Multiple Sclerosis

Multiple Sclerosis Signs and Symptoms

Multiple Sclerosis Symptoms

Multiple sclerosis (MS) is a complex disease that can be challenging to diagnose, in large part due to the diversity of symptoms it causes. In other words, MS manifests itself uniquely in each person affected by it. This is why one friend with MS may seem to be highly functional, and another friend with MS is unable to work due to her MS-related disabilities.

In addition to the unique types of symptoms seen in MS, symptoms also vary in duration; some come and go, some are permanent.

Also, symptoms vary in intensity—some are mild and bearable, and others are severe and disabling.

While there is a wide range of potential MS symptoms, there are some that are more common than others, such as abnormal sensations, fatigue, bladder problems, and depression.

The Most Common Symptoms of Multiple Sclerosis

View both normal and impaired nerve impulses.

In the brain and spinal cord, nerve fibers (axons) are responsible for transmitting impulses from one nerve cell to another.

The myelin sheath, which surrounds and coats these nerve fibers, is what allows these impulses to travel efficiently and rapidly.

In MS, a person's immune system attacks the myelin sheath, either damaging or destroying it. This impairs nerve signaling, causing MS symptoms to manifest. Symptoms, therefore, will vary depending on which nerve signaling pathways are affected.

Muscle-Related Symptoms

The nerves in your spinal cord control the muscles in your body. So when nerve communication is impaired, muscle-related symptoms may arise. One of the most common muscle-related symptoms in MS is weakness.

As you can imagine, weakness in the arms or hands may make it difficult for someone to complete basic activities like cooking, brushing their teeth, or carrying a child. Weakness in the legs, ankle, and feet may result in falls and difficulty walking. It's important to understand that weakness is not always a visible symptom, and it can be hard for the person experiencing it to describe.

Spasticity (involuntary muscle tightness) is another muscle-related symptom in MS. It is most common in the legs, but can occur in the arms, joints, and lower back. The intensity of spasticity is highly variable—some people describe a mild tightening or stiffness, whereas others have severe, painful muscle cramping that impairs movement or even standing up.

Tremor (shaking that is out of your control) may also occur in MS and can affect the arms, legs, head, body, or muscles that control speech or sexual functioning.

There are two main types of tremor in MS.

  • Intentional tremor: characterized by shaking when a person reaches for something
  • Gross tremor: characterized by wide motions of the arms and legs

The good news is that physical and occupational therapy can help you manage your muscle problems with the use of exercises, massage, and assistive devices.

Fatigue

For many people with MS, fatigue is their most debilitating complaint—and it's often misunderstood, adding to the frustration of experiencing this symptom. The thing about fatigue is that it's not simply a tiredness that can be alleviated by a cat nap or relaxation. The physical exhaustion of MS is an overwhelming, whole-body exhaustion that can make basic activities like showering, eating, or even talking unbearable.

Many people with MS also describe mental fatigue, commonly referred to as brain fog, where daily tasks like focusing on a conversation or watching a movie can be extraordinarily challenging and unpleasant.

The complex part about fatigue in MS is that it can be caused by the disease itself (the demyelination that occurs in the brain and spinal cord) or other factors like:

  • MS-related medications (both disease-modifying therapies and those used to manage certain symptoms)
  • Primary sleep disorders (e.g. insomnia and restless leg syndrome are common in MS)
  • Sleep problems associated with other MS symptoms (like an overactive bladder or muscle cramps that keep you up at night)
  • Heat sensitivity
  • Depression

This is why teasing apart the causes of your fatigue with your neurologist is important. It may be a tedious process, but it's worthwhile.

In fact, there are a number of ways to combat MS fatigue. One of the best ways is through an exercise or yoga program. Don't scratch your heads here, as there are scientific studies to back this up, even though it seems counterintuitive.

Sensory Symptoms and Pain

MS commonly causes an array of abnormal sensations like numbness and tingling, burning, aching, prickling, cramping, tightness, itching, stabbing, tearing, or pressure—and they can occur anywhere in the body. While some of these sensory disturbances are more of a nuisance than uncomfortable, others can be painful and debilitating.

There is also no good explanation for why some people experience pain in MS and others do not.

One sensory-related sign sometimes seen in people with MS is called Lhermitte's sign. This occurs when a person touches their chin to their chest, which causes a sudden, electric-like feeling that shoots from his or her neck down to the spine. It's not seen in everyone with MS, but when present, it indicates that a person's MS has affected certain nerves within the spinal cord.

The so-called MS hug is another classic sign and is characterized by tightness around the chest or stomach (it can also affect the arms and legs).

Therapy can be tailored to the type of sensory symptoms a person is experiencing. For instance, massage, stretching, a muscle relaxant, and an assistive walking device may help someone with leg cramps due to spasticity, while certain anticonvulsant medications may help someone with severe sensations of "pins and needles."

Cognitive Symptoms

Cognitive dysfunction affects about half of all people with MS and commonly includes problems with memory, attention, concentration, finding words, and processing information from your environment.

Problems with cognition can have significant emotional and social consequences, as a person may feel uncomfortable interacting with others. They may worry that they won't be able to find their words in a conversation or participate as well in a hobby or activity as before their MS diagnosis.

