MS relapses are often described based on the part of the nervous system being affected, a good example being optic neuritis. Optic neuritis is a common symptom of MS, and is often experienced as blurred vision, diminished color vision (especially for red), or even blindness in one eye. Often, but not always, patients will experience pain on the side of the optic neuritis. Fifty-five percent of MS patients will have an attack of optic neuritis at some point in time, and it is the first symptom of MS in approximately 15 percent of patients. This has led to general recognition of optic neuritis as an early sign of MS, especially if tests also reveal abnormalities on an MRI or in the patient's spinal fluid.
Relapses affecting the spinal cord are referred to as transverse myelitis. Spinal cord symptoms can include muscle weakness in the arms or legs, changes in sensation, and impairment in bladder and bowel function. Motor symptoms can range from mild weakness or loss of dexterity to partial or complete paralysis in the worst cases. If the legs are affected, walking can be impaired. Sensory symptoms can include a loss of sensation, or the development of ‘false’ sensations such as burning, stinging, or prickling. At times these sensations, called paresthesias, can be painful. Bladder symptoms can include urinary frequency, urgency, or hesitancy, and in the worst cases, incontinence.
Relapses in the brainstem (the lower part of the brain) can result in a wide range of symptoms. Double vision, weakness of the facial muscles, sensory symptoms of the face, speech and swallowing difficulties, and problems with balance, coordination, and tremor can all result from relapses in this part of the brain.
In addition to the symptoms which result from relapses, many MS patients also experience other chronic symptoms which appear more gradually and separate from relapses. Fatigue, depression, spasticity, and cognitive difficulties all fall into this category.
Fatigue can mean different things to different patients, but fatigue in some form or another is the most common symptom reported by MS patients. Fatigue can take the form of muscles which weaken rapidly with activity, to a generalized lack of energy to complete a day’s activities, to a persistent desire to sleep or rest. In addition to fatigue resulting directly from MS, fatigue can also occur in response to other MS symptoms (such as walking with a weakened leg) or from other medical conditions (such as anemia or thyroid dysfunction).
Depression is the most common emotional disorder affecting MS patients. While living with the symptoms and uncertainty of MS can cause depression on its own, depression can also be caused directly by MS itself. Fortunately, most cases of MS-related depression respond to treatment the same way depression does in the general population. In addition, about 10 percent of patients suffer from other psychiatric disorders such as manic-depression or paranoia. Five percent may experience episodes of inappropriate laughter or weeping unrelated to the patient's actual emotional state. This syndrome, known as pseudobulbar affect, is thought to be due to demyelination in the brainstem, the area of the brain that controls facial expression and emotions, and is usually seen only in severe cases.
Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are frequently overlooked. Detailed testing, called neuropsychological testing, can characterize the nature and severity of cognitive symptoms. Even though major intellectual and language abilities are generally spared, these cognitive impairments are frequently associated with difficulties at work and a major contributor to lost employment. Cognitive symptoms occur when lesions develop in brain areas responsible for information processing. These deficits tend to become more apparent as the information to be processed becomes more complex. Scientists do not yet know whether altered cognition in MS reflects problems with information acquisition, retrieval, or a combination of both.
Other symptoms which are commonly associated with MS include spasticity - the involuntary increase in tone of muscles leading to stiffness and spasms. Heat sensitivity is another common MS symptom. In about 60 percent of MS patients, heat-whether generated by temperatures outside the body or by exercise-may cause temporary worsening of many MS symptoms. In these cases, eradicating the heat eliminates the problem. Some temperature-sensitive patients find that a cold bath may temporarily relieve their symptoms. For the same reason, swimming is often a good exercise choice for people with MS. Bladder function, bowel function, and sexual function can all also be affected by MS.
The erratic symptoms of MS can affect the entire family as patients may become unable to work at the same time they are facing high medical bills and additional expenses for housekeeping assistance and modifications to homes and vehicles. The emotional drain on both patient and family is immeasurable. Support groups and counseling may help MS patients, their families, and friends find ways to cope with the many problems the disease can cause.
Possible Symptoms of Multiple Sclerosis
- Muscle weakness
- Spasticity
- Impairment of pain, temperature, touch senses
- Pain (moderate to severe)
- Ataxia
- Balance problems and walking difficulty
- Tremor
- Speech disturbances
- Vision disturbances
- Vertigo
- Bladder dysfunction
- Bowel dysfunction
- Sexual dysfunction
- Depression
- Euphoria
- Cognitive abnormalities
- Fatigue