15 Multiple Sclerosis Symptoms You Should Know About

Introduction to Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system, including the brain, spinal cord, and optic nerves. In MS, the immune system mistakenly attacks the protective covering of nerve fibers called myelin, causing inflammation and damage. This disruption interferes with the communication between the brain and the rest of the body, leading to a wide range of symptoms that can vary greatly from person to person.

MS is one of the most common neurological conditions affecting young adults, typically diagnosed between ages 20 and 40, though it can occur at any age. Women are approximately two to three times more likely to develop MS than men. The symptoms of multiple sclerosis can be unpredictable, ranging from mild to severe, and may come and go in episodes or progress gradually over time.

Understanding the early signs and symptoms of MS is crucial for early diagnosis and management. While there is currently no cure for multiple sclerosis, recognizing symptoms early can help individuals seek appropriate medical care and potentially slow disease progression. Below, we explore the 15 most common symptoms of multiple sclerosis that affect both men and women.

1. Fatigue and Exhaustion

Fatigue is one of the most common and debilitating symptoms of multiple sclerosis, affecting approximately 80% of people with MS. This is not ordinary tiredness that improves with rest; rather, it is a profound exhaustion that can interfere with daily activities and quality of life.

MS-related fatigue typically:

• Occurs daily and may worsen as the day progresses
• Is aggravated by heat and humidity
• Comes on easily and suddenly
• Is generally more severe than normal fatigue
• Interferes with responsibilities and work

This type of fatigue can be primary (directly caused by MS damage to the nervous system) or secondary (resulting from other MS symptoms like sleep disturbances, depression, or medication side effects). Many people describe it as an overwhelming sense of tiredness that makes even simple tasks feel impossible.

2. Vision Problems

Vision disturbances are often among the first noticeable symptoms of multiple sclerosis and can significantly impact daily life. The most common vision problem in MS is optic neuritis, which is inflammation of the optic nerve that connects the eye to the brain.

Common vision symptoms include:

• Blurred or double vision (diplopia)
• Pain when moving the eyes
• Partial or complete vision loss, usually in one eye
• Dimmed or faded color vision
• Involuntary eye movements (nystagmus)
• Blind spots in the visual field

Optic neuritis typically affects one eye at a time and may improve over several weeks or months, though some residual symptoms may persist. Vision problems can be particularly concerning and should prompt immediate medical evaluation to rule out MS and other serious conditions.

3. Numbness and Tingling Sensations

Numbness and tingling, medically known as paresthesia, are among the most frequent early signs of multiple sclerosis. These sensations occur when MS damages the nerves that transmit sensory information from the body to the brain.

These sensations commonly affect:

• The face, including numbness around the mouth
• Arms and hands
• Legs and feet
• The trunk or torso

People with MS describe these sensations as pins and needles, burning, or the feeling that a body part has “fallen asleep.” The numbness can range from mild and barely noticeable to severe enough to interfere with the ability to use the affected limb. Some individuals may experience reduced ability to sense temperature or touch, which can increase the risk of injuries or burns.

4. Muscle Weakness

Muscle weakness is a prevalent symptom of multiple sclerosis that can affect any part of the body. This weakness results from damage to the nerves that control muscle movement, as well as from disuse of muscles due to other MS symptoms.

Characteristics of MS-related muscle weakness:

• May affect one side of the body more than the other
• Often begins in the legs, making walking difficult
• Can progress to affect arms and hands
• May worsen with fatigue or heat exposure
• Can lead to difficulty with balance and coordination

Muscle weakness can significantly impact mobility and independence, making it challenging to perform everyday tasks such as climbing stairs, carrying objects, or walking long distances. The weakness may be constant or may fluctuate, sometimes improving temporarily before worsening again.

5. Balance and Coordination Problems

Difficulties with balance and coordination, known as ataxia, are common in multiple sclerosis and result from damage to areas of the brain and spinal cord that control movement and spatial awareness.

Balance and coordination issues may manifest as:

• Unsteady gait or difficulty walking
• Dizziness or vertigo (sensation of spinning)
• Tremors in the hands, arms, or legs
• Difficulty with fine motor skills like writing or buttoning clothes
• Increased risk of falls
• Feeling off-balance when standing or walking

These problems can range from mild clumsiness to severe disability requiring assistive devices like canes or walkers. The unpredictable nature of balance problems can make people with MS feel unsafe and may limit their participation in activities they once enjoyed.

6. Bladder and Bowel Dysfunction

Bladder and bowel problems affect the majority of people with multiple sclerosis at some point during their disease course. These symptoms result from MS lesions interrupting the nerve signals between the brain and the bladder or bowel.

