SYMPTOMS AND COURSE

The symptoms of MS are different for everyone and vary widely in severity and duration. Symptoms include weakness, tingling, numbness, fatigue, incoordination, balance and vision problems, tremors, muscle stiffness known as spasticity, slurred speech, depression, bowel or bladder problems, sexual dysfunction, problems with memory or reasoning, and partial or complete paralysis. Although MS can cause severe discomfort and disability, it does not usually shorten life span.

Often MS begins with a single subtle symptom, such as blurred vision or leg tingling. For many people with MS, symptoms come and go unpredictably, making it difficult to plan for the future. While some people experience a course that does not significantly alter their lifestyles, others experience severe symptoms that may rob them of physical and mental abilities, their livelihoods, and their independence. Because it can alter family routines and roles, MS affects everyone in the family.

There are four recognized patterns of MS. In the relapsing-remitting course, which affects most people with MS, a person experiences an attack of symptoms, which then completely or partially subside until the next attack. About half of those with this form of the disease will later develop secondary-progressive MS, which involves progressive worsening of symptoms and may also include occasional flare-ups followed by partial recoveries. Less common is primary-progressive MS, involving a steady worsening of disability from disease outset, such as painful muscle spasms, urinary incontinence, and possibly, eventually, paralysis. Another less common form is progressive-relapsing MS, which starts with a pattern of steadily worsening disability along with periodic flare-ups.

What sort of symptoms can you get with MS?

Patients with MS experience a wide range of symptoms. Some problems occur often, and some are seldom seen. They all depend on where the inflammation and demyelination is situated in the CNS. The course of illness is different for each individual. Even when there are no symptoms, there is progression of damage to the central nervous system over time. That’s why it is important for patients with MS to stay on therapy. Some of the symptoms that may occur with MS are as follows:

Optic Neuritis

This is an inflammation of the optic nerve, the nerve that controls the eye. Over a period of days, you may develop blurred vision. Sometimes you may feel pain behind your eye, which increases when you turn your eye.

After initial symptoms, there is 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 fibers that control movement - what we call motor function. Often, MS is active on the nerve fibers that control muscle movement. Many people with MS lose muscular strength in the arms and legs as the disease progresses. The loss can range from reduced dexterity (the fingers no longer work so well) to paralysis of an arm or leg. Loss of muscular strength occurs not only in the form of relapses (temporary attacks) but also as a gradual (progressive) process without recovery.. Gradual loss of strength occurs more frequently in the legs than in the arms. Depending on the severity, you may need to rely on a cane, crutches, or even a wheelchair to get around.

Symptoms Affecting the Sense of Touch

The vast nervous system includes many sensory nerve fibers dedicated to helping you be aware of your environment. They provide the sense of touch in your fingers, and your ability to feel cold or heat on all parts of your body. When these fibers are damaged through MS, your sense of touch may be replaced by feelings of numbness or tingling. Parts of your body may feel burning 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 in 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 your ability to walk, the extra strain in the muscles of your back and legs can become painful. MS can also cause extra tension in the muscles of your arms and legs: this is known as "spasticity" and can also be painful.

The Muscles Controlling Bladder and Bowels

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

Sexual Problems

Having MS can lead to problems related to sexual activity, especially if your 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

The part of the brain known as the cerebellum controls and corrects all our movements. Damage from MS can result in poor balance or coordination. You may, for instance, have difficulty grasping small objects, writing clearly, or keeping a steady hand. When walking across a room, you may find yourself losing your balance, as if you were intoxicated. 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 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 your energy is used up every day with just a little exertion.

Cognitive Function

At some point in the course of your illness with MS, you may notice changes in cognitive function, such as your memory and 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

Many persons with MS experience periods of depression. Sometimes it is linked directly to physical changes in the brain caused by MS. Understandably, it may also be an emotional reaction to having the illness and learning to cope with the symptoms and the challenges they represent. If you are experiencing feelings or symptoms of depression or hopelessness, discuss them with your doctor because treatment for depression is available.

Symptoms of MS

Multiple sclerosis is a very variable condition and the symptoms depend on which areas of the central nervous system have been affected. There is no set pattern to MS and everyone with MS has a different set of symptoms, which vary from time to time and can change in severity and duration, even in the same person.

There is no typical MS. Most people with MS will experience more than one symptom, and though there are symptoms common to many people, no person would have all of them.

The systems commonly affected include:

Visual disturbances

blurring of vision
double vision (diplopia)
optic neuritis
involuntary rapid eye movement
(rarely) total loss of sight

Balance & co-ordination problems

loss of balance
tremor
unstable walking (ataxia)
giddiness (vertigo)
clumsiness of a limb
lack of co-ordination
weakness: this can particularly affect the legs and walking

Spasticity

altered muscle tone can and muscle stiffness can affect mobility and walking
spasms

Altered sensation

tingling
‘pins and needles’
numbness (paraesthesia)
burning sensations
pain may be associated with MS, e.g. facial pain, (such as trigeminal neuralgia), and muscle pains

Abnormal speech

slowing of speech
slurring of words
changes in rhythm of speech
difficulty in swallowing (dysphagia)

Fatigue

a debilitating kind of general fatigue which is unpredictable or out of proportion to the activity. Fatigue is one of the most common (and one of the most troubling) symptoms of MS

Bladder & bowel problems

Bladder problems include the need to pass water frequently and/or urgently, incomplete emptying or emptying at inappropriate times.
Bowel problems include constipation and, infrequently, loss of bowel control

Sexuality & intimacy

impotence
diminished arousal
loss of sensation

Sensitivity to heat

this symptom very commonly causes a transient worsening of symptoms

Cognitive & emotional disturbances

loss of short term memory
loss of concentration, judgment or reasoning

Whilst some of these symptoms are immediately obvious, others such as fatigue, altered sensation, memory and concentration problems are often hidden symptoms. These can be difficult to describe to others and sometimes family and carers do not appreciate the effects these have on the person with MS and on employment, social activities and quality of life.