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Symptoms of Multiple Sclerosis
When a neurologic disorder is suspected, doctors usually evaluate all of the body systems during the physical examination, but they focus on the nervous system. They do a neurologic examination, which includes evaluation of mental status, cranial nerves, motor and sensory nerves, reflexes, coordination, balance, walking (gait), regulation of internal body processes (by the autonomic nervous system (ANS)), and blood flow to the brain. Doctors may evaluate some areas more thoroughly than others depending on what type of disorder they suspect.

Neurologic symptoms (those symptoms caused by a disorder that affects part or all of the nervous system) can vary greatly because the nervous system controls so many different body functions. Symptoms can include all forms of pain, including headache and back pain. Muscles, skin sensation, the special senses (vision, taste, smell, and hearing), and other senses depend on nerves to function normally. Thus, neurologic symptoms can include muscle weakness or lack of coordination, abnormal sensations in the skin, and disturbances of vision, taste, smell, and hearing.

Neurologic symptoms may be minor (such as a foot that has fallen asleep) or life threatening (such as coma due to stroke). The characteristics and pattern of symptoms help doctors diagnose a neurologic disorder such as multiple sclerosis (MS).

The symptoms of MS may be mild or severe, for short durations or long, and they may appear in various combinations. Depending on the area of the central nervous system (CNS), the number of areas damaged, and severity of each scar, determines the outcome. Complete or partial remission of symptoms, especially in the early stages of the disease, occurs in approximately 70% of those with MS.

Clinical symptoms in MS primarily reflect the presence of inflammatory lesions in specific areas of the brain, spinal cord, or optic nerve tracts. Virtually any neurologic sign or symptom can occur, depending upon the location of a specific lesion. However, there has been some evidence that endogenous cytokine production in MS may contribute to neuropsychiatric symptoms, such as fatigue and depression.

The initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye. Inexplicably, visual problems tend to clear up in the later stages of MS. Inflammatory problems of the optic nerve may be diagnosed as retrobulbar or optic neuritis.

Many symptoms of MS can be seen or noticed by others if they watch you carefully, and then there are many that are "invisible" or never noticed. Fatigue is one of those symptoms that is probably misinterpreted, with most people thinking that you are tired all of the time. Speech can also be misinterpreted and thought to be from alcohol or improper grammar. Symptoms such as vision and hearing loss may never be noticed, at least by those around you.

The following are the most common symptoms of MS:

Fatigue
People with MS may become more easily worn out after physical activity than usual. There is also a type of fatigue called "lassitude" or "MS fatigue" that many believe to be unique to people with MS, which is generally more severe than normal fatigue.
Numbness or tingling
It’s common for someone with MS to have sensory changes. These can include numbness, tingling, itching, burning, or even feeling cold in the face, body, or extremities.
Vision problems
Many people with MS may experience vision problems. These can include blurred vision, loss of normal color vision, blindness in one eye, a dark spot in the field of vision, double vision, and uncontrolled eye movements or "jumping vision". Some of these symptoms may occur when MS attacks the nerve connecting your eye to your brain.
Memory or focus problems
MS may affect the ability to remember things. It may also make it more difficult to think and focus.
Mood changes
People with MS may also have mood disorders, such as depression.
Balance and coordination issues
People with MS frequently have balance and coordination issues, which can be a result of damage to nerves that control the movement of muscles.
Muscle pain
Some people with MS may experience tightness or tension in their muscles.
Bowel and bladder control issues
Many people with MS develop issues with controlling the urge to urinate, or experience frequent nighttime urination. They may also have trouble with constipation or controlling their bowel movements.
Sexual issues
The nerve damage caused by MS can lead to issues with sexual function.
Heat sensitivity
Many people with MS experience a temporary worsening of MS symptoms when exposed to heat or dealing with a fever.

The most noticeable symptoms tend to be those relating to motor control and coordination. The majority of the other symptoms remain out of the eyes of others and this is probably why those with MS are often told that they look fine and don't look sick. Some of those with any illness or disease may feel that if they are sick, they want everyone to know, and then others might just want to keep it to themselves. Disclosure is, for the most part, up to the individual that carries the burden of MS for the rest of their life.

Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance at some time during the course of the disease. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis. Fatigue may be triggered by physical exertion and improve with rest, or it may take the form of a constant and persistent tiredness.

Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or "pins and needles" sensations, pain, and loss of sensation. Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, those with MS may suffer from hearing loss.

Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked. In fact, they are often detectable only through comprehensive testing. Patients themselves may be unaware of their cognitive loss; it's often a family member or friend who first notices a deficit. Such impairments are usually mild, rarely disabling, and intellectual and language abilities are generally spared.

