Numbness or Tingling

 

By Editorial Team

Reviewed by: HU Medical Review Board | Last reviewed: February 2024 | Last updated: February 2024

Living with multiple sclerosis (MS) comes with its share of challenges. A common symptom of MS is numbness or tingling in the face, hands, arms, legs, or feet. While usually not painful, these sensations can be unsettling. Understanding these symptoms can help people with MS manage and cope with numbness and tingling more effectively.^1-3

What are numbness and tingling?

Numbness and tingling are sensations that come from the nervous system. Numbness is the loss of sensation or feeling in a particular part of the body. Tingling refers to a prickling or "pins and needles" sensation. Imagine the feeling when your arm or foot falls asleep. It feels numb, heavy, and often comes with a pins-and-needle sensation.^1-4

Numbness and tingling are not always linked to MS. Numbness and tingling can be linked to other medical conditions like diabetes, carpel tunnel syndrome, shingles, and vitamin deficiencies. Always talk with your doctor about any new symptoms you experience.²

How do numbness and tingling affect people with MS?

Numbness and tingling are some of the most common symptoms of multiple sclerosis. For people with MS, numbness and tingling can happen anywhere in the body. These sensations often occur in the face, hands, arms, legs, and feet. They may be the first symptom a person experiences in their MS journey.^1,2,4

These symptoms can range from mild to more intense. They can be temporary or long-lasting (chronic). For many people with MS, the numbness and tingling comes and goes. Every person is different.^1,2,4

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There are 4 types of numbness. The first 3 are common in people with MS:²

• Parenthesis– Burning or prickling sensation. It is also described as tingling, buzzing, skin crawling, and itching.
• Dysesthesia – Burning sensation along a nerve or changes from non-painful touch to painful.
• Hyperesthesia – An increase in sensitivity to pain.
• Anesthesia – Complete loss of any sensation such as touch, pain, or temperature. This symptom is very rare in people with MS.

Here are some real-life examples of how these symptoms might impact your day-to-day functioning. For instance, if you:^1,2,4

• Have numbness in your feet, you might have difficulty keeping your balance while walking
• Have numbness in your hands, you may have trouble writing, typing, dressing yourself, and handling objects
• Have numbness in your face, you may have slurred speech

In some cases, the numbness and tingling may become so severe that you are unable to use the affected body part. Be extra careful when experiencing severe symptoms.^1,4

For arm or foot numbness, be careful around heat sources, such as fires or hot water, to prevent burns. For face numbness, be careful when eating so as not to bite the inside of your mouth or tongue. Fortunately, for most people with MS, numbness and tingling are not permanent sensations.^1,4

What causes numbness and tingling in MS?

Numbness and tingling in MS are typically linked to demyelination. Demyelination is a process where the protective covering of nerve fibers (myelin) is damaged. This causes communication problems between your brain and your body. The disruption in the normal flow of nerve signals leads to abnormal sensations – such as numbness and tingling – in the affected areas.⁴

What are treatment options for numbness and tingling?

Because numbness and tingling usually come and go and are typically not painful, medicine is not prescribed in most cases. However, if these symptoms arise due to an acute MS flare, your doctor may prescribe a steroid to reduce inflammation and help you recover feeling in the affected area faster. This can be helpful for those whose daily activities or jobs are negatively impacted by MS.^1,2,4

Other drugs that might be used to treat severe numbness and tingling symptoms include:²

• Antiseizure drugs may help control painful burning or electric shock-like sensations. These drugs include:
• Neurontin® (gabapentin)
• Lyrica® (pregabalin)
• Antidepressants may also be prescribed to help reduce numbness. These include:²
• Cymbalta® (Duloxetine)
• Pamelor® (nortriptyline)
• Tofranil® (imipramine)
• Elavil® (amitriptyline)

Many of these drugs may increase drowsiness. Always talk with your doctor before taking any medicine to treat MS symptoms.²

Lifestyle habits that can help

There are other ways besides medicine to relieve MS numbness and tingling symptoms. Here are some other approaches that can help manage MS symptoms on a broader scale:⁵

• Use assistive devices – In some cases, a brace, cane, or orthotic inserts may help improve mobility and reduce the risk of falls.
• Consider physical therapy – Working with a physical therapist can help improve strength, balance, and coordination. A physical therapist can also help teach strategies to aid in performing daily activities.
• Be mindful of temperature changes – Increased body heat can worsen symptoms, so take steps to stay cool whenever possible.
• Take steps to relieve stress – Stress can be a trigger for MS symptoms. Incorporate moments of your day when you can take some time to relax. Yoga and deep breathing exercises can be very helpful.
• Get regular exercise – Regular movement is recommended for people with MS. If working up a sweat bothers you or worsens MS symptoms, try swimming.

These are general positive lifestyle changes that are recommended for those with MS. But every person is different. Do what works for you.

