The symptoms of multiple sclerosis (MS) can differ from person to person. They may be mild or they may be debilitating. Symptoms may be constant or they may come and go.
There are four typical patterns of progression of the disease.
The progression of MS typically follows one of these patterns.
Clinically isolated syndrome
This is the early pattern, where the first episode of neurologic symptoms caused by inflammation and demyelination of nerves occurs. Symptoms may or may not progress to other patterns associated with MS.
In the relapsing-remitting pattern of progression, periods of severe symptoms (exacerbations) are followed by periods of recovery (remissions). These may be new symptoms or a worsening of existing symptoms. Remissions may last months or even years and may partially or completely go away during remissions. Exacerbations may occur with or without a trigger such as infection or stress.
Primary-progressive MS progresses gradually and is characterized with worsening symptoms, with no early remissions. There may be periods when symptoms are actively progressing or remain inactive or unchanged temporarily; however, there is usually gradual progression of the disease with periods of sudden relapse. Progressive-relapsing MS is a pattern of relapses within primary-progressive pattern that is rare (accounts for about 5 percent of cases).
After an initial period of remissions and relapses, secondary-progressive MS progresses gradually. There may be times it is actively progressing or not progressing. The overall difference between this and relapse-remitting MS is that the accumulation of disability continues.
The most common first symptoms of MS are:
- numbness and tingling in one or more extremities, in the trunk, or on one side of the face
- weakness, tremor, or clumsiness in the legs or hands
- partial loss of vision, double vision, eye pain, or areas of visual alteration
Other common symptoms include the following.
Fatigue is a common and often the most debilitating symptom of MS. It may occur in several different forms:
- activity-related fatigue
- fatigue due to deconditioning (not being in good shape)
- lassitude—also known as “MS fatigue”
The fatigue associated with MS is often worse in the late afternoon.
Bladder and bowel dysfunction
Bladder and bowel dysfunction can be ongoing or intermittent problems in MS. Bladder frequency, waking up at night to void, and bladder accidents can be symptoms of this problem. Bowel dysfunction can result in constipation, bowel urgency, loss of control, and irregular bowel habits.
Weakness in multiple sclerosis can be related to an exacerbation or a flare-up, or can be an ongoing problem.
Cognitive changes related to MS can be obvious or very subtle. They may include memory loss, poor judgment, decreased attention span, and difficulty reasoning and solving problems.
Acute and chronic pain
Like symptoms of weakness, pain in MS can be acute or chronic. Burning sensations and electric shock–like pain can occur spontaneously or in response to being touched.
MS spasticity can affect your mobility and comfort. Spasticity can be defined as spasms or stiffness and may involve pain and discomfort.
Both clinical depression and a similar, less severe emotional distress are common in people with MS. About 50 percent of people with MS experience depression at some time during their illness.