Symptoms:

Symptoms of multiple sclerosis appear in a variety of ways. Most patients first have a single attack of symptoms called a clinical isolated syndrome, which typically occurs between the ages of 20 - 40 years. Initial symptoms may be mild enough that patients do not always quickly 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.

Early Symptoms

Symptoms more likely to occur earlier in the disease include:

Optic neuritis and other eye problems.

• Optic neuritis, inflammation of the nerves in the eye, affects over 50% of patients and is the first symptom in about 16% of patients. Symptoms include unclear or doubled vision, usually in one eye. Some people see a shimmering effect. Patients may also have pain or involuntary jerking or movement of the eye (called nystagmus). In 20% of people with this condition, MS develops within 2 years after the onset of these symptoms.
• Other symptoms may include difficulty tracking with both eyes and a sensation that the environment is moving.

Fatigue. Fatigue is typically worse in the afternoon and may be accompanied by an increase in body temperature. At the onset, this occurs in about 20% of patients, but as the disease progresses, this is a significant symptom in nearly all patients.

Changes in sensations in the arms and legs.

• Patients can feel heaviness, weakness, or clumsiness in the limbs.
• Tingling or loss of sensations can also occur, usually in the legs. Symptoms often begin at the end of the legs or arms and move up towards the beginning of the limb. The patient may also have painful sensations around the abdomen.
• Lhermitte’s sign is often an early sign of multiple sclerosis. This electrical sensation, produced by bending the neck forward, runs down the back and into the legs.

Muscle weakness in the legs and poor coordination. Weakness may often occur during heat exposure and after exercise. Patients may also have problems with balance and a tremor.

Spasticity. Spasticity is the inability to control muscle tone, leading to spasms and stiffness. It is very common in MS. Symptoms include sensations of burning, itching, aching, and quivering. They usually occur in the arms and legs and last from seconds to minutes.

Disturbances in the bladder. Some patients have problems urinating at will, a condition called urinary retention. It often takes the form of urge incontinence (also called hyperactive or irritable bladder). People with urge incontinence need to urinate frequently or are unable to reach the bathroom before leakage occurs.

Bowel dysfunction. Patients often experience constipation and episodes of stool incontinence.

All symptoms continue over time.

Additional Symptoms That Occur Over Time

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, optic neuritis (pain in the eye), 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 impotence, and women often have problems with vaginal lubrication. Sexual dysfunction appears to be highly associated with urinary dysfunction.

Difficulty Swallowing. Up to half of patients have trouble chewing or swallowing, problems that may be caused or made worse by many MS medications.

Speech and Hearing Problems. The difficulty of controlling the voice quality and articulating words may cause speech problems. (Problems with language itself, however, are very rare in MS.) Hearing problems also occur in MS, sometimes affecting speech.

Problems in Thinking and Concentration. Cognitive problems, such as having trouble concentrating and solving problems, affect about half of patients. More people with MS leave work because of cognitive difficulties than because of physical problems, according to a one study. In about 10% of cases, mental dysfunction may be severe and resemble dementia. The severity of mental changes appears to be associated with the degree of loss of brain tissue. This offers another argument for early treatment as interferon medications may improve these symptoms.

Emotional Mood Swings. Depression is very common. About 10% of patients suffer from psychosis (manic depression and paranoia). About 5% of patients with severe MS have uncontrolled and extreme mood swings called the laughing/weeping syndrome.

Possible Symptom Triggers

Infections. Viral infections have long been known to worsen MS symptoms. An important 2006 study indicated that bacterial infections can also trigger MS relapses. In the study, relapses appeared within 2 weeks of a viral or bacterial infection.

Heat. Heat, whether generated by ambient temperature, infection, or physical activity, worsens MS symptoms in about 60% of patients.

Stress. There is a strong correlation between severe stress and exacerbation of MS symptoms. Stress is not a cause of MS, however.

Trauma. Some experts believe that injury (trauma) to the head, neck, or upper back may trigger new or recurrent symptoms by disrupting the blood-brain barrier and allowing immunological attacks on the brain. This is a highly controversial theory, however, with very little supporting evidence.