Signs and symptoms of ms

When a person with multiple sclerosis (MS) experiences new symptoms, or has a recurrence of old ones lasting more than 24 hours, he or she is experiencing an exacerbation, or attack. These symptoms vary from person to person and from time to time in the same person. No two patients have the same complaints and no one develops all of the symptoms.

Most people with MS have a pattern of attacks and remissions throughout the course of their disease. Symptoms may go away completely, leaving no residual effects, or partially, leaving some degree of permanent damage. Sometimes the lesion produces no symptoms at all because it is located in a relatively insignificant region of the central nervous system.

Symptoms depend on the location of the MS lesions in the brain and spinal cord. MS symptoms may include the following:

Balance and Coordination

Problems with walking (gait) and balance are common in people with MS. In 13% of people diagnosed with MS, these problems are the first signs of the disease. About half of people with progressive disease report shaky movements, unsteady gait or intention tremors, or uncontrollable shaking when trying to touch a target. Muscle weakness, numbness, dizziness, and vision problems can all contribute to problems with balance and coordination.

People with balance problems may or may not have dizziness (vertigo). Sometimes people become dizzy when they change their position, such as when first standing up. Such episodes of dizziness may make people with MS feel nauseated or cause them to fall. Balance problems without dizziness tend to be more constant, causing people with MS to sway or stagger while walking.

Coordination problems and shaking tremors may affect the hands or feet, causing clumsiness. Specialized walking aids (assistive devices) may be needed when simple tasks, such as walking heel to toe, become difficult.

Symptoms.

Spasticity

When the nerve pathways to muscles are disrupted, movement can become stiff and slow. The control of movement relies on a delicate balance between muscles contracting and relaxing. In spasticity, there is an increase in muscle tone, and certain muscle groups tend to be more affected than others. This is an initial symptom in 30 to 40 percent of people diagnosed with MS. It occurs in 60 percent of people with progressive disease.

People with spasticity complain of heaviness, stiffness, and pain in the arms and legs. Muscles feel tight and limb movements are slower. Over time, range of motion can be lost and spasms can also occur. It requires more work and energy to walk and perform everyday activities.

Bladder Problems

Bladder problems are commonly associated with MS. People with MS may have to urinate frequently, often with little warning. Some people find it hard to control the stop and start of the urine stream (hesitation) or have difficulty emptying the bladder completely (urinary retention). Some urine may inadvertently leak out uncontrollably (incontinence). There is an increased risk for urinary tract infections in people who are unable to empty the bladder completely. In most cases urinary problems can be controlled with medications. In rare cases the urine must be removed manually using a small tube inserted directly into the bladder (catheter).

Bowel Problems

Constipation is common in people with MS, and is often aggravated when people with MS don't drink enough fluids in an effort to avoid urine accidents. Leakage of stool (fecal incontinence) and diarrhea are not usually reported. Hard stools that are difficult to pass can cause pain and discomfort. Constipation is easily controlled with medication, increasing fluid intake, increasing fiber in the diet, and maintaining a regular bowel schedule.

Vision Problems

Vision problems are caused by damage to the myelin surrounding the nerves that supply the eyes (optic nerves). It is the first symptom in 15 to 20 percent of people diagnosed with MS. It rarely involves both eyes at the same time, but can appear on one side followed by the other. Eye problems usually begin with blurred vision, followed by vision loss in one spot. Sometimes the entire field of vision is affected.

Common vision complaints include:

Dimming of vision
Sensitivity to light (photophobia)
Decrease in clear vision (visual acuity)
Poor light contrast
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