This causes scar tissue (sclerosis, also called plaque or lesions) to form on nerve fibers, disrupting the flow of electrical impulses throughout the nervous system. This nerve damage can lead to a broad range of MS symptoms, from blurred vision to numbness to weakness to loss of balance and more. For people with relapsing-remitting MS (RRMS), symptoms can worsen significantly, and new symptoms may arise, during relapses, or periods of acute inflammation in the central nervous system. For people with primary-progressive MS, symptoms get steadily worse from the beginning, although how quickly they get worse varies from person to person. And for people with secondary-progressive MS, a stage of MS that follows RRMS, the pattern of worsening symptoms during relapses followed by fewer symptoms during remissions eventually changes to a steady progression of symptoms, usually with few or no relapses. Overheating, caused by fever, hot baths, or sun exposure, and stress, can also trigger or temporarily worsen MS symptoms. When the body cools back down, or the stress is alleviated, the symptoms generally abate as well. Still, the earliest symptoms of MS often include vision problems, such as blurred or double vision, color distortions, and a condition called optic neuritis, which causes eye pain and rapid loss of vision. Other early symptoms can include:
FatigueBalance problems and clumsinessNumbness, tingling, or prickling sensations (“pins and needles”) in the arms, legs, torso, or face, known as paresthesiaDizzinessHeat sensitivity
A first episode of MS-like symptoms that lasts for at least 24 hours and is caused by inflammation or loss of myelin in the central nervous system is called clinically isolated syndrome (CIS). In some cases, a person with CIS never has another such episode and does not develop MS. In others, a person does have another episode and is diagnosed with MS. And in still others, an MRI in a person with apparent CIS reveals lesions from earlier episodes, indicating that the person in fact has MS. Given the nonspecific nature of all of these symptoms, many people with MS are initially diagnosed with something else. RELATED: 16 Conditions Commonly Mistaken for Multiple Sclerosis You may experience being tired all day long or become easily fatigued from mental or physical exertion. When MS-related fatigue is severe, it’s called “lassitude.” Some of the strategies people with MS use to minimize or at least manage their fatigue include:
Following a healthy dietPacing themselves and taking planned restsExercising to maintain muscle strength and flexibilityGetting adequate sleep by addressing any symptoms that are interrupting sleepLearning energy-conservation techniquesAvoiding heat exposureGetting help for depression, which can cause fatigueTaking a medication that promotes wakefulness
An experimental, noninvasive form of brain stimulation called transcranial direct current stimulation (tDCS) has been shown in a few studies to reduce fatigue in people with MS. In tDCS, two electrodes are placed on the head over brain areas believed to be involved in MS fatigue, and a low-intensity electrical current is passed through the electrodes. For MS, an anodal, or positive, current is used to excite neuronal activity. (For other conditions, cathodal, or negative, current might be used to inhibit neuronal activity.) Additional studies of transcranial direct current stimulation and fatigue, cognition, pain, and walking ability in people with MS are ongoing. Learn More About Strategies for Dealing With MS Fatigue
Muscles that are weak, stiff, and sometimes painfulRestless legs syndromeDifficulties controlling the bladder or urgency to urinateDifficulty walking due to muscle weakness, spasticity, loss of balance, sensory deficits, foot drop, and fatigueConstipation and bowel incontinenceCognitive impairments affecting concentration, attention, memory, problem-solving, and judgmentVertigoSexual problems, such as erectile dysfunction, vaginal dryness, and the inability to orgasmClinical depressionEmotional changes, such as mood swings, irritability, and uncontrolled laughing and crying (called pseudobulbar affect)
Less common symptoms of MS include:
Slurred or difficult-to-understand speech, as well as the inability to produce voice sounds (dysphonia)Difficulty with fine motor controlUncontrollable shaking or tremorParalysisRespiratory problemsDifficulty chewing and swallowingAltered or diminished sense of taste and smellSeizuresItchy skin (pruritus)Hearing problemsHeadaches, particularly migraine-related headachesPsychosis, or loss of contact with reality
RELATED: When MS Attacks the Spinal Cord Neuropathic pain may be experienced as pain in the hands and feet, back pain, headaches, painful spasms, Lhermitte’s sign, and trigeminal neuralgia. Lhermitte’s sign is a brief and sharp, electric shock–like sensation that runs from the back of the head down the spine and into the limbs. It is usually triggered by bending the neck forward. Trigeminal neuralgia causes a sharp, stabbing pain in the face that originates from damage to the trigeminal nerve, which is responsible for facial motor functions and sensations. It’s sometimes confused with dental pain. Another type of pain associated with MS is the MS hug, or a feeling of squeezing or constriction around the chest or abdomen. The MS hug is caused by spasms in the muscles surrounding the rib cage, and in some people, it can cause difficulty breathing. Some forms of pain related to MS tend to be short lived, while others can become chronic. Neuropathic pain, pain caused by spasticity, and pain associated with immobility and fatigue tend to become chronic and require ongoing efforts to manage.
Slowed processing of new informationDifficulty learning and remembering new informationDifficulty with organizing information and problem-solvingTrouble focusing and maintaining attentionDeficits in visuospatial skills, or the ability to properly perceive the world around themProblems understanding and using languageDifficulty doing calculations
Early baseline testing for all adults and children with MSAnnual reassessment with the same test as used for baseline screeningMore comprehensive testing for adults whose tests have revealed cognitive deficits or who have demonstrated cognitive declineNeuropsychological evaluation for children with MS under age 18 who have an unexplained change in function at schoolInterventions for adults and children to improve functioning at home, work, or school
Generally, such tests are administered by a neuropsychologist, a specialist who studies how brain function affects cognitive function and behavior. But since traditional testing can be time-consuming, and not all neurology offices employ a neuropsychologist, an initiative known as BICAMS (Brief International Cognitive Assessment for MS) has been working to develop a cognitive assessment test that takes less time and can be administered by non-neuropsychologists. The test, which has been in development since 2012, is currently being used in research on cognitive disability. In some cases, cognitive rehabilitation can improve cognitive function, or individuals can learn to compensate for deficits by, for example, setting alarms, writing reminder notes, or minimizing distractions. MS symptoms can also come and go from one day or week to the next, as well as change gradually over time. And there is no single test that can definitively diagnose the disease. For all of these reasons, people with MS often go for months, years, or even decades not knowing the cause of their symptoms or believing they have some other condition. That’s unfortunate, because early treatment with MS disease-modifying medication can slow the overall progression of the disease. Other forms of treatment, such as a variety of rehabilitative therapies, can similarly improve physical and cognitive functioning and quality of life. Learn More About Diagnosing Multiple Sclerosis: Imaging and Laboratory Tests, Neurological Examinations The MSAA offers information about MS symptoms, their management, and medications that may be used in their management. The MSAA’s My MS Manager app allows users to track their MS symptoms and store other medical information. National Multiple Sclerosis Society (NMSS) The website of the NMSS describes common and less common MS symptoms as well as complications that can arise from those symptoms. The society’s MS Navigators are available by phone or online chat every weekday to help individuals needing information or resources related to MS. MS International Federation The MS International Federation offers written information about MS symptoms as well as videos about some aspects of the disease and short vignettes about people around the world living with MS. Some of their resources have been translated into languages other than English.
