Multiple sclerosis (MS) is a progressive, immune-mediated disorder. That means the system designed to keep your body healthy mistakenly attacks parts of your body that aren’t harmful. The protective coverings of nerve cells are damaged, which leads to diminished function in the brain and spinal cord.

MS is a disease with unpredictable symptoms that can vary in intensity. While some people experience fatigue and numbness, severe cases of MS can cause paralysis, vision loss, and diminished brain function.

MS is a lifelong disease, but it can be managed and researchers are continually looking for more effective treatments.

Common early signs of multiple sclerosis (MS) include:

For some people, the earliest signs of MS might include clinically isolated syndrome (CIS), neurologic symptoms that last at least 24 hours and can’t be associated with another cause. It includes what’s called demyelination which is damage to myelin, the protective coating that helps to protect nerve cells in the central nervous system.

Although CIS doesn’t necessarily lead to MS, it could be an early sign. Symptoms of a CIS episode could include:

  • Optic neuritis. This is damage to the myelin of your optic nerve which may cause vision issues and eye pain.
  • Lhermitte’s sign. This condition is caused by a demyelinating lesion on the spinal cord that causes a tingling or shock feeling going down the back and neck, especially when you bend your neck down.
  • Transverse myelitis. Transverse myelitis is when the spinal cord is involved and can cause muscle weakness, numbness, and other issues.

An MRI can sometimes be a useful tool in helping to determine if there’s only been one episode of CIS or multiple episodes, which may indicate MS.

Primary symptoms of MS stem from the damage to the protective nerve covering, the myelin. Your doctors can help you manage these symptoms using medication, occupational therapy, and physical therapy.

Here are some of the more common symptoms of MS:

Vision problems

Visual problems are one of the most common symptoms of MS. Inflammation affects the optic nerve and disrupts vision. This can cause blurred vision or loss of vision. Sometimes the cranial nerves or the brainstem can be involved, causing eye movement problems or double vision. These are three common vision symptoms of MS:

  • optic neuritis — inflammation of the optic nerve
  • nystagmus — unstable movement of the eye, sometimes called “dancing eyes”
  • diplopia — double vision

You may not notice the vision problems immediately. With optic neuritis, pain when you look up or to one side also can accompany vision loss. There are a variety of ways to cope with MS-related vision changes.

Tingling and numbness

MS affects nerves in the brain and spinal cord (the body’s message center). The sensory nerves in the spinal cord can be affected by demyelination, causing diminished sensation when you touch something, which can affect your ability to walk or do things with your hands. You can also have paresthesias (sensations like numbness, tingling, or burning).

Tingling sensations and numbness are one of the most common warning signs of MS. Common sites of numbness include the face, arms, legs, and fingers.

Pain and spasms

Chronic pain and involuntary muscle spasmsare also common with MS. Pain can be a direct result of the demyelination or by the symptoms themselves causing secondary pain.

Types of MS pain could include neuropathic pain. This acute pain is caused by nerves miscommunicating signals to the brain. Examples include:

MS can also cause chronic neuropathic pain, where the acute pain mentioned above can also be experienced on a more ongoing basis. This may include dysesthesias (painful sensations in the limbs) or pruritis, which causes itching, tingling, and similar sensations.

Muscle stiffness or spasms (spasticity) are also common. You might experience stiff muscles or joints as well as uncontrollable, painful jerking movements of the extremities. The legs are most often affected, but back pain is also common.

Type of spasticity associated with MS include flexor spasticity, where muscles become very tight so that they bend and are unable to be straightened, and extensor spasticity, where muscles have the opposite problem — they’re so tight that the arms or legs become straightened and can’t bend.

Slurred speech and trouble swallowing, particularly in later stages of the condition, can also occur due to motor issues.

Fatigue and weakness

Unexplained fatigue and weaknessaffect many people living with MS. Fatigue is often related to the number of lesions in the brain and to inflammation. Weakness can develop due to muscle atrophy (muscles shrinking from lack or use) or due to demyelination of the nerves.

Chronic fatigue occurs when nerves deteriorate in the spinal column. Usually, the fatigue appears suddenly and lasts for weeks before improving. The weakness is most noticeable in the legs at first.

People who have MS can have intermittent fatigue, recurrent fatigue, or constant chronic fatigue. There’s sometimes an increased chance of having the separate diagnosis of chronic fatigue syndrome for people who have MS.

Balance problems and dizziness

Dizziness and problems with coordination and balance can decrease the mobility of someone with MS. This can contribute to problems with your gait. People with MS often feel lightheaded, dizzy, or as if their surroundings are spinning (vertigo). This symptom often occurs when you stand up.

