MS (Multiple Sclerosis) Symptoms and Signs

Multiple sclerosis is a disease that affects the central nervous system. MS symptoms and signs may be difficult to recognize early in the disease process except for some classical symptoms.

Since Multiple sclerosis is a progressive disease, its symptoms and signs may aggravate with each flare of the disease.

If diagnosed and treated early, patients with MS may live a normal life. However, it can cause severe disability in most patients even with treatment.

Early treatment with high-dose methylprednisolone, plasma exchange, and biological medicines can result in favorable outcomes.

What is MS (Multiple Sclerosis)?

It was first described by Jean-Martin Charcot in 1868. It is a disabling autoimmune disease of CNS involving the brain and spinal cord.

MS is an autoimmune disease in which auto-antibodies are produced against the myelin sheath of neurons in the brain and spinal cord of one’s own cells.

The lesions of MS in the brain and spinal cord are differentiated by spatial and temporal origin.

• “Spatial” means that the lesions are spread through the brain (primarily the white matter of the brain).
• “Temporal” distribution of lesions in MS means that there is usually a gap (a time interval) between two or more lesions.

The disease can progress in many ways but most commonly there are three prominent classifications:

1. Relapsing-Remitting disease
2. Secondary progressive disease
3. Primary progressive disease

Among these three types of MS variants, the worst prognosis is carried by primary progressive disease.

MS Symptoms and Signs:

MS symptoms and signs are variable. One patient may have symptoms that may be different from another patient. In addition, the symptoms of MS can be different in the same person in every flare.

Symptoms may also be different depending on the type of Multiple Sclerosis. In some patients, the disease onset is gradual and episodic with years between the two episodes.

The disease may be extremely debilitating and the affected person may not be able to do his/her daily chores and become bed bound.

The Mcdonald’s criteria is currently being used to diagnose Multiple sclerosis

MS Symptoms:

MS can manifest with variable symptoms. Symptoms may differ from person to person and even in a single person, the symptoms may be different with each flare.

Common MS Symptoms are listed here:

• Tingling sensation in limbs:

Tingling is an abnormal feeling commonly described as if an insect is crawling on the skin. Other common description is pricking, stinging, and burning feeling in the skin.

Tingling is the medical term for paraesthesias. It happens when the nerves are either abnormally sensitive or abnormally insensitive.

The longer the nerve, the more commonly it is going to be affected. Tingling is therefore commonly felt in the hands and feet.

• Shooting pains:

Shooting pains that arise from the back or the back of the head and neck are commonly felt by patients with multiple sclerosis.

This is commonly felt when the person bends his head forward. This is also called “Lhermitte’s sign” or the “Barbar Chair Sign“. As the name suggests, when the person flexes his/ her neck, a shooting pain radiates down the arms and legs is felt.

Sharp pain on the back of the thigh radiating from the back like sciatica can also be felt.

• Eye-related symptoms:

Eye symptoms are very common. The affected person may feel double vision (diplopia), pain and blurred vision, impaired color perception, and tunnel vision.

Patients may not be able to perceive colors and see things as “black and white“. It is also not uncommon that a person with MS may completely go blind in one or both eyes.

• Weakness:

Limb weakness is very common in patients with Multiple Sclerosis. Weakness can affect one arm, one leg, both arms, both legs, or the whole side. It may rarely affect the whole body.

Weakness may or may not be accompanied by loss of sensations, tingling, or paraesthesias.

In addition, the weakness may also be reported as stiffness or muscle strain initially. The muscles become stiff with time and difficult to move especially around the joints.

• Urinary incontinence or retention.

Urinary symptoms manifesting as retention or incontinence can develop. In patients with urinary retention, the urinary bladder fills and over-distends. This may become painful and the urine may become infected.

Patients may not get relief from strain. Persistent retention of urine may also impair kidney functions, called obstructive uropathy.

In patients with predominant incontinence symptoms, the urine dribbles out all the time and the patient can not control or stop it.

• Dementia:

Memory impairment can also be present but is usually a late manifestation. It is present when the disease progresses and in patients with extensive disease.

The term “dementia” is not usually used in patients with MS as memory impairment is not as severe as in patients with other conditions of dementia like Alzheimer’s.

• Speech deficits:

Impairment of speech manifesting as slurring or difficulty in articulating words may be present. Dysarthria is the term commonly used to describe speech in these patients.

Speech impairment and problems with the articulation of words are due to the muscles of the lips and tongue getting affected as the nervous supply to these muscles is cut down.