Common bladder symptoms include:

• Urgency (sudden, strong need to urinate)
• Frequency (needing to urinate often)
• Hesitancy (difficulty starting urination)
• Incomplete emptying of the bladder
• Nocturia (waking multiple times at night to urinate)
• Urinary incontinence

Bowel symptoms may include:

• Constipation
• Diarrhea
• Loss of bowel control
• Difficulty with bowel evacuation

These symptoms can be embarrassing and significantly affect quality of life, but they are manageable with appropriate strategies and medical guidance. It’s important to discuss these issues with healthcare providers as they can lead to complications if left untreated.

7. Cognitive Changes

Cognitive impairment affects approximately 50% of people with multiple sclerosis and can be one of the most challenging aspects of the disease. MS-related cognitive changes result from damage to areas of the brain responsible for processing and managing information.

Common cognitive symptoms include:

• Problems with short-term memory
• Difficulty concentrating or maintaining attention
• Slower information processing speed
• Trouble with multitasking
• Difficulty finding the right words (word-finding problems)
• Problems with planning and problem-solving
• Reduced ability to learn new information

These cognitive changes are usually mild to moderate and differ from dementia. They may be subtle at first and can fluctuate depending on factors like fatigue, stress, or heat exposure. Cognitive symptoms can impact work performance, social relationships, and overall independence, making them particularly important to address.

8. Pain and Uncomfortable Sensations

Pain is a common but often underrecognized symptom of multiple sclerosis, affecting approximately 50-70% of people with the condition. MS can cause several different types of pain through various mechanisms.

Types of pain in MS include:

• Neuropathic pain: Burning, stabbing, or shooting sensations caused by damaged nerves
• Trigeminal neuralgia: Sudden, severe facial pain
• Lhermitte’s sign: Electric shock sensation running down the spine when bending the neck forward
• MS hug: Tight, squeezing sensation around the torso
• Headaches and migraines
• Musculoskeletal pain: Aching in muscles and joints due to altered posture or gait

Pain can be acute (sudden and short-lived) or chronic (persistent and long-lasting). The unpredictable nature of MS pain can be frustrating and may significantly impact mood, sleep, and quality of life. Understanding the type and cause of pain is essential for effective management.

9. Emotional Changes and Depression

Emotional and mood changes are extremely common in multiple sclerosis and can result from both the psychological impact of living with a chronic illness and direct effects of MS on the brain.

Common emotional symptoms include:

• Depression: Affecting up to 50% of people with MS
• Anxiety and worry
• Mood swings and irritability
• Pseudobulbar affect (uncontrollable laughing or crying that doesn’t match emotions)
• Stress and feeling overwhelmed
• Grief over losses related to MS

Depression in MS is more than just sadness about having the disease; it can be directly caused by immune system changes and demyelination in areas of the brain that regulate mood. Emotional changes can significantly impact relationships, work, and overall well-being. It’s crucial to recognize that these symptoms are a legitimate part of MS and deserve proper attention and care.

10. Sexual Dysfunction

Sexual problems are common in both men and women with multiple sclerosis but are often not discussed due to embarrassment or lack of awareness. MS can affect sexual function through direct neurological damage, as well as indirectly through other symptoms like fatigue and mood changes.

Sexual symptoms in women may include:

• Decreased sensation in the genital area
• Reduced vaginal lubrication
• Difficulty achieving orgasm
• Loss of libido (sex drive)
• Pain during intercourse

Sexual symptoms in men may include:

• Erectile dysfunction
• Difficulty achieving or maintaining erection
• Reduced sensation
• Difficulty with ejaculation
• Decreased libido

Secondary factors such as fatigue, spasticity, bladder problems, and depression can also significantly impact sexual function and intimacy. While these issues can be sensitive to discuss, healthcare providers can offer various strategies and treatments to help manage sexual dysfunction.

11. Spasticity and Muscle Spasms

Spasticity refers to muscle stiffness and involuntary muscle spasms that occur in approximately 80% of people with multiple sclerosis. This symptom results from damage to nerve pathways that control muscle movement and tone.

Spasticity can cause:

• Tight, stiff muscles, most commonly in the legs
• Painful muscle spasms or cramps
• Difficulty with movement and walking
• Problems with posture
• Sleep disturbances due to nighttime spasms
• Joint stiffness and reduced range of motion

Spasticity can range from mild muscle tightness to severe, painful spasms that significantly impair mobility. It often worsens with certain triggers such as infections, temperature changes, tight clothing, or full bladder. The severity of spasticity can fluctuate throughout the day and may be worse at night. If left unmanaged, severe spasticity can lead to contractures (permanent muscle shortening) and decreased mobility.

12. Speech and Swallowing Difficulties

Problems with speech (dysarthria) and swallowing (dysphagia) can occur in multiple sclerosis when the disease affects the nerves that control the muscles involved in speaking and swallowing.