The good news is that cognitive symptoms are often pretty subtle. In fact, they are usually much more noticeable to the person experiencing them than to others. Also, there are effective and easy strategies to manage cognitive problems, so you can feel comfortable and confident again using your brain.

Depression

Depression is a huge source of distress in people with MS, and it can occur at any stage. It is often an invisible symptom like fatigue, anxiety, or pain, so it is much more difficult to recognize in loved ones and even yourself.

Like fatigue, the cause of depression can be from the demyelination that occurs in the brain, from MS-related medications (especially interferon disease-modifying therapies like Avonex, Betaseron, or Rebif), and/or the stress of living with a chronic illness.

The symptoms of depression are highly variable, but they often include feeling down and/or experiencing a loss of pleasure or interest in activities you once enjoyed for a period of at least two weeks. (We all have down days, but depression persists.)

Other symptoms may include:

  • Overwhelming and daily feelings of hopelessness and/or guilt
  • Loss of appetite (and less commonly, an increase in appetite)
  • Sleep disturbance (sleeping more or less than usual)
  • Loss of interest in sex
  • Unexplained body aches and pains
  • Loss of energy
  • Thoughts of suicide

If you are experiencing one or more of these symptoms, or are concerned about your own mental health or the mental health of a loved, please address your worries with a healthcare professional. Also, be sure to seek immediate medical attention if you have suicidal thinking or have engaged in suicidal behavior.

Bladder and Bowel Symptoms

Do not feel alone or ashamed if you suffer from bladder problems—they occur in about 80 percent of people with MS and may include:

  • Urinating more frequently
  • Urgency or hesitancy when urinating
  • Loss of control of urination 

Urinary tract infections are also common in MS, and it can sometimes be hard to distinguish what is an infection versus what is your MS. Sometimes it's both, as infection can be a trigger for an MS relapse. If your MS-related bladder problems have increased or seem different, be sure to contact your neurologist, so you can receive the appropriate care.

Bowel problems, especially constipation, are also common in MS. Diarrhea may also occur. The cause of bowel problems in MS may be due to the loss of myelin surrounding the nerve fibers that are responsible for sending messages between the brain and the bowels. Medications, a lack of mobility, depression, and fatigue can also contribute to bowel problems, mostly constipation.

Preventing bowel problems from occurring in the first place is your best bet. This can be accomplished through adequate fluid and fiber intake, and daily exercise.

Some people need stool softeners or laxatives to maintain a normal bowel regimen, but this should only be done under the guidance of a physician.

Sexual Dysfunction

This can be a very sensitive and difficult topic to discuss with your partner and doctor, but please do—sexual dysfunction is a common complaint in MS, and there are a number of therapies available.

Common examples of sexual problems in MS include:

Vision Problems

Vision problems are common, but very infrequently lead to blindness (an understandable fear among those with MS).

Nystagmusinvoluntary eye movements—may occur in MS, sometimes subtly and sometimes so significantly that it impairs vision.

Another potential vision symptom is diplopia, or double vision. This can be an alarming symptom that occurs when the muscles that control eye movement are weakened by MS. The good news though is that diplopia is usually short-lived.

Optic neuritis can also occur in MS, especially in the early stages. Optic neuritis occurs when there is inflammation of the nerve that carries signals from the eye to the brain. It may cause blurry vision, eye pain, or even blindness in one eye, but it's usually temporary.

Vertigo

There are a number of causes of vertigo (the sensation that you are spinning) in a person with MS. Vertigo can be a side effect from a medication or an inner ear problem. It can also be due to demyelination in the brainstem (a stalk that connects the brain to the spinal cord).

While not a hard and fast rule, vertigo from MS is usually worsened with certain head movements. It's also typically associated with rapid eye movements, which your doctor can see on a physical examination. If you have vertigo, your doctor may inquire about other potential symptoms that occur when MS affects the brainstem, like speech problems (slurring of words or speaking slowly) or double vision.

Health Concerns That Can Look Like Multiple Sclerosis

There is no single blood or imaging test that can confirm the diagnosis of MS. Rather, your neurologist must evaluate your symptoms, perform a physical exam, and consider tests like an MRI of your brain and/or spinal cord.

In other words, the diagnosis of MS is a complex task, not something you can do on your own. So try not to worry if you are experiencing MS-like symptoms. Ease your mind and see your doctor. Don't carry that burden.

MS is a serious diagnosis, and there are a number of other health conditions (some less serious than others) than can mimic MS. Your doctor will want to rule those out first. Examples of MS mimickers include:

A Word From Verywell

There is no cure for MS yet, but there are a number of effective disease-modifying therapies available. These therapies have been found to reduce the number of MS relapses and slow overall MS disease activity.

That being said, just because you have fatigue, pain, and/or depression does not mean you have MS. Seeing a doctor for a proper evaluation and diagnosis is important if you are experiencing MS-like symptoms. You deserve answers to why you are feeling the way you are.

Sources:

Birnbaum, M.D. George. (2013). Multiple Sclerosis: Clinician’s Guide to Diagnosis and Treatment, 2nd Edition. New York, New York. Oxford University Press.

National MS Society: MS Symptoms. Accessed: July 16, 2016.

Ziemssen T. Symptom Management in Patients With Multiple Sclerosis. J Neurol Sci. 2011 Dec;311 Suppl 1:S48-52.

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