• Fatigue:

Fatigue in MS patients is one of the dominant and symptoms the earliest symptoms reported. However, because fatigue is a very vague symptom and is present in many medical conditions, it is usually disregarded.

Patients are lethargic when performing very simple tasks such as doing routine household activities.

The severity of fatigue is not associated with the severity of Multiple sclerosis. Fatigue is reported by up to 95% of MS patients.

People try vitamins, supplements, and other maneuvers but get little relief. Exercise can relieve some of the symptoms.

• Depression and anxiety:

Depression and anxiety are common symptoms of MS. However, these conditions are present in people without MS as well.

Because of their high prevalence in normal people, these symptoms are usually not considered symptoms of MS.

They are usually considered complications of MS. Because MS is a disease associated with marked disability, the incidence of depression is very high.

• Hearing impairment:

Rarely hearing may be affected. Depending on the lesions in the brain, the hearing loss may be unilateral or bilateral.

Unilateral hearing loss is way more common than bilateral hearing loss. Furthermore, bilateral hearing loss can only occur if the person has frequent flares.

Hearing loss may be preceded by tinnitus and vertigo which are more common symptoms of MS compared to hearing loss.

• Seizures:

2-5% of the patients suffering from MS can have seizures. Although seizures as the presenting symptom are very rare, they can happen.

Seizures may be localized partial seizures or partial seizures with secondary generalization. However, focal simple partial seizures are more common in MS patients.

• Difficulty swallowing:

Bulbar symptoms like dysphagia can be present. Patients with MS can have difficulty swallowing, especially in the advanced stage of the disease.

Swallowing requires multiple muscles to contract synchronously. In patients with MS, the neuronal stimulus to these muscles is affected. Patients, therefore, develop difficulty in swallowing.

Swallowing of liquids is usually more difficult than solids. Patients may notice a cough after taking liquids as the liquid may enter the airways instead of going into the stomach.

• Change in bowels:

Altered bowel habits are also common symptoms among patients with MS. The change in bowel habits is due to the altered gut-brain axis.

Patients may report constipation or fecal incontinence. Most patients are constipated. Others may feel urgency when they feel the urge to empty their bowels.

MS Signs:

The clinical signs of MS, like the symptoms, are also very variable. Common signs are spasticity and motor weakness which can be unilateral or bilateral.

Spasticity can affect the gait as well. the gait can also become ataxic when the lesions are present in the cerebellum of the brain. The cerebellum controls coordination and balance.

• Optic neuritis:

Optic neuritis is present in most patients with MS. It can be the presenting sign in about 20% of the patients.

It can be detected by the “swinging flashlight test” in which the afferent pupillary defect can be identified.

Fundus examination is important to confirm the diagnosis of optic neuritis. Optic neuritis is especially present in a variant of MS called Devic’s Disease or Neuromyelitis Optica (NMO). In NMO, the spine and eyes are commonly affected.

• Muscle spasms:

Muscle spasms are the presenting signs in more than 2/3rds of the patients (40 – 80%) of the patients.

Patients may report difficulty in performing a task, involuntary muscle contractions, heaviness, or unpredictable movements.

• Sensorineural hearing deficits:

This is often unrecognized and may not be reported by the patient. However, compared to the general population, sensorineural hearing loss is very common in MS patients.

• Cognitive impairment:

This is another common feature of MS and affects about 40 to 60% of the patients with MS. Patients may have impaired memory, low attention span, difficulty in executing general tasks at the usual speed, and impaired perception.

• Epileptic fits:

Focal simple partial seizures are the most common type of seizure in MS patients. Seizures are usually recurrent and may worsen as the disease progress.

• Mononeuritis multiplex:

MS affects multiple nerves of different parts of the body at the same time, hence the name mono neuritis multiplex.

• Bulbar palsies:

Bulbar palsies are present when MS affects the cranial nerves. Patients with MS may have difficulty moving their tongues, chewing, swallowing, drooling saliva, and articulating words.

• Dawson’s sign/ Dawson’s fingers:

This is a radiographic manifestation of periventricular demyelinating plaques which are perpendicular to lateral ventricles or corpus callosum.

• Uthoff’s sign:

A slight rise in the temperature while taking a hot bath can worsen the ongoing symptoms and signs of relatively stable multiple sclerosis.

• Barbar Chair Sign (Lhermitte sign):

“Barbar chair sign” is the sudden current-like sensation that runs down from the cervical spine to the arms and legs when the neck is flexed.

About 50% of patients suffering from MS go on to develop debilitating symptoms despite the treatment. The disease has no cure rather its treatment is targeted toward reducing the duration and frequency of relapses.