Symptoms of Multiple Sclerosis
Sensory symptoms can include tingling, numbness, burning and itching in the arms, legs, trunk, or face and motor symptoms might include loss of strength and dexterity, clumsiness and lack of co-ordination in a leg or hand. People may have difficulty with bladder control and can feel unusually tired (fatigue), which is a very common and debilitating symptom. A few patients may have seizures. Cognitive and psychological symptoms also occur, which may be very subtle initially including poor judgement or inattention, mood swings, giddiness, depression and apathy.
Depression may be reactive or partly due to the cerebral lesions of multiple sclerosis.
In view of the wide range of symptoms it is most helpful when considering disability to consider whether they are acute or chronic and the impact on mobility, independence in activities of daily living, the psychological state and general well-being. Some clinical features are more typical of the early phase of MS while others are more likely to arise later in the clinical course. An alternative approach using the types of nerves fibres affected is provided in the link at the bottom of the page. There will be people whose MS does not fit this ‘typical’ picture.
Early Symptoms
Onset of symptoms typically occurs between the ages of 20 and 40 years with a peak incidence in people in their 20s and 30s. Early symptoms may include the following:
- Optic neuritisor inflammation of the nerves in the eye. Usually in one eye and may be associated with loss of vision. Pain or involuntary jerking movements of the eye (nystagmus) may also occur. In 20% of people with this condition MS develops within two years after the onset of optic neuritis. In 45% to 80% MS develops within 15 years.
- Fatigue. Fatigue is a feeling of overwhelming tiredness. It is a common symptom of MS, affecting 85% of people with the condition. Fatigue may be accompanied by an increase in body temperature and its severity is not related to the level of disability.
- Heaviness or clumsiness in the arms and legs. (These are often the first symptoms for people with primary progressive MS often developing slowly in the upper legs.)
- Tingling sensations. This is often described as ‘ants under the skin’, ‘pins and needles’ or ‘like firing electric shocks’ by people searching for the best words to describe these unusual sensations.
- Poor co-ordination.
- Lhermitte's sign. This is an electrical sensation that runs down the back and into the legs, which is produced by bending the neck forward.
Later Symptoms
As the disease develops over months or years, symptoms can occur in practically every region in the body and may include the following:
- Spasticity. Increased muscle tone and resistance to movement, particularly in the muscles used to maintain posture.
- Imbalance and dizziness.
- Tremors.
- Spasm-related symptoms (spasticity). Including painful spasms, stiffness and quivering movements and sensations. They usually occur in the extremities and last from a few seconds to several minutes.
- Sensory Symptoms including pain:
- Paraesthesia - partial numbness, tingling and vibration sensations,
- Anaesthesia - complete numbness/loss of sensation,
- Neuralgia, Neuropathic and Neurogenic pain - pain without apparent cause as well as burning, itching and electrical shock sensations,
- Trigeminal Neuralgia -facial pain,
- L'Hermitte's sign - electric shocks and buzzing sensations when moving head,
- Proprioceptive Dysfunction - loss of awareness of location of body parts.
- Speech difficulties (dysarthria)
- Slurring of words, imprecise and slow speech (common),
- Low volume or weak voice,
- Problems co-ordinating speech e.g. stuttering,
- Mispronunciation of words,
- Monotonous tone of voice,
- Abnormally long pauses between words or syllables of words – this is called ‘scanned speech,’
- Failure to complete words.
Dysarthria is due to a wide range of problems with vocalisation including, change in the rate and rhythm of speech resulting in poor articulation and slurred speech. Spasticity of speech muscles which can give rise to difficulty with pronunciation and disruption of the airflow during speech resulting in distorted consonants and speaking in short phrases.
When cognitive abilities are affected dysphasia, in which there is a lack of understanding of what is being said and an inability to recall the vocabulary and grammar necessary to build a sentence, may also occur:
- Difficulty swallowing,
- Symptoms in the gastro-intestinal, urinary and genital tracts. A wide
range of symptoms are possible but those most commonly occurring are:
- Acid reflux, swallowing problems, impaired sense of taste,
- Bladder dysfunction leading to urinary urgency or hesitancy, partial retention of urine and mild urinary incontinence,
- Erectile dysfunction in men and genital anaesthesia in women,
- Constipation – infrequent or irregular bowel movements,
- Faecal urgency,
- Frank urinary and faecal incontinence may occur in advanced MS.
- Cognitive and mood problems
Cognition refers to a wide range of different intellectual processes our brains undertake to perform tasks and maintain every day functions.
- Cognitive dysfunction - short-term and long-term memory problems, forgetfulness, slow word recall - symptoms include inaccurate perceptions, decreased concentration, short-term memory loss (amnesia), inability to think clearly, poor recall, reduced judgment and unexpected changes in behaviour,
- Depression,
- Mood swings, emotional lability, euphoria,
- Anxiety,
- Dementia.
Click on the links for details of:
Amended April 2008
