Symptoms of Multiple Sclerosis

Multiple sclerosis (MS) symptoms include fatigue, muscle weakness, vision issues, cognitive dysfunction, and many more. In fact, there are so many possible symptoms of MS that it's rare for two people with this disease to have the exact same ones. On top of that, in most cases, the symptoms of MS come and go (relapse and remit), and their severity can vary greatly.

Frequent Symptoms

Symptoms of MS are the result of autoimmune activity—the immune system attacks the myelin sheath (fatty coating of nerves) that helps with the transmission of electrical impulses tied to movement, breathing, thinking, and more. This is called demyelination. Each person's specific symptoms depend on the location and extent of demyelination.

While each case of MS is unique, a particular set of symptoms is common, including:

• Fatigue: Physical and mental exhaustion that isn't relieved by sleep or rest is the most debilitating aspect of MS for many people.
• Muscle-related symptoms: Impaired nerve communication can lead to weakness, tremor, and spasticity (involuntary tightness), which can eventually become bad enough to require the use of assistive devices such as a cane or wheelchair.
• Bowel and bladder symptoms: Frequent urination, urinary urgency or hesitancy, incontinence, constipation, and/or frequent urinary tract infections affect about 80% of people with MS.
• Cognitive dysfunction: Pervasive short-term memory problems, difficulty concentrating, word-finding issues, and sensory processing problems occur in about 50% of MS cases.
• Depression: The challenges of chronic illness combined with demyelination are both believed to contribute to mood problems, as can some common MS drugs, including Avonex/Rebif (interferon beta-1a) and Betaseron (interferon beta-1b).
• Sexual dysfunction: This can involve difficulty maintaining an erection, inability to orgasm, loss of desire, reduced or unpleasant sensations in the vagina, or vaginal dryness.
• Vision problems: These may be early symptoms and are due to optic neuritis (damage to the optic nerve). Symptoms can strike one or both eyes and include a dull ache, pain with eye movement, impaired or lost vision, loss of color vision, blind spots, and flashing or flickering lights.
• Vertigo: The sensation of spinning can result from MS-related damage to the brainstem (which connects the brain and spinal cord), a lesion in the cerebellum, or abnormal eye movement called nystagmus.
• Pain and other sensory symptoms: Electrical nerve zings, numbness and tingling, prickling, stabbing, tearing, or feelings of pressure can occur and be severe. Lhermitte's sign and the MS hug are two distinct MS pain symptoms.

Rare Symptoms

Some people with MS aren't aware that these uncommon symptoms are related to the disease. Rare symptoms include:

• Trigeminal neuralgia (tic douloureux): Shock-like or burning pains in the face are due to damage to the fifth cranial nerve.
• Glossopharyngeal neuralgia: Pain in the tongue, throat, ear, or tonsils results from damage to the ninth cranial nerve.
• Paroxysmal symptoms: Momentary spasms in the limbs and sometimes in the muscles associated with speech or swallowing are sometimes mistaken for seizures.
• Pseudobulbar affect: Uncontrollable laughing or crying that's extreme or inappropriate to the situation may result from nerve damage in the cerebellum.
• Pruritus: This neurologically caused "itch" doesn't respond to scratching or topical treatments.
• Swallowing problems (dysphagia): Choking or coughing can happen while you eat or drink.
• Respiratory difficulties: Shallow breathing, shortness of breath, hiccups, cough, and frequent sighs may result from muscle weakness.
• Hearing loss: Temporary lessening or loss of hearing affects about 6% of people with MS; actual deafness is exceedingly rare.
• Seizures: These can affect between 2% and 5% of people with MS.

Complications

Complications aren't true symptoms, but things that can happen as a result of them. Not everyone will experience them, and they vary greatly in those who do. Some possible complications of MS include:

• Aspiration pneumonia: A lung infection caused by inhaling food particles due to dysphagia or difficulties swallowing
• Malnutrition and dehydration: A result of dysphagia making eating difficult
• Pressure sores: Due to lack of mobility
• Venous thromboembolism: Blood clots blocking blood vessels, possibly due to lack of mobility, spasticity, or a steroid-medication side effect

When to See a Doctor

If you have symptoms that could indicate MS, and especially if they come and go, be sure to talk to your doctor about it. Early MS diagnosis and treatment have long-term benefits, so don't hesitate or wait to bring up what you're experiencing.

After your diagnosis, it's important to let your doctor know about any changes or new symptoms you experience. It's typical for MS symptoms to get better or completely go away for a time, and then come back with new or worse symptoms.

Remember that just because MS can cause something doesn't mean it's always the cause. You don't want to dismiss something as "just another MS symptom" only to have it be something else that needs prompt diagnosis and treatment.

Frequency Asked Questions

At what age do MS symptoms usually appear?

MS symptoms usually first appear between ages 20 and 40. However, it is possible to experience symptoms at any age.

What are the earliest warning signs of MS?

Painful vision loss in one eye, facial paralysis or drooping, weakness or numbness that persists for a day or more, and long-lasting, severe dizziness can be early warning signs of MS. If you experience one or more of these symptoms, seek medical evaluation. Whether or not you have MS, it is important to maintain your health and these could lead to diagnosis of other medical conditions as well.

A Word From Verywell

Looking over these lists can be overwhelming. Keep in mind that you probably won't experience most of the potential symptoms. With proper treatment and management, you may be able to avoid the bulk of them.