Bladder and bowel dysfunction

A dysfunctional bladder is another common symptom. This can include:

Urinary-related symptoms are often manageable. Less often, people with MS experience constipation, diarrhea, or loss of bowel control.

Sexual dysfunction

Sexual arousal and function can also be a problem for people with MS because it begins in the central nervous system — where MS attacks. It could stem from physical problems with fatigue, spasticity, or secondary emotional symptoms.

Cognitive problems

Many with MS will develop some kind of issue with their cognitivefunction. This can include:

  • memory problems
  • shortened attention span
  • trouble concentration
  • difficulty staying organized

Depression and other emotional health problems are also common.

Changes in emotional health

Major depression is common among people with MS. The stresses of MS can also cause irritability, mood swings, and, rarely, a condition called pseudobulbar affect. This involves bouts of uncontrollable crying and laughing.

Coping with MS symptoms, along with relationship or family issues, can make depression and other emotional disorders even more challenging. MS support groups can be helpful in coping with these changes.

Not everyone with MS will have the same symptoms. Different symptoms can manifest during relapses or attacks. Along with the symptoms mentioned on the previous slides, MS can also cause:

Secondary symptoms of MS aren’t caused by the main driver of MS symptoms (demyelination). They’re actually complications caused by the body’s reactions to it. There are many varied symptoms that could occur, like muscle weakness from lack of use and increased stress and emotional issues.

Your doctor can help you alleviate existing symptoms and prevent them from occurring by addressing the primary symptoms of MS.

Sex and gender exist on spectrums. This article will use the terms “men,” “women,” or both to refer to sex assigned at birth. Click here to learn more.

Generally, MS is much more common in women than in men. The reasons for this are still being researched but likely include both genetic and environmental factors.

People who are considering getting pregnant with an MS diagnosis should talk with their doctors about all options for treatment and symptom management.

MS is diagnosed less often in men than women by a ratio of 3-to-1. This has been especially noticeable in the last 30 years as the gap has widened. This could be due to a number of issues like access to healthcare, childbirth, and lifestyle factors. Vitamin D deficiency is being researched as a likely factor as well.

MS seems to progress faster in men than in women in certain types of MS, like relapse-onset MS.

MS symptoms in women vs. men

More common experiences for women with MSMore common experiences for men with MS
An MS diagnosis is more common in women than in men. Vitamin D deficiency may be a potential cause for higher rates in women.Men seem to have more neurodegeneration than women, or loss of nerve function.
Secondary progressive MS and relapsing remitting MS tend to be more common in women than men.Approximately equal numbers of men and women are diagnosed with primary progressive MS.
Women tend to have more MS lesions, or scar tissue.Men tend to have more cognitive issues in later stages, though sometimes fare better with attention tasks.
Pregnancy has been associated with a temporarily lowered risk of relapse, but some treatments may not be advised while pregnant.
Menopause tends to lessen sex-related differences in later MS diagnoses.

A doctor — most likely a neurologist — will perform several tests to diagnose MS, including:

  • Neurological exam: Your doctor will check for impaired brain or spine function.
  • Eye exam: This is a series of tests designed to evaluate your vision.
  • MRI: This is a technique that uses a powerful magnetic field and radio waves to create cross-sectional images of the brain and spinal cord.
  • Spinal tap: Also called a lumbar puncture, this test involves a long needle that’s inserted into your spine to remove a sample of fluid circulating around your brain and spinal cord.

Doctors use these tests to look for demyelination to the central nervous system affecting at least two separate areas. They must also determine that at least 1 month has passed between the episodes. These tests are also used to rule out other conditions.

MS often astounds doctors because of how much it can vary in both its severity and the ways that it affects people. Attacks can last a few weeks and then disappear. But relapses can get progressively worse and more unpredictable, and come with different symptoms. Early detection may help prevent MS from progressing quickly.

If you don’t already have a neurologist, the Healthline FindCare tool can help you find a physician in your area.

Misdiagnosis

Misdiagnosis is also possible. An older study from 2012 found that nearly 75 percent of surveyed MS specialists had seen at least three patients over the past 12 months who’d been misdiagnosed.

MS is a challenging disorder, but researchers have discovered many treatments that can slow its progression and manage symptoms.

The best defense against MS is seeing your doctor immediately after you experience the first warning signs. This is especially important if someone in your immediate family has the disorder, as it’s likely one of the key risk factors for MS.

Don’t hesitate. It could make all the difference.

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