Cognitive symptoms occur when lesions develop in brain areas responsible for information processing. These deficits tend to become more apparent as the information to be processed becomes more complex. Fatigue may also add to processing difficulties. It's not yet known whether altered cognition in MS reflects problems with information acquisition, retrieval, or a combination of both. Types of memory problems may differ depending on the individual's disease course, but there doesn't appear to be any direct correlation between duration of illness and severity of cognitive dysfunction.

Depression, which is unrelated to cognitive problems, is another common feature of MS. In addition, about 10% of patients suffer from more severe psychotic disorders such as manic-depression and paranoia. About 5% may experience episodes of inappropriate euphoria and despair unrelated to the patient's actual emotional state known as "laughing/weeping syndrome." This syndrome is thought to be due to demyelination in the brainstem, the area pf the brain that controls facial expression and emotions, and is usually seen only in severe cases.

As the disease progresses, sexual dysfunction may become a problem. Bowel and bladder control may also be lost.

Other common symptoms that may appear include:

decreased memory decreased spontaneity
decreased judgment muscle spasticity
muscle atrophy depression
weakness of one or more extremities paralysis of one or more extremities
tremor of one or more extremities loss of ability to think abstractly
dysfunctional movement progressing in legs decreased attention span
loss of ability to generalize facial pain
extremity pain double vision
loss of vision usually in one eye at a time eye symptoms worsen during eye movement
eye discomfort uncontrollable rapid eye movements
walking/gait abnormalities decreased control of intricate movement
positive Babinski's reflex slurred speech
muscle spasms especially in legs difficulty speaking or understanding speech
loss of balance hearing loss
dizziness vertigo

In about 60% of MS patients, heat may cause temporary worsening of many MS symptoms. Some temperature-sensitive patients find that a cold bath may temporarily relieve their symptoms. For this same reason, swimming is often a good exercise choice for people with MS.

The erratic symptoms of MS can affect the entire family as patients may become unable to work at the same time they are facing high medical bills and additional expenses for housekeeping assistance and modifications to homes and vehicles. The emotional drain on both patient and family is immeasurable. Support groups and counseling may help MS patients, their families, and friends find ways to cope with the many problems the disease can cause.

Paroxysmal Symptoms

Several different paroxysmal syndromes occur in MS. Paroxysmal symptoms in MS are brief sudden attacks of abnormal posturing of the extremities, loss of tone in the legs (drop attacks) or other manifestations that may appear similar to an epileptic seizure but are of different origin.

Paroxysmal is a term for any MS symptoms that begin suddenly and only last for a few seconds to a few minutes at most. These symptoms may reappear from 5 to 40 times a day in similar short bursts. They may be painful and disrupting or they can just be annoying. The attacks usually stop after a few months.

Examples of paroxysmal symptoms include:
Lhermitte's sign (electric shock like sensations induced by neck flexion)
Tonic seizures or spasms of an arm or leg
Paroxysmal dysarthria/ataxia
Paroxysmal sensory disturbances (trigeminal neuralgia)
Uhthoff's symptoms (transient blurring of vision associate with exertion and elevated body temperature)

They may be precipitated by hyperventilation or movement. These syndromes are also distinguished by their marked responsiveness to very low dosages of anticonvulsant medications.

This doesn't signal a relapse or worsening of the disease. These symptoms are probably just due to a transmission of nerve impulses across sites where they don't normally occur and where there has been previous damage. This can be caused by some sort of stimulation, such as irritating clothing or movement.
Secondary and Tertiary Symptoms
While the primary symptoms described on this page are the direct result of damage to the myelin and nerve fibers in the CNS, the secondary symptoms of MS are the complications that can arise as a result of the primary symptoms. Now while secondary symptoms can be treated, the optimal goal is to avoid them by treating the primary symptoms.

Examples of secondary symptoms are:

Bladder dysfunction can cause repeated urinary tract infections.

Immobility can lead to pressure sores.

Inactivity can result in loss of muscle tone and disuse weakness, poor postural alignment and trunk control, decreased bone density, and shallow inefficient breathing.

Tertiary symptoms are caused by the social and psychological problems of the primary and secondary symptoms of MS.

These symptoms are the social, vocational and psychological complications of the primary and secondary symptoms. A person who becomes unable to walk or drive may lose their livelihood. The strain of dealing with a chronic illness caused by MS may disrupt personal relationships.

Depression is frequently seen among people with MS. Depression is unique in that it may be a primary, secondary, or tertiary symptom. Professional assistance from psychologists, social workers, physical and occupational therapists, and public health agencies is indicated for managing many tertiary symptoms.