Speech problems may include:

• Slurred or slow speech
• Changes in voice quality or volume
• Difficulty controlling speech volume
• Scanning speech (long pauses between words or syllables)
• Hoarseness or breathy voice

Swallowing difficulties may involve:

• Sensation of food sticking in the throat
• Coughing or choking while eating or drinking
• Need to swallow multiple times to clear food
• Difficulty coordinating breathing and swallowing
• Nasal regurgitation of liquids

While these symptoms are less common in early MS, they can develop as the disease progresses. Swallowing difficulties are particularly important to address as they can lead to choking, aspiration pneumonia (when food or liquid enters the lungs), and malnutrition or dehydration.

13. Dizziness and Vertigo

Dizziness and vertigo are common symptoms in multiple sclerosis, experienced by many people with MS at some point during their disease course. These symptoms occur when MS lesions affect areas of the brain or brainstem that control balance and spatial orientation.

People with MS may experience:

• Vertigo: A spinning sensation, feeling like you or your surroundings are moving
• Lightheadedness or feeling faint
• Unsteadiness or loss of balance
• Nausea or vomiting associated with dizziness
• Sensation of being pulled to one side
• Difficulty focusing vision during head movement

Vertigo in MS can be sudden and severe, sometimes lasting for days or weeks before improving. It can be particularly disabling as it makes it difficult to stand, walk, or perform daily activities. The sensation can be worsened by head movements, position changes, or visual stimuli. Dizziness and vertigo can also increase the risk of falls, making it important to take appropriate precautions.

14. Heat Sensitivity (Uhthoff’s Phenomenon)

Heat sensitivity, also known as Uhthoff’s phenomenon, is a characteristic feature of multiple sclerosis where symptoms temporarily worsen with increased body temperature. This occurs because heat can slow or block nerve signals in damaged nerve fibers.

Common triggers include:

• Hot weather or high humidity
• Hot baths or showers
• Exercise or physical activity
• Fever or illness
• Sun exposure
• Eating hot foods or drinks

Effects of heat sensitivity may include:

• Increased fatigue
• Worsening of existing symptoms
• Blurred vision
• Weakness
• Cognitive difficulties
• Balance problems

The important thing to understand about heat sensitivity is that it causes temporary symptom worsening, not new damage to the nervous system. Symptoms typically improve once body temperature returns to normal. However, this sensitivity can significantly limit activities, especially during summer months or in warm climates.

15. Walking Difficulties (Gait Problems)

Walking difficulties, or gait disturbances, are among the most common and visible symptoms of multiple sclerosis, affecting up to 75% of people with MS at some point. These problems result from a combination of various MS symptoms affecting the ability to walk normally.

Walking difficulties in MS can include:

• Dragging one or both feet
• Shuffling gait
• Difficulty lifting the feet (foot drop)
• Unsteady or wide-based gait
• Needing to hold onto walls or furniture for support
• Reduced walking speed
• Increased effort required to walk
• Difficulty walking long distances

Contributing factors to gait problems include:

• Muscle weakness, especially in the legs
• Spasticity and stiffness
• Balance and coordination problems
• Sensory loss in the feet
• Fatigue
• Vision problems

Walking difficulties can significantly impact independence and quality of life, affecting the ability to work, participate in social activities, and perform daily tasks. Many people with MS eventually require assistive devices such as canes, walkers, or wheelchairs to maintain mobility and safety.

What Causes Multiple Sclerosis

The exact cause of multiple sclerosis remains unknown, but researchers believe it results from a combination of genetic, environmental, and immunological factors. MS is classified as an autoimmune disease, meaning the body’s immune system mistakenly attacks its own tissues—in this case, the myelin sheath that protects nerve fibers.

Genetic Factors

While MS is not directly inherited, genetics play a role in susceptibility:

• Having a first-degree relative (parent or sibling) with MS increases risk
• Certain gene variants, particularly those related to immune system function, are associated with higher MS risk
• However, most people with MS have no family history of the disease
• Identical twins have only a 25-30% chance of both developing MS, indicating environmental factors are also important

Environmental Factors

Several environmental factors have been linked to increased MS risk:

• Geographic location: MS is more common in countries farther from the equator, suggesting a connection to sunlight exposure and vitamin D levels
• Vitamin D deficiency: Low levels of vitamin D appear to increase MS risk
• Viral infections: Certain viruses, particularly Epstein-Barr virus (which causes mononucleosis), have been associated with increased MS risk
• Smoking: Cigarette smoking significantly increases the risk of developing MS and may accelerate disease progression
• Obesity: Being overweight during adolescence has been linked to higher MS risk

Immunological Factors

The immune system dysfunction in MS involves:

• T-cells and B-cells (types of white blood cells) crossing the blood-brain barrier
• These immune cells mistakenly identifying myelin as foreign and attacking it
• Inflammatory response causing damage to myelin and the underlying nerve fibers
• Disruption of normal nerve signal transmission

Other Risk Factors

• Age: MS is typically diagnosed between ages 20-40, though it can occur at any age
• Sex: Women are 2-3 times more likely to develop MS than men
• Other autoimmune diseases: Having thyroid disease, type 1 diabetes, or inflammatory bowel disease slightly increases MS risk

It’s important to note that having one or more risk factors does not mean a person will definitely develop MS, and many people with MS have no identifiable risk factors. Research continues to explore the complex interplay of factors that lead to MS development.