Talk with your doctor

If you currently have any numbness or tingling in any area of your body, speak with your doctor. They can help develop a treatment plan that is right for you.²

 

Comparison Review of MS Drugs

 

By Editorial Team

Disease-modifying therapies (DMTs) are currently the best way to prevent relapses and slow the disability of multiple sclerosis (MS). There are several DMTs available on the market, which are listed below. When considering which treatment is best, each individual should talk to their doctor about the treatment options that are right for their unique situation, as well as all the potential benefits and risks of each treatment.¹

Treatment experiences can vary

MS is a disease that greatly varies in how it affects different people, the frequency and severity of relapses or exacerbations, the symptoms presented, and the rate of disease progression. How well a particular drug works in one person may be different from how well it works in another person. It is helpful to keep in mind these variations between people when considering which treatment to choose.

Considerations when choosing between different treatments

Common considerations when choosing between different treatments include:

• Cost
• Effectiveness in preventing new relapses
• Side effects/safety
• Route of administration

Cost of different MS treatments

Cost will vary based on each individual’s health insurance coverage and benefits. Several of the drug manufacturers have patient assistance programs that can also help cover the cost of medications.

MS treatment safety and effectiveness

All drugs that receive approval from the US Food and Drug Administration must undergo several controlled clinical trials to prove that the product is effective and safe. However, the degree of effectiveness at preventing relapses and the safety profile differ between DMTs. During some of these trials, new potential treatments may be compared to existing standard treatments, called head-to-head studies.²

Slowing down progression and reducing relapses

However, there is no one trial or source of information that compares all of the current DMTs to each other. All of the DMTs available have demonstrated through clinical trials that they reduce the frequency and severity of relapses in relapsing forms of MS, reduce the development of new MS lesions, and appear to slow down disability progression. Only one DMT, ocrelizumab (Ocrevus®), is approved for both relapsing forms and primary progressive MS (PPMS).^1,3

Comparison by route of administration

Subcutaneous injections:

• Interferon beta-1a (Rebif®)
• Interferon beta-1b (Betaseron®)
• Interferon beta-1b (Extavia®)
• Glatiramer acetate (Copaxone®, Glatopa®)
• Peginterferon beta-1a (Plegridy®)
• Ofatumumab (Kesimpta®)

Intramuscular injection:

•         Interferon beta-1a (Avonex®)

·         Peginterferon beta-1a (Plegridy®)

IV infusions:

• Alemtuzumab (Lemtrada®)
• Mitoxantrone (Novantrone®)
• Natalizumab (Tysabri®)
• Ocrelizumab (Ocrevus®)
• Ublituximab (Briumvi®)

Oral medications:

• Cladribine (Mavenclad®)
• Dimethyl fumarate (Tecfidera®)
• Diroximel fumarate (Vumerity®)
• Fingolimod (Gilenya®, Tascenso ODT™)
• Ozanimod (Zeposia®)
• Siponimod (Mayzent®)
• Teriflunomide (Aubagio®)
• Monomethyl Fumarate (Bafiertam®)
• Ponesimod (Ponvory®)

Comparison by common side effects

All medications can cause unwanted side effects. However, not all patients experience the same side effects. The side effects listed below are not all the possible side effects that these medications may cause. Individuals should talk to their doctor about what to expect and report any concerns to their doctor.^4-19

