Multiple Sclerosis (MS): Early Signs and Common Symptoms

 

Multiple Sclerosis (MS): Early Signs and Common Symptoms

Medically Reviewed by Carol DerSarkissian, MD on September 26, 2020

People with multiple sclerosis (MS) tend to have their first symptoms between the ages of 20 and 40. Usually the symptoms get better, but then they come back. Some come and go, while others linger.

No two people have exactly the same symptoms. You may have a single symptom, and then go months or years without any others. A problem can also happen just one time, go away, and never return. For some people, the symptoms get worse within weeks or months.

Early Signs of MS

• For many people, the first brush with what’s later diagnosed as MS is what doctors call clinically isolated syndrome (CIS). This episode of neurological symptoms usually lasts 24 hours. It happens when your immune system mistakenly tells your body to attack myelin, the protective sheath over nerve cells in your brain and spine. You may hear your doctor call this demyelination. It causes scars, or lesions, that make it harder for signals to travel between your brain and your body. Monofocal episode: You have one symptom.
• Multifocal episode: You have more than one symptom.

The most common symptoms in CIS are:

Optic neuritis: This condition damages the nerve that connects your eye to your brain. It usually affects just one eye, but in rare cases, it involves both. You might notice:

• Blurry vision
• Colors appear dull
• Pain in your eye, especially when you move it

Numbness & Tingling: It usually affects your legs. You might feel:

• An electric shock-like feeling when you move your head or neck. It may travel down your spine or into your arms or legs.
• Numbness, often in your face
• Tingling

Not everyone who has CIS will get MS. The odds are higher if you have lesions in your brain from loss of myelin. If you have another CIS or other MS symptoms later, your doctor will do a test called an MRI that takes a picture of your brain to look for them. Learn more about the differences between CIS and MS.

Primary MS Symptoms

These come from ongoing damage to your myelin. They aren’t pleasant, but your MS treatment team can help you keep most of them under control with medication, rehabilitation, and other tactics. The most common symptoms are:

Bladder and bowel problems: You may have to pee more often, need to go at night, or have trouble emptying your bladder fully. Bowel issues like constipation are also common. Read more on bladder control problems and bowel problems with MS.

Clumsiness or lack of coordination: MS can make it hard to get around. You might have:

• Trouble walking
• A hard time keeping your balance
• Changes in your gait

View a slideshow on what your walk says about you.

Dizziness: You may feel lightheaded. You may also have vertigo, that feeling that the room is spinning. Know the causes of dizziness and vertigo with MS.

Emotional changes and depression: It’s tough to adjust to the idea that you have a chronic disease, let alone one that’s hard to predict and that will take a physical toll. Fear of the unknown can make you anxious. Plus the disease damages nerve fibers in your brain, and that can affect your emotions. So can medications, like corticosteroids, used to treat MS. Get more information on how to manage depression with MS.

Eye problems: In addition to the optic neuritis that comes with CIS, MS can cause:

• Nystagmus: involuntary eye movements
• Diplopia: double vision

Learn more about vision problems linked to MS.

Fatigue: You may feel very tired. It often comes on in the afternoon and causes weak muscles, slowed thinking, or sleepiness. It isn’t usually related to the amount of work you do. Some people with MS say they can feel tired even after a good night's sleep. Get tips on how to manage fatigue with MS.

Heat-related problems: You might notice them as you warm up during exercise. You could feel tired and weak or have trouble controlling certain body parts, like your foot or leg. As you rest and cool down, these symptoms are likely to go away. Know more on how to manage heat sensitivity with MS.

 

Muscle spasms: They usually affect your leg muscles. They’re an early symptom for almost half the people with MS. They also affect people with progressive MS. You might feel mild stiffness or strong, painful spasms. Read more on how to treat MS-related muscle spasms.

Sexual troubles: These include vaginal dryness in women and erection problems in men. Both men and women may be less responsive to touch, have a lower sex drive, or have trouble reaching orgasm. Learn more on how to maintain intimacy when you have MS.

Speech problems: MS could cause long pauses between your words and slurred or nasal speech. You might have swallowing problems as the disease advances. Get more information on symptoms of speech and swallowing problems with MS.

Thinking problems: It might be hard to focus from time to time. This will probably mean slowed thinking, poor attention, or fuzzy memory. Some people have severe problems that make it hard to do daily tasks, but that’s rare. MS doesn’t usually change your intellect or ability to read and understand conversation. Find out more on how MS affects the brain and cognition.

Tremors: About half of people with MS have them. They can be minor shakes or so intense it’s hard to do everyday activities. Read more about the types of tremors caused by MS.

Trouble walking: MS can cause muscle weakness or spasms, which make it tough to walk. Balance problems, numb feet, and fatigue can also happen. Learn more about mobility aids and assistive devices for MS.

