
• loss of balance
• decreased ability to control small or intricate movements
• walking/gait abnormalities
• muscle spasms (especially in the legs)
• dizziness
• vertigo
• urinary hesitancy , difficult to begin urinating
• strong urge to urinate (urinary urgency)
• frequent need to urinate (urinary frequency)
• incontinence (leakage of urine, loss of control over urination)
• decreased memory
• decreased spontaneity
• decreased judgment
• loss of ability to think abstractly
• loss of ability to generalize
• depression
• decreased attention span
• slurred speech
• difficulty speaking or understanding speech
• fatigue , tired easily

Additional symptoms that may be associated with this disease:

• constipation
• hearing loss
• positive Babinski's reflex

Note: Symptoms may vary with each attack. They may last days to months, then reduce or disappear, then recur periodically. With each recurrence, the symptoms are different as new areas are affected. Fever can trigger or worsen attacks, as can hot baths, sun exposure, and stress.

Signs and tests:

Symptoms of MS may mimic many other neurologic disorders. Diagnosis is made by ruling out other conditions.

A history of at least two attacks separated by a period of reduced or no symptoms may indicate one pattern of attack/remission seen in MS (known as relapsing-remitting pattern). If there are observable decreases in any functions of the central nervous system (such as abnormal reflexes), the diagnosis of MS may be suspected.

Examination by the health care provider may show focal neurologic deficits (localized decreases in function). This may include decreased or abnormal sensation, decreased ability to move a part of the body, speech or vision changes, or other loss of neurologic functions. The type of neurologic deficits usually indicates the location of the damage to the nerves.

Eye examination may show abnormal pupil responses, changes in the visual fields or eye movements, nystagmus (rapid eye movements) triggered by movement of the eye, decreased visual acuity , or abnormal findings on a fundoscopy (an examination of the internal structures of the eye).

Tests that indicate or confirm multiple sclerosis include:

• head MRI scan that shows scarring or a new lesion
• spine MRI scan that shows scarring or a new lesion
• lumbar puncture (spinal tap)
• CSF oligoclonal banding
• CSF IgG index

References:

Hafler DA. Multiple sclerosis. J Clin Invest . 2004 Mar 15; 113(6): 788-794.

Goetz, CG, ed. Multiple Sclerosis. In: Textbook of Clinical Neurology . 2nd ed. Saunders. Philadelphia, PA: 2003;1060-1076

National Multiple Sclerosis Society. Available at: http://www.nmss.org/ . Accessed June 6, 2005.

• Review Date: 11/7/2005
• Reviewed By: Kevin Sheth, M.D., Department of Neurology, Brigham and Women's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA. Review provided by VeriMed Healthcare Network.

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