Frequently Asked Questions About Multiple Sclerosis

What is multiple sclerosis (MS)?

Multiple sclerosis is a chronic autoimmune disease that affects the central nervous system (brain, spinal cord, and optic nerves). The immune system attacks the protective covering of nerve fibers called myelin, disrupting communication between the brain and body. This leads to a wide variety of symptoms that can vary in severity and duration.

What are the first signs of MS?

The first signs of MS vary from person to person but commonly include vision problems (especially optic neuritis), numbness or tingling in the limbs or face, fatigue, weakness, balance problems, and bladder issues. Many people experience only mild symptoms initially that may come and go.

Are MS symptoms different in women and men?

While the core symptoms of MS are similar in both sexes, some differences exist. Women tend to experience more relapses, especially during childbearing years, and may have more sensory symptoms and fatigue. Women are also more likely to have MS symptoms that fluctuate with hormonal changes. Men may develop MS later in life and are more likely to have progressive forms of the disease with more severe disability progression.

Can MS symptoms come and go?

Yes, MS symptoms often come and go, especially in the relapsing-remitting form of MS, which is the most common type. Symptoms may appear suddenly during a relapse or flare-up, last for days or weeks, and then partially or completely resolve during periods of remission. However, some symptoms may persist or gradually worsen over time.

What triggers MS symptoms to worsen?

Common triggers that can temporarily worsen MS symptoms include heat and humidity, stress, infections or illness, lack of sleep, fatigue, and certain medications. These triggers don’t cause new damage but can temporarily unmask or intensify existing symptoms. Symptoms typically improve once the trigger is removed or addressed.

How is MS diagnosed?

There is no single test for MS. Diagnosis typically involves a combination of medical history, neurological examination, MRI scans of the brain and spinal cord to detect lesions, lumbar puncture (spinal tap) to analyze cerebrospinal fluid, and evoked potential tests to measure electrical activity in the brain. Doctors must also rule out other conditions that can mimic MS symptoms.

Is MS hereditary?

MS is not directly inherited, but there is a genetic component. Having a first-degree relative with MS increases your risk, but most people with MS have no family history of the disease. If one parent has MS, the risk to their children is approximately 2-5%, compared to 0.1-0.2% in the general population.

Can MS be cured?

Currently, there is no cure for multiple sclerosis. However, various disease-modifying therapies can help slow disease progression, reduce the frequency and severity of relapses, and manage symptoms. Research continues to advance our understanding of MS and develop new treatments. Early diagnosis and appropriate management can significantly improve quality of life for people with MS.

Does everyone with MS end up in a wheelchair?

No, not everyone with MS requires a wheelchair. While MS can affect mobility, the course of the disease varies greatly among individuals. Many people with MS remain able to walk throughout their lives, though they may need assistive devices like canes. Approximately two-thirds of people with MS remain able to walk, though they may have some difficulty. Early treatment and appropriate management can help preserve mobility.

Can lifestyle changes help with MS symptoms?

Yes, certain lifestyle modifications can help manage MS symptoms and potentially slow disease progression. These include regular exercise appropriate to your ability level, maintaining a healthy diet, getting adequate sleep, managing stress, avoiding smoking, staying cool to minimize heat-related symptom worsening, and maintaining adequate vitamin D levels. These changes should complement, not replace, medical treatment.

When should I see a doctor about possible MS symptoms?

You should consult a doctor if you experience persistent or recurring neurological symptoms such as vision changes, numbness or tingling, significant fatigue, balance problems, muscle weakness, or bladder issues. While these symptoms can have many causes, early evaluation is important. If you experience sudden vision loss, severe weakness, or difficulty speaking or swallowing, seek immediate medical attention.

What is the life expectancy for someone with MS?

People with MS generally have a near-normal life expectancy, typically living only 5-10 years less than the general population. This gap has narrowed significantly with modern treatments. Most people with MS do not die from the disease itself but from the same conditions that affect the general population, such as heart disease and cancer. Quality of life and disability management are more significant concerns than life expectancy for most people with MS.

References:

• National Multiple Sclerosis Society – MS Symptoms
• Mayo Clinic – Multiple Sclerosis
• National Institute of Neurological Disorders and Stroke – Multiple Sclerosis
• Johns Hopkins Medicine – Multiple Sclerosis
• NHS – Multiple Sclerosis
• Multiple Sclerosis Foundation – Symptoms