Unusual sensations: In addition to the pins and needles sensation that’s part of CIS, you might also have severe itching, burning, stabbing, or tearing pains. You could feel a tightness around your ribs or upper belly known as the MS hug. Doctors call these uncomfortable symptoms dysesthesia. View a slideshow on unusual symptoms and sensations caused by MS.

Secondary Symptoms

These are problems created by your primary MS symptoms, not by damaged myelin.

• Not being able to empty your bladder can lead to a bladder infection.
• If you have trouble walking and are often fatigued, you’re likely to become less active. That can take a toll on your muscle tone, make your breathing shallow, and even affect your bone density.

Doctors can treat secondary symptoms, but the goal is to avoid them by treating the primary symptoms.

 

Tertiary Symptoms

These are the social, psychological, and job-related problems of life with MS.

• If MS makes it hard for you to walk or drive, you may not be able to do your job well.
• Because it’s tough to get around and hard to talk to people about what life with a chronic disease is like, you may not be as social as you once were.
• You could get depressed. It’s a byproduct of the changes MS makes in your brain and in your life.

Because MS varies so much, it's best not to compare yourself with other people who have it. Your experience is likely to be different. Most people learn to manage their symptoms and can keep leading full, active lives.

 

 

Your Genes and Multiple Sclerosis (MS)

 

By Paul Frysh

Medically Reviewed by Sabrina Felson, MD on April 19, 2022

In basic terms, scientists simply don’t know what causes multiple sclerosis, or MS. Your genes – the genetic material that you inherit from your biological parents – play at least some part. But they are not the sole cause.

In MS, your immune system goes haywire and starts to damage your central nervous system (brain and spinal cord). Scientists are still trying to figure out how this response works and what causes it. Scientists think that for some people, genes may cause your immune system to interact with something in some way to cause the disease.

These may include:

Environment. Environmental factors, like smoking, low levels of vitamin D, and obesity in childhood, have been shown to raise the risk for MS. People who live in certain parts of the world – for instance, those further away from the equator – tend to get MS more often. The reasons for this aren’t yet clear. Some scientists think it involves higher vitamin D levels near the equator.

There are also some theories that exposure to things like chemical solvents and allergens, among other things, contribute to MS risk. But research hasn’t shown this yet.

Infections. Infection with certain germs may raise your risk for MS. Research points in particular to the virus that causes mononucleosis (Epstein-Barr virus). But scientists are also investigating measles, human herpesvirus-6, and others.

Who Gets MS?

One of the reasons scientists assume a role for genes in the development of MS is that some closely related groups get the disease more than others.

To start with, women are twice as likely as men to develop MS. It’s also more commonly diagnosed in white Americans than Black Americans or those of Asian heritage. And MS is rare or doesn’t exist in many Native American societies. This all suggests that genes may also play a role in who gets MS.

In addition, though many groups share some of the same genes or gene mutations that raise MS risk, this is not always the case. For example, in one study, of 73 genes that raised MS risk in white Americans, only eight did the same in Black Americans. Are there other genes that raise the risk of this disease for Black Americans but not for white Americans? What are they, and might they change the approach to treatment?

More research needs to be done on the causes of MS, both in general and in different ethnic groups so that we can understand both the risk factors for MS and the right way to treat it in different people.

 

Can You Inherit MS From Your Parents?

Not really. There is no known gene or set of genes that guarantees that you will get MS if your parents have it. But a family history of MS does raise your risk for the disease.

For example, the rate of MS in the general population is about 1 in 1,000. But if you have a parent with MS, your chances go up to 1 in 50. And if both parents have MS, your risk goes up further to about 1 in 8. Other possible family history situations show that the closer your relationship to someone with MS, the higher your chances of having it:

If a second-degree relative (grandparents, uncles, aunts) or third-degree relative (great grandparents, great uncles and aunts, first cousins) have MS, your risk is about 1 in 100.

If your sibling or non-identical twin has MS, your risk is about 1 in 20.

If your identical twin has MS, your risk is about 1 in 4.

Scientists are especially interested in statistics about twins because identical twins have exactly the same genetic material. So if genes were the sole cause, both should have MS. But most of the time only one twin gets it, which means other things are at work.

Which Genes Raise Your Risk for MS?

Scientists know of more than 200 genes or genetic variations (mutations) that may contribute to MS. A lot of these genes help build and maintain the immune system. Some of them are linked to other diseases that also involve a malfunction of the immune system, such as Crohn’s disease and rheumatoid arthritis.

Others simply increase your chances for developing certain risk factors for MS. For example, lower vitamin D levels raise the risk of MS in some people. Certain gene variations are linked to lower vitamin D levels and thus a higher risk of MS. And genes that raise your risk of having high BMI (a measure of body fat) – another risk factor for MS – also make you more likely to get the disease.

In some cases, there may be particular gene mutations that raise your risk of MS, but in many people, it seems to be that no single gene raises your MS risk, but that it’s the interaction of several of them.

Researchers continue to look for more clues about the relationship between genes and MS.