• Alemtuzumab (Lemtrada®) – Rash, headache, fever, inflammation of the nasal passages and throat, nausea, vomiting, fatigue, insomnia, red welts on skin, itching, thyroid gland disorders, joint pain, pain in arms or legs, back pain, mouth and throat pain, abdominal pain, diarrhea, sinus infection, tingling or prickling sensation, dizziness, flushing.
• Cladribine (Mavenclad®) - Upper respiratory tract infection, headache, lymphopenia
• Dimethyl fumarate (Tecfidera®) – Flushing, abdominal pain, diarrhea, nausea
• Diroximel fumarate (Vumerity®) – Flushing (developing red or hot skin), redness, itching, or rash, nausea and vomiting, diarrhea, stomach pain or indigestion
• Fingolimod (Gilenya®) – Headache, diarrhea, increased liver enzymes, cough, flu-like symptoms, sinus symptoms, infections, back pain, abdominal pain, and pain in the arms and legs
• Glatiramer acetate (Copaxone®) – Reactions at the injection site, lowered blood pressure, rash, difficulty breathing, and chest pain
• Interferon beta-1b (Extavia®) – Reactions at the injection site, flu-like symptoms, low counts of white blood cells, muscle aches, increased liver enzymes, headache, spasticity, pain, rash, difficulty sleeping, abdominal pain, depression, joint pain, and weakness or lack of energy
• Interferon beta-1a (Avonex®) – Reactions at the injection site, flu-like symptoms, low counts of white blood cells, muscle aches, increased liver enzymes, headache, spasticity, pain, rash, difficulty sleeping, abdominal pain, depression, joint pain, and weakness or lack of energy
• Interferon beta-1a (Rebif®) – Reactions at the injection site, flu-like symptoms, low counts of white blood cells, muscle aches, increased liver enzymes, headache, spasticity, pain, rash, difficulty sleeping, abdominal pain, depression, joint pain, and weakness or lack of energy
• Interferon beta-1b (Betaseron®) – Reactions at the injection site, flu-like symptoms, low counts of white blood cells, muscle aches, increased liver enzymes, headache, spasticity, pain, rash, difficulty sleeping, abdominal pain, depression, joint pain, and weakness or lack of energy
• Mitoxantrone (Novantrone®) – Nausea, hair loss, menstrual disorders (including amenorrhea), weakness or lack of energy
• Natalizumab (Tysabri®) – Headache, fatigue, joint pain, urinary tract infection, inflammation in the stomach, vaginal infection, depression, pain in arms or legs, abdominal discomfort, diarrhea, rash
• Ocrelizumab (Ocrevus®) – Infusion-related reactions
• Ozanimod (Zeposia®) – Upper respiratory infection, urinary tract infection, liver function changes, high blood pressure or changes in blood pressure when standing up (orthostatic hypotension), back pain
• Peginterferon beta-1a (Plegridy®) – Flu-like symptoms, headache, injection site reactions, blood count abnormalities, asthenia (feeling weak or tired), abdominal pain, diarrhea, nausea and vomiting, myalgia (muscle or joint pain)
• Siponimod (Mayzent®) – Headache, high blood pressure, increased liver enzymes
• Teriflunomide (Aubagio®) – Headache, diarrhea, nausea, hair loss, increased liver enzymes

Comparison by safety concerns

While rare, DMTs may cause serious side effects. Not everyone who takes these medications experiences serious side effects. Individuals should discuss all safety concerns with their doctor prior to beginning treatment with a DMT.^4-19

• Alemtuzumab (Lemtrada®) – Infusion-associated reactions and severe allergic reactions, rare viral disease (progressive multifocal leukoencephalopathy), development of secondary or new autoimmunity, including thyroid autoimmune disorders, increased risk of certain cancers, infections (including opportunistic such as herpes virus, human papilloma virus, fungal infections, listeria, and nocardiosis)
• Cladribine (Mavenclad®) – Increased risk of infections and malignancies, worsening of chronic infections such as HIV, hepatitis or TB, fetal harm.
• Dimethyl fumarate (Tecfidera®) – Severe allergic reaction, lowered white blood cell counts, liver injury, rare viral disease (progressive multifocal leukoencephalopathy), swelling (angioedema) in the face, tongue, throat, abdomen, hands, or feet
• Diroximel fumarate (Vumerity®) – Allergic reactions including welts and hives, PML (progressive multifocal leukoencephalopathy – a rare brain infection, shingles, decrease in white blood cell count, severe liver problems
• Fingolimod (Gilenya®) – Change in heart rhythm that may cause sudden death, increased risk of infections, rare viral disease (progressive multifocal leukoencephalopathy), increased fluid in the retina (macular edema), posterior reversible encephalopathy syndrome, respiratory effects, liver injury, risk of causing birth defects, increased blood pressure, basal cell carcinoma
• Glatiramer acetate ( Copaxone®) – Post-injection reaction (rapid heartbeat, anxiety, throat constriction)
• Interferon beta-1a (Avonex®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
• Interferon beta-1a (Rebif®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
• Interferon beta-1b (Betaseron®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
• Interferon beta-1b (Extavia®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
• Mitoxantrone (Novantrone®) – Congestive heart failure (can result in death) may occur either during or months to years after termination of therapy. Secondary acute myeloid leukemia, infection, lowered white blood cell counts, depression, vomiting, kidney failure
• Natalizumab (Tysabri®) – Rare viral disease (progressive multifocal leukoencephalopathy), severe allergic reactions, suppression of the immune system, increased risk of infections (including herpes simplex virus, meningitis), and liver injury
• Ocrelizumab (Ocrevus®) – Increased risk of infections, increased risk of certain cancers
• Ozanimod (Zeposia®) – Change in heart rhythm, increased risk of infections, liver damage, respiratory effects, macular edema, increased blood pressure
• Peginterferon beta-1a (Plegridy®) – Liver damage, severe allergic reaction, depression (and suicidal thoughts), congestive heart failure, seizures, autoimmune disorders, leukopenia thrombotic microangiopathy, decreased peripheral blood counts
• Siponimod (Mayzent®) – Macular edema, increased risk of infections, decrease in heart rate
• Teriflunomide (Aubagio®) – Liver injury, risk of causing birth defects, bone marrow effects, suppression of the immune system, increased risk of infections, peripheral neuropathy, skin conditions, increased blood pressure, respiratory effects, pancreatitis, lowered white blood cell counts