Symptoms in MS

Symptoms in MS vary in both severity and type. Symptoms can also vary over time with different predominant symptoms occurring at different times.

Multiple sclerosis (MS) is the most common autoimmune neurologic condition. It primarily targets young adults between the ages of 20-40 with most people diagnosed between the ages of 15 and 50. Diagnosing MS isn't easy, and for this reason, symptoms are often carefully reviewed when the medical history is taken. Similar to most autoimmune disorders, symptoms in MS vary in both severity and the predominant type of symptoms seen. This article describes the disease course in MS as well as the neurologic symptoms associated with it.

MS is suspected of being caused by a combination of genetic and environmental factors. Patients predisposed to developing MS are suspected of being exposed to an environmental trigger such as the Epstein-Barr virus (EBV) in childhood and later re-exposed to a similar trigger in young adulthood. The acute onset of symptoms that heralds MS, however, is not associated clinically with recent viral exposure. The onset of MS is usually insidious, with patients reporting clumsiness or weakness gradually occurring.

In most cases, patients with MS experience an acute neurologic episode. Symptoms appear to respond well to treatment and the episode spontaneously resolves within several weeks to months. In about one-half of these patients, the initial episode is followed by periods of remission that alternate with subsequent neurologic episodes causing a remitting-relapsing type of disease. Over time, these symptomatic episodes tend to occur more often. The remaining patients with MS don't experience subsequent episodes although they experience a gradual diminishment of neurologic functions over time. Relapsing MS occurs as inflammatory lesions in the brain and spinal cord cause plaques of demyelination and axonal loss. An inflammatory process perpetuates the disease process, and treatment with immunosuppressive agents like interferon-beta can interrupt or slow the disease process. The early stage of MS lasts about 11-15 years and is followed by a secondary progressive form of the disease.

A smaller subset of patients, representing about 10-15 percent of all patients with MS, develops a primary-progressive form of the disease in which remissions rarely occur. This type of MS shows rapid disease progression.

Up to half of all patients diagnosed with MS will need some type of ambulatory assistance by 15 years after the onset of symptoms, and at least 60 percent of patients will be cognitively impaired by this time. Symptoms of MS can be unifocal, primarily affecting one part or system of the body, or they may be multifocal, with multiple organs affected. There is no set pattern to disease progression. Symptoms in subsequent episodes are generally not a continuation of symptoms that occur in the initial episode. One eye may be affected without involvement of the other eye. Numbness may be noted in one extremity although the affected extremity develops no other impairment, and no other extremities experience numbness.

Common symptoms in MS include weakness, fatigue, numbness, visual changes such as unilateral vision loss and double vision, muscle spasms, depression, arthritis, tremor, nerve pain and inflammation (neuritis), hearing loss, ear ringing, paralysis, seizures, gait disturbances, ataxia, vertigo, cognitive dysfunction, and impaired elimination processes. Signs in MS include electrical sensations in the arm, back and legs with forward flexing of the neck (Lhermitte's symptom) and the appearance of eye symptoms with heat exposure (Uhthoff phenomenon).

Both conventional immunosuppressive therapies and complementary treatments, such as the use of alpha lipoic acid and vitamin D supplements, are reported to effectively taper the disease process and reduce symptoms in patients with MS.